|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$184.46
|
| Rate for Payer: Aetna Medicare |
$75.84
|
| Rate for Payer: ASR ASR |
$198.81
|
| Rate for Payer: BCBS Complete |
$81.98
|
| Rate for Payer: BCBS Trust/PPO |
$168.99
|
| Rate for Payer: BCN Commercial |
$168.99
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Commercial |
$192.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Healthscope Whirlpool |
$204.96
|
| Rate for Payer: Mclaren Commercial |
$184.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Nomi Health Commercial |
$168.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.36
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,409.92
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,807.44 |
| Max. Negotiated Rate |
$2,409.92 |
| Rate for Payer: Aetna Commercial |
$2,168.93
|
| Rate for Payer: ASR ASR |
$2,337.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.03
|
| Rate for Payer: BCN Commercial |
$1,979.03
|
| Rate for Payer: Cash Price |
$1,927.94
|
| Rate for Payer: Cofinity Commercial |
$2,265.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,927.94
|
| Rate for Payer: Healthscope Commercial |
$2,337.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,409.92
|
| Rate for Payer: Mclaren Commercial |
$2,168.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,048.43
|
| Rate for Payer: Nomi Health Commercial |
$1,976.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,807.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,120.73
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$85.81
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$85.81 |
| Rate for Payer: Aetna Commercial |
$77.23
|
| Rate for Payer: Aetna Medicare |
$31.75
|
| Rate for Payer: ASR ASR |
$83.24
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS Trust/PPO |
$70.75
|
| Rate for Payer: BCN Commercial |
$70.75
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: Cofinity Commercial |
$80.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.65
|
| Rate for Payer: Healthscope Commercial |
$83.24
|
| Rate for Payer: Healthscope Whirlpool |
$85.81
|
| Rate for Payer: Mclaren Commercial |
$77.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.94
|
| Rate for Payer: Nomi Health Commercial |
$70.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.19
|
| Rate for Payer: Priority Health Narrow Network |
$60.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.51
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$85.81
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$85.81 |
| Rate for Payer: Aetna Commercial |
$77.23
|
| Rate for Payer: ASR ASR |
$83.24
|
| Rate for Payer: BCBS Trust/PPO |
$70.47
|
| Rate for Payer: BCN Commercial |
$70.47
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: Cofinity Commercial |
$80.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.65
|
| Rate for Payer: Healthscope Commercial |
$83.24
|
| Rate for Payer: Healthscope Whirlpool |
$85.81
|
| Rate for Payer: Mclaren Commercial |
$77.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.94
|
| Rate for Payer: Nomi Health Commercial |
$70.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.51
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$51.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$51.12 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: ASR ASR |
$49.59
|
| Rate for Payer: BCBS Trust/PPO |
$41.98
|
| Rate for Payer: BCN Commercial |
$41.98
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Healthscope Whirlpool |
$51.12
|
| Rate for Payer: Mclaren Commercial |
$46.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$41.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.99
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$51.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$49.59
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.15
|
| Rate for Payer: BCN Commercial |
$42.15
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Healthscope Whirlpool |
$51.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$46.01
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$41.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.79
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$35.84
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,993.92
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,745.44 |
| Max. Negotiated Rate |
$4,993.92 |
| Rate for Payer: Aetna Commercial |
$4,494.53
|
| Rate for Payer: ASR ASR |
$4,844.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,101.01
|
| Rate for Payer: BCN Commercial |
$4,101.01
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cofinity Commercial |
$4,694.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.14
|
| Rate for Payer: Healthscope Commercial |
$4,844.10
|
| Rate for Payer: Healthscope Whirlpool |
$4,993.92
|
| Rate for Payer: Mclaren Commercial |
$4,494.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.83
|
| Rate for Payer: Nomi Health Commercial |
$4,095.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,394.65
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,993.92
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$4,993.92 |
| Rate for Payer: Aetna Commercial |
$4,494.53
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$4,844.10
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,117.49
|
| Rate for Payer: BCN Commercial |
$4,117.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cofinity Commercial |
$4,694.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$4,844.10
|
| Rate for Payer: Healthscope Whirlpool |
$4,993.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$4,494.53
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.83
|
| Rate for Payer: Nomi Health Commercial |
$4,095.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.44
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,979.62
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,583.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,394.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$919.70
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$689.77 |
| Max. Negotiated Rate |
$919.70 |
| Rate for Payer: Aetna Commercial |
$827.73
|
| Rate for Payer: ASR ASR |
$892.11
|
| Rate for Payer: BCBS Trust/PPO |
$755.26
|
| Rate for Payer: BCN Commercial |
$755.26
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cofinity Commercial |
$864.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.76
|
| Rate for Payer: Healthscope Commercial |
$892.11
|
| Rate for Payer: Healthscope Whirlpool |
$919.70
|
