|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,207.13
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$905.35 |
| Max. Negotiated Rate |
$1,207.13 |
| Rate for Payer: Aetna Commercial |
$1,086.42
|
| Rate for Payer: ASR ASR |
$1,170.92
|
| Rate for Payer: BCBS Trust/PPO |
$991.30
|
| Rate for Payer: BCN Commercial |
$991.30
|
| 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: Healthscope Commercial |
$1,170.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.13
|
| Rate for Payer: Mclaren Commercial |
$1,086.42
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,062.27
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.36
|
| Rate for Payer: BCN Commercial |
$1,111.36
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,312.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.34
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| 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 |
$1,312.74
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,115.83
|
| Rate for Payer: BCN Commercial |
$1,115.83
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,312.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| 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 |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| 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 |
$1,120.99
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$896.79
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
| 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 CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$892.35
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$669.26 |
| Max. Negotiated Rate |
$892.35 |
| Rate for Payer: Aetna Commercial |
$803.12
|
| Rate for Payer: ASR ASR |
$865.58
|
| Rate for Payer: BCBS Trust/PPO |
$732.80
|
| Rate for Payer: BCN Commercial |
$732.80
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Commercial |
$838.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Healthscope Commercial |
$865.58
|
| Rate for Payer: Healthscope Whirlpool |
$892.35
|
| Rate for Payer: Mclaren Commercial |
$803.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Nomi Health Commercial |
$731.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.27
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$892.35
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$892.35 |
| Rate for Payer: Aetna Commercial |
$803.12
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$865.58
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$735.74
|
| Rate for Payer: BCN Commercial |
$735.74
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Commercial |
$838.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$865.58
|
| Rate for Payer: Healthscope Whirlpool |
$892.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$803.12
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Nomi Health Commercial |
$731.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$781.88
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$625.54
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$858.47
|
| Rate for Payer: BCN Commercial |
$858.47
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$912.30
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$729.88
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$780.90 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Trust/PPO |
$855.03
|
| Rate for Payer: BCN Commercial |
$855.03
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$1,999.48 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: Aetna Medicare |
$1,289.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$858.47
|
| Rate for Payer: BCN Commercial |
$858.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,289.99
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$708.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,418.99
|
| Rate for Payer: PHP Medicaid |
$691.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$912.30
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health Narrow Network |
$729.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$1,999.48
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP DNSP |
$1,289.99
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$780.90 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Trust/PPO |
$855.03
|
| Rate for Payer: BCN Commercial |
$855.03
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$351.13 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: ASR ASR |
$454.13
|
| Rate for Payer: BCBS Trust/PPO |
$384.47
|
| Rate for Payer: BCN Commercial |
$384.47
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| 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 |
$454.13
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$386.01
|
| Rate for Payer: BCN Commercial |
$386.01
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$351.13 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| Rate for Payer: ASR ASR |
$454.13
|
| Rate for Payer: BCBS Trust/PPO |
$384.47
|
| Rate for Payer: BCN Commercial |
$384.47
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$421.36
|
| 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 |
$454.13
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$386.01
|
| Rate for Payer: BCN Commercial |
$386.01
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$440.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$454.13
|
| Rate for Payer: Healthscope Whirlpool |
$468.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$421.36
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| 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 |
$116.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$98.65
|
| Rate for Payer: BCN Commercial |
$98.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$116.06
|
| Rate for Payer: Healthscope Whirlpool |
$119.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$107.69
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.06
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$170.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$84.89
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$84.89 |
| Rate for Payer: Aetna Commercial |
$76.40
|
| 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 |
$82.34
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$69.99
|
| Rate for Payer: BCN Commercial |
$69.99
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$82.34
|
| Rate for Payer: Healthscope Whirlpool |
$84.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$76.40
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| 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 |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74.38
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$59.51
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$84.89
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$84.89 |
| Rate for Payer: Aetna Commercial |
$76.40
|
| Rate for Payer: ASR ASR |
$82.34
|
| Rate for Payer: BCBS Trust/PPO |
$69.71
|
| Rate for Payer: BCN Commercial |
$69.71
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Healthscope Commercial |
$82.34
|
| Rate for Payer: Healthscope Whirlpool |
$84.89
|
| Rate for Payer: Mclaren Commercial |
$76.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.70
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,457.68
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,093.26 |
| Max. Negotiated Rate |
$1,457.68 |
| Rate for Payer: Aetna Commercial |
$1,311.91
|
| Rate for Payer: ASR ASR |
$1,413.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.05
|
| Rate for Payer: BCN Commercial |
$1,197.05
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cofinity Commercial |
$1,370.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.14
|
| Rate for Payer: Healthscope Commercial |
$1,413.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,457.68
|
| Rate for Payer: Mclaren Commercial |
$1,311.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.03
|
| Rate for Payer: Nomi Health Commercial |
$1,195.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,282.76
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,457.68
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,457.68 |
| Rate for Payer: Aetna Commercial |
$1,311.91
|
| 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 |
$1,413.95
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.86
|
| Rate for Payer: BCN Commercial |
$1,201.86
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cofinity Commercial |
$1,370.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,413.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,457.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,311.91
|
| 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 |
$1,239.03
|
| Rate for Payer: Nomi Health Commercial |
$1,195.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.26
|
| 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 |
$1,231.12
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$984.90
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,282.76
|
| 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 GE REFLUX
|
Facility
|
OP
|
$1,291.08
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,291.08 |
| Rate for Payer: Aetna Commercial |
$1,161.97
|
| 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 |
$1,252.35
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,064.50
|
| Rate for Payer: BCN Commercial |
$1,064.50
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cofinity Commercial |
$1,213.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,252.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,161.97
|
| 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 |
$1,097.42
|
| Rate for Payer: Nomi Health Commercial |
$1,058.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.31
|
| 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 |
$930.31
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$744.25
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,136.15
|
| 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 GE REFLUX
|
Facility
|
IP
|
$1,291.08
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$968.31 |
| Max. Negotiated Rate |
$1,291.08 |
| Rate for Payer: Aetna Commercial |
$1,161.97
|
| Rate for Payer: ASR ASR |
$1,252.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,060.23
|
| Rate for Payer: BCN Commercial |
$1,060.23
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cofinity Commercial |
$1,213.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.86
|
| Rate for Payer: Healthscope Commercial |
$1,252.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.08
|
| Rate for Payer: Mclaren Commercial |
$1,161.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.42
|
| Rate for Payer: Nomi Health Commercial |
$1,058.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,136.15
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,176.06 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| 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 |
$1,009.96
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$858.47
|
| Rate for Payer: BCN Commercial |
$858.47
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| 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 |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| 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 |
$916.26
|
| 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 GI BLOOD LOSS
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$780.90 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Trust/PPO |
$855.03
|
| Rate for Payer: BCN Commercial |
$855.03
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,506.09
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,506.09 |
| Rate for Payer: Aetna Commercial |
$1,355.48
|
| 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 |
$1,460.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,241.77
|
| Rate for Payer: BCN Commercial |
$1,241.77
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,415.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,460.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,506.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,355.48
|
| 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 |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| 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 |
$1,305.58
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,044.46
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.36
|
| 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 LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,506.09
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,129.57 |
| Max. Negotiated Rate |
$1,506.09 |
| Rate for Payer: Aetna Commercial |
$1,355.48
|
| Rate for Payer: ASR ASR |
$1,460.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.80
|
| Rate for Payer: BCN Commercial |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,415.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Healthscope Commercial |
$1,460.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,506.09
|
| Rate for Payer: Mclaren Commercial |
$1,355.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,325.36
|
|
