|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,731.32
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,211.92 |
| Max. Negotiated Rate |
$1,731.32 |
| Rate for Payer: Aetna Commercial |
$1,558.19
|
| Rate for Payer: ASR ASR |
$1,679.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.29
|
| Rate for Payer: BCN Commercial |
$1,342.29
|
| Rate for Payer: Cash Price |
$1,385.06
|
| Rate for Payer: Cofinity Commercial |
$1,627.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,385.06
|
| Rate for Payer: Healthscope Commercial |
$1,731.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.38
|
| Rate for Payer: Mclaren Commercial |
$1,558.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,523.56
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,731.32
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,731.32 |
| Rate for Payer: Aetna Commercial |
$1,558.19
|
| 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 |
$1,679.38
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.29
|
| Rate for Payer: BCN Commercial |
$1,342.29
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,385.06
|
| Rate for Payer: Cash Price |
$1,385.06
|
| Rate for Payer: Cofinity Commercial |
$1,627.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,385.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,731.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,679.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,558.19
|
| 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 |
$1,471.62
|
| 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 |
$1,211.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$996.93
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$797.54
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,523.56
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,701.22
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,190.85 |
| Max. Negotiated Rate |
$1,701.22 |
| Rate for Payer: Aetna Commercial |
$1,531.10
|
| Rate for Payer: ASR ASR |
$1,650.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.96
|
| Rate for Payer: BCN Commercial |
$1,318.96
|
| Rate for Payer: Cash Price |
$1,360.98
|
| Rate for Payer: Cofinity Commercial |
$1,599.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.98
|
| Rate for Payer: Healthscope Commercial |
$1,701.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.18
|
| Rate for Payer: Mclaren Commercial |
$1,531.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,446.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,497.07
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,701.22
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,701.22 |
| Rate for Payer: Aetna Commercial |
$1,531.10
|
| 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 |
$1,650.18
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.96
|
| Rate for Payer: BCN Commercial |
$1,318.96
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,360.98
|
| Rate for Payer: Cash Price |
$1,360.98
|
| Rate for Payer: Cofinity Commercial |
$1,599.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,701.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,531.10
|
| 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 |
$1,446.04
|
| 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 |
$1,190.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$996.93
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$797.54
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,497.07
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,270.68
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
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 BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,270.68
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
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 BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,160.25
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,160.25 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| 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 |
$1,125.44
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$899.54
|
| Rate for Payer: BCN Commercial |
$899.54
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cofinity Commercial |
$1,090.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,160.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,044.22
|
| 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 |
$986.21
|
| 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 |
$812.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$610.06
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$488.05
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,021.02
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,160.25
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$812.18 |
| Max. Negotiated Rate |
$1,160.25 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: ASR ASR |
$1,125.44
|
| Rate for Payer: BCBS Trust/PPO |
$899.54
|
| Rate for Payer: BCN Commercial |
$899.54
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cofinity Commercial |
$1,090.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.20
|
| Rate for Payer: Healthscope Commercial |
$1,160.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.44
|
| Rate for Payer: Mclaren Commercial |
$1,044.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$986.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,021.02
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,300.78
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,300.78 |
| Rate for Payer: Aetna Commercial |
$1,170.70
|
| 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 |
$1,261.76
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.49
|
| Rate for Payer: BCN Commercial |
$1,008.49
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$1,222.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,300.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,261.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,170.70
|
| 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 |
$1,105.66
|
| 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 |
$910.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.25
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$760.20
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,144.69
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,300.78
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$910.55 |
| Max. Negotiated Rate |
$1,300.78 |
| Rate for Payer: Aetna Commercial |
$1,170.70
|
| Rate for Payer: ASR ASR |
$1,261.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.49
|
| Rate for Payer: BCN Commercial |
$1,008.49
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$1,222.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.62
|
| Rate for Payer: Healthscope Commercial |
$1,300.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,261.76
|
| Rate for Payer: Mclaren Commercial |
$1,170.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,144.69
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$857.70
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$857.70 |
| Rate for Payer: Aetna Commercial |
$771.93
|
| Rate for Payer: Aetna Medicare |
$480.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.55
|
| Rate for Payer: ASR ASR |
$831.97
|
| Rate for Payer: BCBS Complete |
$275.96
|
| Rate for Payer: BCBS MAPPO |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$664.97
|
| Rate for Payer: BCN Commercial |
$664.97
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$806.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$857.70
|
| Rate for Payer: Healthscope Whirlpool |
$831.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$480.44
|
| Rate for Payer: Mclaren Commercial |
$771.93
|
| Rate for Payer: Mclaren Medicaid |
$262.80
|
| Rate for Payer: Mclaren Medicare |
$480.44
|
| Rate for Payer: Meridian Medicaid |
$275.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$528.48
|
| Rate for Payer: PHP Medicaid |
$262.80
|
| Rate for Payer: PHP Medicare Advantage |
$480.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$780.51
|
| Rate for Payer: Priority Health Medicare |
$480.44
|
| Rate for Payer: Priority Health Narrow Network |
$608.97
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.78
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: VA VA |
$480.44
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$857.70
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$600.39 |
| Max. Negotiated Rate |
$857.70 |
| Rate for Payer: Aetna Commercial |
$771.93
|
| Rate for Payer: ASR ASR |
$831.97
|
| Rate for Payer: BCBS Trust/PPO |
$664.97
|
| Rate for Payer: BCN Commercial |
$664.97
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$806.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Healthscope Commercial |
$857.70
|
| Rate for Payer: Healthscope Whirlpool |
$831.97
|
| Rate for Payer: Mclaren Commercial |
$771.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.78
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$700.53 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: Aetna Medicare |
$480.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.55
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Complete |
$275.96
|
| Rate for Payer: BCBS MAPPO |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$480.44
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Mclaren Medicaid |
$262.80
|
| Rate for Payer: Mclaren Medicare |
$480.44
|
| Rate for Payer: Meridian Medicaid |
$275.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$528.48
|
| Rate for Payer: PHP Medicaid |
$262.80
|
| Rate for Payer: PHP Medicare Advantage |
$480.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$910.69
|
| Rate for Payer: Priority Health Medicare |
$480.44
|
| Rate for Payer: Priority Health Narrow Network |
$710.54
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: VA VA |
$480.44
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$690.41 |
| Max. Negotiated Rate |
$1,577.72 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: Aetna Medicare |
$1,262.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,577.72
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Complete |
$725.00
|
| Rate for Payer: BCBS MAPPO |
$1,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,262.18
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Mclaren Medicaid |
$690.41
|
| Rate for Payer: Mclaren Medicare |
$1,262.18
|
| Rate for Payer: Meridian Medicaid |
$725.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,325.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,451.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,388.40
|
| Rate for Payer: PHP Medicaid |
$690.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,262.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$910.69
|
| Rate for Payer: Priority Health Medicare |
$1,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$710.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: VA VA |
$1,262.18
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$700.53 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$180.61 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.61
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: ASR ASR |
$111.55
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Commercial |
$89.16
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Healthscope Whirlpool |
$111.55
|
| Rate for Payer: Mclaren Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.20
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.12 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$63.26
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$63.26
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$13.18
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.26
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$57.94
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,401.08
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,401.08 |
| Rate for Payer: Aetna Commercial |
$1,260.97
|
| 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 |
$1,359.05
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.26
|
| Rate for Payer: BCN Commercial |
$1,086.26
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cofinity Commercial |
$1,317.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,401.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,359.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,260.97
|
| 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 |
$1,190.92
|
| 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 |
$980.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,043.62
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$834.90
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,232.95
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