| Rate for Payer: Mclaren Commercial |
$827.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.75
|
| Rate for Payer: Nomi Health Commercial |
$754.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.34
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$919.70
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$919.70 |
| Rate for Payer: Aetna Commercial |
$827.73
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$892.11
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$758.29
|
| Rate for Payer: BCN Commercial |
$758.29
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cofinity Commercial |
$864.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$892.11
|
| Rate for Payer: Healthscope Whirlpool |
$919.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$827.73
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.75
|
| Rate for Payer: Nomi Health Commercial |
$754.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.77
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$805.84
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$644.71
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,172.40 |
| Rate for Payer: Aetna Commercial |
$1,055.16
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,137.23
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$966.64
|
| Rate for Payer: BCN Commercial |
$966.64
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Commercial |
$1,102.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,137.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,055.16
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Nomi Health Commercial |
$961.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$889.15
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$711.32
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,031.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$879.30 |
| Max. Negotiated Rate |
$1,172.40 |
| Rate for Payer: Aetna Commercial |
$1,055.16
|
| Rate for Payer: ASR ASR |
$1,137.23
|
| Rate for Payer: BCBS Trust/PPO |
$962.77
|
| Rate for Payer: BCN Commercial |
$962.77
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Commercial |
$1,102.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Healthscope Commercial |
$1,137.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,172.40
|
| Rate for Payer: Mclaren Commercial |
$1,055.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Nomi Health Commercial |
$961.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,031.71
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,087.65
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$815.74 |
| Max. Negotiated Rate |
$1,087.65 |
| Rate for Payer: Aetna Commercial |
$978.88
|
| Rate for Payer: ASR ASR |
$1,055.02
|
| Rate for Payer: BCBS Trust/PPO |
$893.18
|
| Rate for Payer: BCN Commercial |
$893.18
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cofinity Commercial |
$1,022.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.12
|
| Rate for Payer: Healthscope Commercial |
$1,055.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.65
|
| Rate for Payer: Mclaren Commercial |
$978.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.50
|
| Rate for Payer: Nomi Health Commercial |
$891.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$815.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$957.13
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,087.65
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,087.65 |
| Rate for Payer: Aetna Commercial |
$978.88
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,055.02
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$896.77
|
| Rate for Payer: BCN Commercial |
$896.77
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cofinity Commercial |
$1,022.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,055.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$978.88
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.50
|
| Rate for Payer: Nomi Health Commercial |
$891.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$815.74
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$953.00
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$762.44
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$957.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,322.01
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$991.51 |
| Max. Negotiated Rate |
$1,322.01 |
| Rate for Payer: Aetna Commercial |
$1,189.81
|
| Rate for Payer: ASR ASR |
$1,282.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.63
|
| Rate for Payer: BCN Commercial |
$1,085.63
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,242.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Healthscope Commercial |
$1,282.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.01
|
| Rate for Payer: Mclaren Commercial |
$1,189.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,163.37
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,322.01
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,322.01 |
| Rate for Payer: Aetna Commercial |
$1,189.81
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,282.35
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.00
|
| Rate for Payer: BCN Commercial |
$1,090.00
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,242.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,282.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,189.81
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,158.35
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$926.73
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,163.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,228.56
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$921.42 |
| Max. Negotiated Rate |
$1,228.56 |
| Rate for Payer: Aetna Commercial |
$1,105.70
|
| Rate for Payer: ASR ASR |
$1,191.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.89
|
| Rate for Payer: BCN Commercial |
$1,008.89
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cofinity Commercial |
$1,154.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.85
|
| Rate for Payer: Healthscope Commercial |
$1,191.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,228.56
|
| Rate for Payer: Mclaren Commercial |
$1,105.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.28
|
| Rate for Payer: Nomi Health Commercial |
$1,007.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,081.13
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,228.56
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,228.56 |
| Rate for Payer: Aetna Commercial |
$1,105.70
