|
HC NIFOMETER
|
Facility
|
IP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$84.13 |
| Rate for Payer: Aetna Commercial |
$75.72
|
| Rate for Payer: ASR ASR |
$81.61
|
| Rate for Payer: ASR Commercial |
$81.61
|
| Rate for Payer: BCBS Trust/PPO |
$68.56
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$79.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$84.13
|
| Rate for Payer: Healthscope Whirlpool |
$81.61
|
| Rate for Payer: Mclaren Commercial |
$75.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: Nomi Health Commercial |
$68.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.03
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$84.13 |
| Rate for Payer: Aetna Commercial |
$75.72
|
| Rate for Payer: Aetna Medicare |
$42.06
|
| Rate for Payer: ASR ASR |
$81.61
|
| Rate for Payer: ASR Commercial |
$81.61
|
| Rate for Payer: BCBS Complete |
$33.65
|
| Rate for Payer: BCBS Trust/PPO |
$68.89
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$79.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$84.13
|
| Rate for Payer: Healthscope Whirlpool |
$81.61
|
| Rate for Payer: Mclaren Commercial |
$75.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: Nomi Health Commercial |
$68.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.71
|
| Rate for Payer: Priority Health Narrow Network |
$58.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.03
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$59.61 |
| Rate for Payer: Aetna Commercial |
$45.11
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$48.62
|
| Rate for Payer: ASR Commercial |
$48.62
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$41.04
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$47.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$50.12
|
| Rate for Payer: Healthscope Whirlpool |
$48.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$45.11
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$41.10
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.92
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$35.13
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$50.12 |
| Rate for Payer: Aetna Commercial |
$45.11
|
| Rate for Payer: ASR ASR |
$48.62
|
| Rate for Payer: ASR Commercial |
$48.62
|
| Rate for Payer: BCBS Trust/PPO |
$40.84
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$47.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Healthscope Commercial |
$50.12
|
| Rate for Payer: Healthscope Whirlpool |
$48.62
|
| Rate for Payer: Mclaren Commercial |
$45.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$41.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.11
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Aetna Commercial |
$4,406.40
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$4,749.12
|
| Rate for Payer: ASR Commercial |
$4,749.12
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,009.33
|
| Rate for Payer: BCN Commercial |
$3,795.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,602.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$4,896.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,749.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$4,406.40
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$4,014.72
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,795.57
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,308.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,182.40 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Aetna Commercial |
$4,406.40
|
| Rate for Payer: ASR ASR |
$4,749.12
|
| Rate for Payer: ASR Commercial |
$4,749.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.75
|
| Rate for Payer: BCN Commercial |
$3,795.87
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,602.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Healthscope Commercial |
$4,896.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,749.12
|
| Rate for Payer: Mclaren Commercial |
$4,406.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$4,014.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,308.48
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$901.67
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$901.67 |
| Rate for Payer: Aetna Commercial |
$811.50
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$874.62
|
| Rate for Payer: ASR Commercial |
$874.62
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$738.38
|
| Rate for Payer: BCN Commercial |
$699.06
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cofinity Commercial |
$847.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$901.67
|
| Rate for Payer: Healthscope Whirlpool |
$874.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$811.50
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.42
|
| Rate for Payer: Nomi Health Commercial |
$739.37
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.04
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$632.07
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$901.67
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$586.09 |
| Max. Negotiated Rate |
$901.67 |
| Rate for Payer: Aetna Commercial |
$811.50
|
| Rate for Payer: ASR ASR |
$874.62
|
| Rate for Payer: ASR Commercial |
$874.62
|
| Rate for Payer: BCBS Trust/PPO |
$734.77
|
| Rate for Payer: BCN Commercial |
$699.06
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cofinity Commercial |
$847.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.34
|
| Rate for Payer: Healthscope Commercial |
$901.67
|
| Rate for Payer: Healthscope Whirlpool |
$874.62
|
| Rate for Payer: Mclaren Commercial |
$811.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.42
|
| Rate for Payer: Nomi Health Commercial |
$739.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.47
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,149.41
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$747.12 |
| Max. Negotiated Rate |
$1,149.41 |
| Rate for Payer: Aetna Commercial |
$1,034.47
|
| Rate for Payer: ASR ASR |
$1,114.93
|
| Rate for Payer: ASR Commercial |
$1,114.93
|
| Rate for Payer: BCBS Trust/PPO |
$936.65
|
| Rate for Payer: BCN Commercial |
$891.14
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$1,080.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.53
|
| Rate for Payer: Healthscope Commercial |
$1,149.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.93
|
| Rate for Payer: Mclaren Commercial |
$1,034.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.00
|
| Rate for Payer: Nomi Health Commercial |
