|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$499.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$119.63 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$241.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$119.63
|
| Rate for Payer: BCN Commercial |
$119.63
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Mclaren Medicaid |
$121.60
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$697.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$751.88
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health SBD |
$499.75
|
| Rate for Payer: Priority Health Tiered Network |
$601.50
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.62
|
| Rate for Payer: UHC Core |
$413.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$311.75
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$499.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$241.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$121.90
|
| Rate for Payer: BCN Commercial |
$121.90
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Mclaren Medicaid |
$121.60
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$697.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$751.88
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health SBD |
$499.75
|
| Rate for Payer: Priority Health Tiered Network |
$601.50
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.62
|
| Rate for Payer: UHC Core |
$413.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$311.75
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$499.75 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health SBD |
$499.75
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.35 |
| Max. Negotiated Rate |
$751.88 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$241.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$117.35
|
| Rate for Payer: BCN Commercial |
$117.35
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Advantage |
$555.28
|
| Rate for Payer: Cofinity Commercial |
$682.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Mclaren Medicaid |
$121.60
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$697.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$751.88
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health SBD |
$499.75
|
| Rate for Payer: Priority Health Tiered Network |
$601.50
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.62
|
| Rate for Payer: UHC Core |
$413.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$311.75
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
OP
|
$1,388.07
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$1,179.86
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$902.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$308.91
|
| Rate for Payer: BCN Commercial |
$308.91
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,110.46
|
| Rate for Payer: Cash Price |
$1,110.46
|
| Rate for Payer: Cofinity Advantage |
$971.65
|
| Rate for Payer: Cofinity Commercial |
$1,193.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,249.26
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.86
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.05
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,179.86
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$874.48
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.25
|
| Rate for Payer: UHC Core |
$723.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$545.51
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
IP
|
$1,388.07
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$874.48 |
| Max. Negotiated Rate |
$1,249.26 |
| Rate for Payer: Aetna Commercial |
$1,179.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$902.25
|
| Rate for Payer: Cash Price |
$1,110.46
|
| Rate for Payer: Cofinity Advantage |
$971.65
|
| Rate for Payer: Cofinity Commercial |
$1,193.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.46
|
| Rate for Payer: Healthscope Commercial |
$1,249.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.05
|
| Rate for Payer: PHP Commercial |
$1,179.86
|
| Rate for Payer: Priority Health SBD |
$874.48
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
IP
|
$1,353.19
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$852.51 |
| Max. Negotiated Rate |
$1,217.87 |
| Rate for Payer: Aetna Commercial |
$1,150.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.57
|
| Rate for Payer: Cash Price |
$1,082.55
|
| Rate for Payer: Cofinity Advantage |
$947.23
|
| Rate for Payer: Cofinity Commercial |
$1,163.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.55
|
| Rate for Payer: Healthscope Commercial |
$1,217.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.89
|
| Rate for Payer: PHP Commercial |
$1,150.21
|
| Rate for Payer: Priority Health SBD |
$852.51
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
OP
|
$1,353.19
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna Commercial |
$1,150.21
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$383.12
|
| Rate for Payer: BCN Commercial |
$383.12
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,082.55
|
| Rate for Payer: Cash Price |
$1,082.55
|
| Rate for Payer: Cofinity Advantage |
$947.23
|
| Rate for Payer: Cofinity Commercial |
$1,163.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,217.87
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.21
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.89
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,150.21
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$852.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.57
|
| Rate for Payer: UHC Core |
$705.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$531.80
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
OP
|
$1,717.83
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$273.33 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna Commercial |
$1,460.16
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,116.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$273.33
|
| Rate for Payer: BCN Commercial |
$273.33
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,374.26
|
| Rate for Payer: Cash Price |
$1,374.26
|
| Rate for Payer: Cofinity Advantage |
$1,202.48
|
| Rate for Payer: Cofinity Commercial |
$1,477.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,546.05
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,460.16
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,288.37
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,460.16
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,082.23
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,116.59
|
| Rate for Payer: UHC Core |
$894.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$675.11
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
IP
|
$1,717.83
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,082.23 |
| Max. Negotiated Rate |
$1,546.05 |
| Rate for Payer: Aetna Commercial |
$1,460.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,116.59
|
| Rate for Payer: Cash Price |
$1,374.26
|
| Rate for Payer: Cofinity Advantage |
$1,202.48
|
| Rate for Payer: Cofinity Commercial |
$1,477.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.26
|
| Rate for Payer: Healthscope Commercial |
$1,546.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,460.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,288.37
|
| Rate for Payer: PHP Commercial |
$1,460.16
|
| Rate for Payer: Priority Health SBD |
$1,082.23
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
IP
|
$817.13
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$514.79 |
| Max. Negotiated Rate |
$735.42 |
| Rate for Payer: Aetna Commercial |
$694.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.13
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cofinity Advantage |
$571.99
|
| Rate for Payer: Cofinity Commercial |