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,191.70
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.95
|
| Rate for Payer: BCN Commercial |
$1,012.95
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cofinity Commercial |
$1,154.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,191.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,228.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,105.70
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.28
|
| Rate for Payer: Nomi Health Commercial |
$1,007.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.42
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$646.44
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$517.15
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,081.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,801.27
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,350.95 |
| Max. Negotiated Rate |
$1,801.27 |
| Rate for Payer: Aetna Commercial |
$1,621.14
|
| Rate for Payer: ASR ASR |
$1,747.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.20
|
| Rate for Payer: BCN Commercial |
$1,479.20
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cofinity Commercial |
$1,693.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.02
|
| Rate for Payer: Healthscope Commercial |
$1,747.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,801.27
|
| Rate for Payer: Mclaren Commercial |
$1,621.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.08
|
| Rate for Payer: Nomi Health Commercial |
$1,477.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.12
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,801.27
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,801.27 |
| Rate for Payer: Aetna Commercial |
$1,621.14
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,747.23
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,485.15
|
| Rate for Payer: BCN Commercial |
$1,485.15
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cofinity Commercial |
$1,693.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,747.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,801.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,621.14
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.08
|
| Rate for Payer: Nomi Health Commercial |
$1,477.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.95
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,176.06
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$940.85
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,769.94
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,327.45 |
| Max. Negotiated Rate |
$1,769.94 |
| Rate for Payer: Aetna Commercial |
$1,592.95
|
| Rate for Payer: ASR ASR |
$1,716.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.47
|
| Rate for Payer: BCN Commercial |
$1,453.47
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cofinity Commercial |
$1,663.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.95
|
| Rate for Payer: Healthscope Commercial |
$1,716.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,769.94
|
| Rate for Payer: Mclaren Commercial |
$1,592.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.45
|
| Rate for Payer: Nomi Health Commercial |
$1,451.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,557.55
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,769.94
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,769.94 |
| Rate for Payer: Aetna Commercial |
$1,592.95
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,716.84
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,459.32
|
| Rate for Payer: BCN Commercial |
$1,459.32
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cofinity Commercial |
$1,663.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,716.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,769.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,592.95
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.45
|
| Rate for Payer: Nomi Health Commercial |
$1,451.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.45
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,176.06
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$940.85
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,557.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,322.01
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,322.01 |
| Rate for Payer: Aetna Commercial |
$1,189.81
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,282.35
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.00
|
| Rate for Payer: BCN Commercial |
$1,090.00
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,242.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,282.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,189.81
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,158.35
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$926.73
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,163.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,322.01
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$991.51 |
| Max. Negotiated Rate |
$1,322.01 |
| Rate for Payer: Aetna Commercial |
$1,189.81
|
| Rate for Payer: ASR ASR |
$1,282.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.63
|
| Rate for Payer: BCN Commercial |
$1,085.63
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,242.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Healthscope Commercial |
$1,282.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.01
|
| Rate for Payer: Mclaren Commercial |
$1,189.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,163.37
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,207.13
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,207.13 |
| Rate for Payer: Aetna Commercial |
$1,086.42
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,170.92
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$995.28
|
| Rate for Payer: BCN Commercial |
$995.28
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cofinity Commercial |
$1,134.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$965.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,170.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,086.42
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.06
|
| Rate for Payer: Nomi Health Commercial |
$989.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.35
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$719.67
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$575.74
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,062.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
