|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$360.18 |
| Rate for Payer: Aetna Commercial |
$340.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.13
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$280.14
|
| Rate for Payer: Cofinity Commercial |
$344.17
|
| Rate for Payer: Healthscope Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: PHP Commercial |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: Priority Health SBD |
$252.13
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
OP
|
$1,011.88
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$910.69 |
| Rate for Payer: Aetna Commercial |
$860.10
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$447.90
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$809.50
|
| Rate for Payer: Cash Price |
$809.50
|
| Rate for Payer: Cofinity Commercial |
$870.22
|
| Rate for Payer: Cofinity Commercial |
$708.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$910.69
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$860.10
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$860.10
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$708.32
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$637.48
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$314.67
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
IP
|
$1,011.88
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$637.48 |
| Max. Negotiated Rate |
$910.69 |
| Rate for Payer: Aetna Commercial |
$860.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.72
|
| Rate for Payer: Cash Price |
$809.50
|
| Rate for Payer: Cofinity Commercial |
$708.32
|
| Rate for Payer: Cofinity Commercial |
$870.22
|
| Rate for Payer: Healthscope Commercial |
$910.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$860.10
|
| Rate for Payer: PHP Commercial |
$860.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$708.32
|
| Rate for Payer: Priority Health SBD |
$637.48
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
IP
|
$1,195.27
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$753.02 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.93
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Cofinity Commercial |
$836.69
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.98
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.69
|
| Rate for Payer: Priority Health SBD |
$753.02
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
OP
|
$1,195.27
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$180.42 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$254.83
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$836.69
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.98
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.69
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$753.02
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$180.42
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$480.35 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$787.85 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$230.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.71
|
| Rate for Payer: BCBS Complete |
$127.15
|
| Rate for Payer: BCBS MAPPO |
$221.37
|
| Rate for Payer: BCBS Trust/PPO |
$87.15
|
| Rate for Payer: BCN Medicare Advantage |
$221.37
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.37
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Mclaren Medicaid |
$121.09
|
| Rate for Payer: Mclaren Medicare |
$221.37
|
| Rate for Payer: Meridian Medicaid |
$127.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Medicare |
$210.30
|
| Rate for Payer: PACE SWMI |
$221.37
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: PHP Medicare Advantage |
$221.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.85
|
| Rate for Payer: Priority Health Medicare |
$221.37
|
| Rate for Payer: Priority Health Narrow Network |
$630.28
|
| Rate for Payer: Priority Health SBD |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$221.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.37
|
| Rate for Payer: UHC Exchange |
$127.70
|
| Rate for Payer: UHC Medicare Advantage |
$228.01
|
| Rate for Payer: VA VA |
$221.37
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$787.85 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$230.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.71
|
| Rate for Payer: BCBS Complete |
$127.15
|
| Rate for Payer: BCBS MAPPO |
$221.37
|
| Rate for Payer: BCBS Trust/PPO |
$88.26
|
| Rate for Payer: BCN Medicare Advantage |
$221.37
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.37
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Mclaren Medicaid |
$121.09
|
| Rate for Payer: Mclaren Medicare |
$221.37
|
| Rate for Payer: Meridian Medicaid |
$127.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Medicare |
$210.30
|
| Rate for Payer: PACE SWMI |
$221.37
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: PHP Medicare Advantage |
$221.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.85
|
| Rate for Payer: Priority Health Medicare |
$221.37
|
| Rate for Payer: Priority Health Narrow Network |
$630.28
|
| Rate for Payer: Priority Health SBD |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$221.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.37
|
| Rate for Payer: UHC Exchange |
$142.76
|
| Rate for Payer: UHC Medicare Advantage |
$228.01
|
| Rate for Payer: VA VA |
$221.37
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$480.35 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$762.46
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$787.85 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna Medicare |