$702.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.70
|
| Rate for Payer: Healthscope Commercial |
$735.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.85
|
| Rate for Payer: PHP Commercial |
$694.56
|
| Rate for Payer: Priority Health SBD |
$514.79
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
OP
|
$817.13
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$694.56
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$107.78
|
| Rate for Payer: BCN Commercial |
$107.78
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cofinity Advantage |
$571.99
|
| Rate for Payer: Cofinity Commercial |
$702.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$735.42
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.56
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.85
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$694.56
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$514.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
OP
|
$1,011.19
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$107.78
|
| Rate for Payer: BCN Commercial |
$107.78
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Advantage |
$707.83
|
| Rate for Payer: Cofinity Commercial |
$869.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$637.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
IP
|
$1,011.19
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.05 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.27
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Advantage |
$707.83
|
| Rate for Payer: Cofinity Commercial |
$869.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: Priority Health SBD |
$637.05
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$1,129.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$1,016.19 |
| Rate for Payer: Aetna Commercial |
$959.74
|
| Rate for Payer: Aetna Medicare |
$564.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.91
|
| Rate for Payer: BCBS Complete |
$451.64
|
| Rate for Payer: BCBS Trust/PPO |
$706.54
|
| Rate for Payer: BCN Commercial |
$706.54
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cofinity Advantage |
$790.37
|
| Rate for Payer: Cofinity Commercial |
$971.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.28
|
| Rate for Payer: Healthscope Commercial |
$1,016.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$903.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: PHP Commercial |
$959.74
|
| Rate for Payer: Priority Health SBD |
$711.33
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,129.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$711.33 |
| Max. Negotiated Rate |
$1,016.19 |
| Rate for Payer: Aetna Commercial |
$959.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.91
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cofinity Advantage |
$790.37
|
| Rate for Payer: Cofinity Commercial |
$971.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.28
|
| Rate for Payer: Healthscope Commercial |
$1,016.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: PHP Commercial |
$959.74
|
| Rate for Payer: Priority Health SBD |
$711.33
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,288.71
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$811.89 |
| Max. Negotiated Rate |
$1,159.84 |
| Rate for Payer: Aetna Commercial |
$1,095.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.66
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cofinity Advantage |
$902.10
|
| Rate for Payer: Cofinity Commercial |
$1,108.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.97
|
| Rate for Payer: Healthscope Commercial |
$1,159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PHP Commercial |
$1,095.40
|
| Rate for Payer: Priority Health SBD |
$811.89
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,288.71
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna Commercial |
$1,095.40
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$547.42
|
| Rate for Payer: BCN Commercial |
$547.42
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cofinity Advantage |
$902.10
|
| Rate for Payer: Cofinity Commercial |
$1,108.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,159.84
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,095.40
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$811.89
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$837.66
|
| Rate for Payer: UHC Core |
$671.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$506.46
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$2,025.10
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$4,171.73 |
| Rate for Payer: Aetna Commercial |
$1,721.34
|
| Rate for Payer: Aetna Medicare |
$1,341.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.26
|
| Rate for Payer: BCN Commercial |
$1,246.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cofinity Advantage |
$1,417.57
|
| Rate for Payer: Cofinity Commercial |
$1,741.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$1,822.59
|
| Rate for Payer: Mclaren Medicaid |
$674.66
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$1,354.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Nomi Health Commercial |
$3,869.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,721.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,171.73
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health SBD |
$1,275.81
|
| Rate for Payer: Priority Health Tiered Network |
$3,337.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,316.32
|
| Rate for Payer: UHC Core |
$1,055.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$795.86
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$2,025.10
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,275.81 |
| Max. Negotiated Rate |
$1,822.59 |
| Rate for Payer: Aetna Commercial |
$1,721.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.32
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cofinity Advantage |
$1,417.57
|
| Rate for Payer: Cofinity Commercial |
$1,741.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.08
|
| Rate for Payer: Healthscope Commercial |
$1,822.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PHP Commercial |
$1,721.34
|
| Rate for Payer: Priority Health SBD |
$1,275.81
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$2,015.23
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$655.68
|
| Rate for Payer: BCN Commercial |
$655.68
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Advantage |
$1,410.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,269.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.90
|
| Rate for Payer: UHC Core |
$1,049.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$791.99
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$2,015.23
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,269.59 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.90
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Advantage |
$1,410.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: Priority Health SBD |
$1,269.59
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,792.32
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,129.16 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Commercial |
$1,523.47
|
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,883.05
|
| Rate for Payer: BCN Commercial |
$2,883.05
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cofinity Advantage |
$1,254.62
|
| Rate for Payer: Cofinity Commercial |
$1,541.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Healthscope Commercial |
$1,613.09
|
| Rate for Payer: Mclaren Medicaid |
$3,150.44
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.47
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.24
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Commercial |
$1,523.47
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health SBD |
$1,129.16
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