$942.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,011.48
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,149.41
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,149.41 |
| Rate for Payer: Aetna Commercial |
$1,034.47
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,114.93
|
| Rate for Payer: ASR Commercial |
$1,114.93
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$941.25
|
| Rate for Payer: BCN Commercial |
$891.14
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$1,080.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,149.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,034.47
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.00
|
| Rate for Payer: Nomi Health Commercial |
$942.52
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$806.49
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$645.19
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,011.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,066.32
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,066.32 |
| Rate for Payer: Aetna Commercial |
$959.69
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,034.33
|
| Rate for Payer: ASR Commercial |
$1,034.33
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$873.21
|
| Rate for Payer: BCN Commercial |
$826.72
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$853.06
|
| Rate for Payer: Cash Price |
$853.06
|
| Rate for Payer: Cofinity Commercial |
$1,002.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,066.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,034.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$959.69
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.37
|
| Rate for Payer: Nomi Health Commercial |
$874.38
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$934.31
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$747.49
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,066.32
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$693.11 |
| Max. Negotiated Rate |
$1,066.32 |
| Rate for Payer: Aetna Commercial |
$959.69
|
| Rate for Payer: ASR ASR |
$1,034.33
|
| Rate for Payer: ASR Commercial |
$1,034.33
|
| Rate for Payer: BCBS Trust/PPO |
$868.94
|
| Rate for Payer: BCN Commercial |
$826.72
|
| Rate for Payer: Cash Price |
$853.06
|
| Rate for Payer: Cofinity Commercial |
$1,002.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.06
|
| Rate for Payer: Healthscope Commercial |
$1,066.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,034.33
|
| Rate for Payer: Mclaren Commercial |
$959.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.37
|
| Rate for Payer: Nomi Health Commercial |
$874.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.36
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,296.09
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$842.46 |
| Max. Negotiated Rate |
$1,296.09 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: ASR ASR |
$1,257.21
|
| Rate for Payer: ASR Commercial |
$1,257.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.18
|
| Rate for Payer: BCN Commercial |
$1,004.86
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Healthscope Commercial |
$1,296.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.21
|
| Rate for Payer: Mclaren Commercial |
$1,166.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: Nomi Health Commercial |
$1,062.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,140.56
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,296.09
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,296.09 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,257.21
|
| Rate for Payer: ASR Commercial |
$1,257.21
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.37
|
| Rate for Payer: BCN Commercial |
$1,004.86
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,296.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,166.48
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: Nomi Health Commercial |
$1,062.79
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.63
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$908.56
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,140.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,204.47
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$782.91 |
| Max. Negotiated Rate |
$1,204.47 |
| Rate for Payer: Aetna Commercial |
$1,084.02
|
| Rate for Payer: ASR ASR |
$1,168.34
|
| Rate for Payer: ASR Commercial |
$1,168.34
|
| Rate for Payer: BCBS Trust/PPO |
$981.52
|
| Rate for Payer: BCN Commercial |
$933.83
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cofinity Commercial |
$1,132.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.58
|
| Rate for Payer: Healthscope Commercial |
$1,204.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.34
|
| Rate for Payer: Mclaren Commercial |
$1,084.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.80
|
| Rate for Payer: Nomi Health Commercial |
$987.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.93
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,204.47
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,204.47 |
| Rate for Payer: Aetna Commercial |
$1,084.02
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,168.34
|
| Rate for Payer: ASR Commercial |
$1,168.34
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$986.34
|
| Rate for Payer: BCN Commercial |
$933.83
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cofinity Commercial |
$1,132.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,204.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,084.02
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.80
|
| Rate for Payer: Nomi Health Commercial |
$987.67
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.34
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$469.07
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,765.95 |
| Rate for Payer: Aetna Commercial |
$1,589.36
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,712.97
|
| Rate for Payer: ASR Commercial |
$1,712.97
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,446.14
|
| Rate for Payer: BCN Commercial |
$1,369.14
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cofinity Commercial |
$1,659.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,765.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,712.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,589.36
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,501.06
|
| Rate for Payer: Nomi Health Commercial |
$1,448.08
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,066.72