$230.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.71
|
| Rate for Payer: BCBS Complete |
$127.15
|
| Rate for Payer: BCBS MAPPO |
$221.37
|
| Rate for Payer: BCBS Trust/PPO |
$84.39
|
| Rate for Payer: BCN Medicare Advantage |
$221.37
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.37
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Mclaren Medicaid |
$121.09
|
| Rate for Payer: Mclaren Medicare |
$221.37
|
| Rate for Payer: Meridian Medicaid |
$127.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PACE Medicare |
$210.30
|
| Rate for Payer: PACE SWMI |
$221.37
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: PHP Medicare Advantage |
$221.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.85
|
| Rate for Payer: Priority Health Medicare |
$221.37
|
| Rate for Payer: Priority Health Narrow Network |
$630.28
|
| Rate for Payer: Priority Health SBD |
$480.35
|
| Rate for Payer: Railroad Medicare Medicare |
$221.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.37
|
| Rate for Payer: UHC Exchange |
$131.30
|
| Rate for Payer: UHC Medicare Advantage |
$228.01
|
| Rate for Payer: VA VA |
$221.37
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$762.46
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$480.35 |
| Max. Negotiated Rate |
$686.21 |
| Rate for Payer: Aetna Commercial |
$648.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.60
|
| Rate for Payer: Cash Price |
$609.97
|
| Rate for Payer: Cofinity Commercial |
$655.72
|
| Rate for Payer: Cofinity Commercial |
$533.72
|
| Rate for Payer: Healthscope Commercial |
$686.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.09
|
| Rate for Payer: PHP Commercial |
$648.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.72
|
| Rate for Payer: Priority Health SBD |
$480.35
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
OP
|
$1,334.17
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$155.53 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Aetna Commercial |
$1,134.04
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$231.12
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cofinity Commercial |
$933.92
|
| Rate for Payer: Cofinity Commercial |
$1,147.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,200.75
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.04
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,134.04
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.92
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$840.53
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$155.53
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
IP
|
$1,334.17
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$840.53 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Aetna Commercial |
$1,134.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.21
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cofinity Commercial |
$1,147.39
|
| Rate for Payer: Cofinity Commercial |
$933.92
|
| Rate for Payer: Healthscope Commercial |
$1,200.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.04
|
| Rate for Payer: PHP Commercial |
$1,134.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.92
|
| Rate for Payer: Priority Health SBD |
$840.53
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
OP
|
$1,300.65
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$1,170.58 |
| Rate for Payer: Aetna Commercial |
$1,105.55
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.18
|
| Rate for Payer: BCBS Complete |
$276.25
|
| Rate for Payer: BCBS MAPPO |
$480.94
|
| Rate for Payer: BCBS Trust/PPO |
$288.48
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$1,040.52
|
| Rate for Payer: Cash Price |
$1,040.52
|
| Rate for Payer: Cofinity Commercial |
$910.46
|
| Rate for Payer: Cofinity Commercial |
$1,118.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,170.58
|
| Rate for Payer: Mclaren Medicaid |
$263.07
|
| Rate for Payer: Mclaren Medicare |
$480.94
|
| Rate for Payer: Meridian Medicaid |
$276.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.55
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,105.55
|
| Rate for Payer: PHP Medicare Advantage |
$480.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.46
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$819.41
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$211.20
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
IP
|
$1,300.65
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$819.41 |
| Max. Negotiated Rate |
$1,170.58 |
| Rate for Payer: Aetna Commercial |
$1,105.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.42
|
| Rate for Payer: Cash Price |
$1,040.52
|
| Rate for Payer: Cofinity Commercial |
$1,118.56
|
| Rate for Payer: Cofinity Commercial |
$910.46
|
| Rate for Payer: Healthscope Commercial |
$1,170.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.55
|
| Rate for Payer: PHP Commercial |
$1,105.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.46
|
| Rate for Payer: Priority Health SBD |
$819.41
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
IP
|
$1,651.13
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,040.21 |
| Max. Negotiated Rate |
$1,486.02 |
| Rate for Payer: Aetna Commercial |
$1,403.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.23
|
| Rate for Payer: Cash Price |
$1,320.90
|
| Rate for Payer: Cofinity Commercial |
$1,155.79
|
| Rate for Payer: Cofinity Commercial |
$1,419.97
|
| Rate for Payer: Healthscope Commercial |
$1,486.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,403.46
|
| Rate for Payer: PHP Commercial |
$1,403.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.79
|
