|
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 |
$211.02 |
| Max. Negotiated Rate |
$1,326.80 |
| Rate for Payer: Aetna Commercial |
$1,194.12
|
| 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 |
$1,287.00
|
| Rate for Payer: ASR Commercial |
$1,287.00
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.52
|
| Rate for Payer: BCN Commercial |
$1,028.67
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,326.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,287.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,194.12
|
| 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 |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| 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 |
$862.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,016.77
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$813.42
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.58
|
| 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 CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$874.85 |
| Rate for Payer: Aetna Commercial |
$787.36
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$848.60
|
| Rate for Payer: ASR Commercial |
$848.60
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$716.41
|
| Rate for Payer: BCN Commercial |
$678.27
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| 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 |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$874.85
|
| Rate for Payer: Healthscope Whirlpool |
$848.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$787.36
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| 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 |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$613.27
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
|
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 |
$787.36
|
| 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 |
$787.36
|
| 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
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| 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 |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| 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 |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$715.57
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
|
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 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 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 |
$1,982.57 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$1,279.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| 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 |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Medicare |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$1,406.99
|
| Rate for Payer: PHP Medicaid |
$685.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| 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 |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$715.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$1,982.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP DNSP |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: VA VA |
$1,279.08
|
|
|
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, 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 |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| 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, SERUM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
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 |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| 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 IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$193.25 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| 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 |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| 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 |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| 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 |
$76.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.25
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$154.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
| 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 N METHYLHISTAMINE, U
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| 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 |
$80.73
|
| Rate for Payer: ASR Commercial |
$80.73
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.16
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| 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 |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| 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 |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.93
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$58.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: ASR Commercial |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.73
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,429.10 |
| Rate for Payer: Aetna Commercial |
$1,286.19
|
| 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 |
$1,386.23
|
| Rate for Payer: ASR Commercial |
$1,386.23
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.29
|
| Rate for Payer: BCN Commercial |
$1,107.98
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,343.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,429.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,286.19
|
| 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 |
$1,214.74
|
| Rate for Payer: Nomi Health Commercial |
$1,171.86
|
| 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 |
$928.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.67
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$893.34
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,257.61
|
| 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 GASTRIC EMPTYING
|
Facility
|
IP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$928.92 |
| Max. Negotiated Rate |
$1,429.10 |
| Rate for Payer: Aetna Commercial |
$1,286.19
|
| Rate for Payer: ASR ASR |
$1,386.23
|
| Rate for Payer: ASR Commercial |
$1,386.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.57
|
| Rate for Payer: BCN Commercial |
$1,107.98
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,343.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Healthscope Commercial |
$1,429.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.23
|
| Rate for Payer: Mclaren Commercial |
$1,286.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.74
|
| Rate for Payer: Nomi Health Commercial |
$1,171.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,257.61
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$822.74 |
| Max. Negotiated Rate |
$1,265.76 |
| Rate for Payer: Aetna Commercial |
$1,139.18
|
| Rate for Payer: ASR ASR |
$1,227.79
|
| Rate for Payer: ASR Commercial |
$1,227.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.47
|
| Rate for Payer: BCN Commercial |
$981.34
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,189.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Healthscope Commercial |
$1,265.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,227.79
|
| Rate for Payer: Mclaren Commercial |
$1,139.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,113.87
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,265.76 |
| Rate for Payer: Aetna Commercial |
$1,139.18
|
| 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 |
$1,227.79
|
| Rate for Payer: ASR Commercial |
$1,227.79
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,036.53
|
| Rate for Payer: BCN Commercial |
$981.34
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,189.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,265.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,227.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,139.18
|
| 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 |
$1,075.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.92
|
| 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 |
$822.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$843.82
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$675.06
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,113.87
|
| 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 GI BLOOD LOSS
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,066.72 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| 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 |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| 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 |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| 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 |
$663.51
|
| 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 |
$898.29
|
| 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 GI BLOOD LOSS
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
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 LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.25
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| 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 |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.15
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| 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 |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| 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 |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,184.20
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$947.36
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
| 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 LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.25
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.15
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,184.20
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$947.36
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
