|
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 MARROW WHOLE BODY
|
Facility
|
OP
|
$1,066.32
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,066.32 |
| Rate for Payer: Aetna Commercial |
$959.69
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,034.33
|
| Rate for Payer: ASR Commercial |
$1,034.33
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$873.21
|
| Rate for Payer: BCN Commercial |
$826.72
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,066.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,034.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$959.69
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.37
|
| Rate for Payer: Nomi Health Commercial |
$874.38
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$747.49
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$1,296.09 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,257.21
|
| Rate for Payer: ASR Commercial |
$1,257.21
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.37
|
| Rate for Payer: BCN Commercial |
$1,004.86
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,296.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,166.48
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| 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 |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$908.56
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,140.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$1,204.47 |
| Rate for Payer: Aetna Commercial |
$1,084.02
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,168.34
|
| Rate for Payer: ASR Commercial |
$1,168.34
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$986.34
|
| Rate for Payer: BCN Commercial |
$933.83
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,204.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,168.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,084.02
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.80
|
| Rate for Payer: Nomi Health Commercial |
$987.67
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,055.36
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$844.33
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,059.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 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 TOTAL BODY
|
Facility
|
OP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,765.95 |
| Rate for Payer: Aetna Commercial |
$1,589.36
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,712.97
|
| Rate for Payer: ASR Commercial |
$1,712.97
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,446.14
|
| Rate for Payer: BCN Commercial |
$1,369.14
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,765.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,712.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,589.36
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| 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 |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,547.33
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,237.93
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,554.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$1,735.24 |
| Rate for Payer: Aetna Commercial |
$1,561.72
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,683.18
|
| Rate for Payer: ASR Commercial |
$1,683.18
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.99
|
| Rate for Payer: BCN Commercial |
$1,345.33
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,735.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,683.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,561.72
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| 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 |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,520.42
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,216.40
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,527.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$1,296.09 |
| Rate for Payer: Aetna Commercial |
$1,166.48
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,257.21
|
| Rate for Payer: ASR Commercial |
$1,257.21
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.37
|
| Rate for Payer: BCN Commercial |
$1,004.86
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,296.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,166.48
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| 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 |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$908.56
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,140.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$1,183.46 |
| Rate for Payer: Aetna Commercial |
$1,065.11
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,147.96
|
| Rate for Payer: ASR Commercial |
$1,147.96
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$969.14
|
| Rate for Payer: BCN Commercial |
$917.54
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,183.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,147.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,065.11
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.94
|
| Rate for Payer: Nomi Health Commercial |
$970.44
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.95
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$829.61
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,041.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,326.80 |
| Rate for Payer: Aetna Commercial |
$1,194.12
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,287.00
|
| Rate for Payer: ASR Commercial |
$1,287.00
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.52
|
| Rate for Payer: BCN Commercial |
$1,028.67
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,061.44
|
| 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: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,326.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,287.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,194.12
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,162.54
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$930.09
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$874.85 |
| Rate for Payer: Aetna Commercial |
$787.37
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$848.60
|
| Rate for Payer: ASR Commercial |
$848.60
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$716.41
|
| Rate for Payer: BCN Commercial |
$678.27
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$822.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$874.85
|
| Rate for Payer: Healthscope Whirlpool |
$848.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$787.37
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$766.54
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$613.27
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$568.65 |
| Max. Negotiated Rate |
$874.85 |
| Rate for Payer: Aetna Commercial |
$787.37
|
| Rate for Payer: ASR ASR |
$848.60
|
| Rate for Payer: ASR Commercial |
$848.60
|
| Rate for Payer: BCBS Trust/PPO |
$712.92
|
| Rate for Payer: BCN Commercial |
$678.27
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$822.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Healthscope Commercial |
$874.85
|
| Rate for Payer: Healthscope Whirlpool |
$848.60
|
| Rate for Payer: Mclaren Commercial |
$787.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.87
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Trust/PPO |
$831.83
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.41
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$715.57
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$1,973.48 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$1,273.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,273.21
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,400.53
|
| Rate for Payer: PHP Medicaid |
$682.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.41
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health Narrow Network |
$715.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,973.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP DNSP |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$682.44
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Trust/PPO |
$831.83
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| 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 |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$375.88
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.18
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$321.76
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Trust/PPO |
$374.04
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| 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 |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$375.88
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$402.18
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$321.76
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