| Rate for Payer: Priority Health SBD |
$1,040.21
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
OP
|
$1,651.13
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$1,486.02 |
| Rate for Payer: Aetna Commercial |
$1,403.46
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.18
|
| Rate for Payer: BCBS Complete |
$276.25
|
| Rate for Payer: BCBS MAPPO |
$480.94
|
| Rate for Payer: BCBS Trust/PPO |
$195.82
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$1,320.90
|
| Rate for Payer: Cash Price |
$1,320.90
|
| Rate for Payer: Cofinity Commercial |
$1,155.79
|
| Rate for Payer: Cofinity Commercial |
$1,419.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,486.02
|
| Rate for Payer: Mclaren Medicaid |
$263.07
|
| Rate for Payer: Mclaren Medicare |
$480.94
|
| Rate for Payer: Meridian Medicaid |
$276.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,403.46
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,403.46
|
| Rate for Payer: PHP Medicare Advantage |
$480.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.79
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$1,040.21
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$171.91
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
IP
|
$785.40
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.51
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$549.78
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.59
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.78
|
| Rate for Payer: Priority Health SBD |
$494.80
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
OP
|
$785.40
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$81.71
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Cofinity Commercial |
$549.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.59
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.78
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$494.80
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
OP
|
$971.92
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$81.71
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$680.34
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$612.31
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.22
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$31.11
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
IP
|
$971.92
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.31 |
| Max. Negotiated Rate |
$874.73 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.75
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Cofinity Commercial |
$680.34
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health SBD |
$612.31
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$938.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$591.00 |
| Max. Negotiated Rate |
$844.29 |
| Rate for Payer: Aetna Commercial |
$797.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.76
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cofinity Commercial |
$656.67
|
| Rate for Payer: Cofinity Commercial |
$806.77
|
| Rate for Payer: Healthscope Commercial |
$844.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.38
|
| Rate for Payer: PHP Commercial |
$797.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.67
|
| Rate for Payer: Priority Health SBD |
$591.00
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$938.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$375.24 |
| Max. Negotiated Rate |
$844.29 |
| Rate for Payer: Aetna Commercial |
$797.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.76
|
| Rate for Payer: BCBS Complete |
$375.24
|
| Rate for Payer: BCBS Trust/PPO |
$518.92
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cofinity Commercial |
$656.67
|
| Rate for Payer: Cofinity Commercial |
$806.77
|
| Rate for Payer: Healthscope Commercial |
$844.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.38
|
| Rate for Payer: PHP Commercial |
$797.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.67
|
| Rate for Payer: Priority Health SBD |
$591.00
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,238.67
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.07 |
| Max. Negotiated Rate |
$1,114.80 |
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.18
|
| Rate for Payer: BCBS Complete |
$276.25
|
| Rate for Payer: BCBS MAPPO |
$480.94
|
| Rate for Payer: BCBS Trust/PPO |
$415.91
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cofinity Commercial |
$867.07
|
| Rate for Payer: Cofinity Commercial |
$1,065.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,114.80
|
| Rate for Payer: Mclaren Medicaid |
$263.07
|
| Rate for Payer: Mclaren Medicare |
$480.94
|
| Rate for Payer: Meridian Medicaid |
$276.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.87
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,052.87
|
| Rate for Payer: PHP Medicare Advantage |
$480.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.07
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$780.36
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$278.98
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,238.67
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$780.36 |
| Max. Negotiated Rate |
$1,114.80 |
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.14
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cofinity Commercial |
$1,065.26
|
| Rate for Payer: Cofinity Commercial |
$867.07
|
| Rate for Payer: Healthscope Commercial |
$1,114.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.87
|
| Rate for Payer: PHP Commercial |
$1,052.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.07
|
| Rate for Payer: Priority Health SBD |
$780.36
|
|