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$853.38
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,554.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,147.87 |
| Max. Negotiated Rate |
$1,765.95 |
| Rate for Payer: Aetna Commercial |
$1,589.36
|
| Rate for Payer: ASR ASR |
$1,712.97
|
| Rate for Payer: ASR Commercial |
$1,712.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.07
|
| Rate for Payer: BCN Commercial |
$1,369.14
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cofinity Commercial |
$1,659.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.76
|
| Rate for Payer: Healthscope Commercial |
$1,765.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,712.97
|
| Rate for Payer: Mclaren Commercial |
$1,589.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,501.06
|
| Rate for Payer: Nomi Health Commercial |
$1,448.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,554.04
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,735.24
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,127.91 |
| Max. Negotiated Rate |
$1,735.24 |
| Rate for Payer: Aetna Commercial |
$1,561.72
|
| Rate for Payer: ASR ASR |
$1,683.18
|
| Rate for Payer: ASR Commercial |
$1,683.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,414.05
|
| Rate for Payer: BCN Commercial |
$1,345.33
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cofinity Commercial |
$1,631.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.19
|
| Rate for Payer: Healthscope Commercial |
$1,735.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,683.18
|
| Rate for Payer: Mclaren Commercial |
$1,561.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.95
|
| Rate for Payer: Nomi Health Commercial |
$1,422.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,527.01
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,735.24
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,735.24 |
| Rate for Payer: Aetna Commercial |
$1,561.72
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,683.18
|
| Rate for Payer: ASR Commercial |
$1,683.18
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.99
|
| Rate for Payer: BCN Commercial |
$1,345.33
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cofinity Commercial |
$1,631.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,735.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,683.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,561.72
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.95
|
| Rate for Payer: Nomi Health Commercial |
$1,422.90
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,066.72
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$853.38
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,527.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,296.09
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,296.09 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,257.21
|
| Rate for Payer: ASR Commercial |
$1,257.21
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.37
|
| Rate for Payer: BCN Commercial |
$1,004.86
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,296.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,166.48
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: Nomi Health Commercial |
$1,062.79
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.63
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$908.56
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,140.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,296.09
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$842.46 |
| Max. Negotiated Rate |
$1,296.09 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: ASR ASR |
$1,257.21
|
| Rate for Payer: ASR Commercial |
$1,257.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.18
|
| Rate for Payer: BCN Commercial |
$1,004.86
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Healthscope Commercial |
$1,296.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.21
|
| Rate for Payer: Mclaren Commercial |
$1,166.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: Nomi Health Commercial |
$1,062.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,140.56
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,183.46
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$769.25 |
| Max. Negotiated Rate |
$1,183.46 |
| Rate for Payer: Aetna Commercial |
$1,065.11
|
| Rate for Payer: ASR ASR |
$1,147.96
|
| Rate for Payer: ASR Commercial |
$1,147.96
|
| Rate for Payer: BCBS Trust/PPO |
$964.40
|
| Rate for Payer: BCN Commercial |
$917.54
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cofinity Commercial |
$1,112.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.77
|
| Rate for Payer: Healthscope Commercial |
$1,183.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,147.96
|
| Rate for Payer: Mclaren Commercial |
$1,065.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.94
|
| Rate for Payer: Nomi Health Commercial |
$970.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,041.44
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,183.46
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,183.46 |
| Rate for Payer: Aetna Commercial |
$1,065.11
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,147.96
|
| Rate for Payer: ASR Commercial |
$1,147.96
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$969.14
|
| Rate for Payer: BCN Commercial |
$917.54
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cofinity Commercial |
$1,112.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,183.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,147.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,065.11
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.94
|
| Rate for Payer: Nomi Health Commercial |
$970.44
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.76
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$522.21
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,041.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$862.42 |
| Max. Negotiated Rate |
$1,326.80 |
| Rate for Payer: Aetna Commercial |
$1,194.12
|
| Rate for Payer: ASR ASR |
$1,287.00
|
| Rate for Payer: ASR Commercial |
$1,287.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.21
|
| Rate for Payer: BCN Commercial |
$1,028.67
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,247.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,326.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,287.00
|
| Rate for Payer: Mclaren Commercial |
$1,194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.58
|
|
