|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
OP
|
$1,243.56
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$1,119.20 |
| Rate for Payer: Aetna Commercial |
$1,057.03
|
| Rate for Payer: Aetna Medicare |
$323.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$388.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$388.61
|
| Rate for Payer: BCBS Complete |
$230.18
|
| Rate for Payer: BCBS MAPPO |
$310.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.33
|
| Rate for Payer: BCN Commercial |
$1,022.33
|
| Rate for Payer: BCN Medicare Advantage |
$310.89
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Commercial |
$1,069.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.89
|
| Rate for Payer: Healthscope Commercial |
$1,119.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.67
|
| Rate for Payer: Mclaren Medicaid |
$219.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.43
|
| Rate for Payer: Meridian Medicaid |
$230.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$341.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.03
|
| Rate for Payer: Nomi Health Commercial |
$1,019.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.67
|
| Rate for Payer: PACE Senior Care Partners |
$295.35
|
| Rate for Payer: PACE SWMI |
$310.89
|
| Rate for Payer: PHP Commercial |
$1,057.03
|
| Rate for Payer: PHP Medicare Advantage |
$310.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,081.90
|
| Rate for Payer: Priority Health Medicare |
$314.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$865.52
|
| Rate for Payer: Railroad Medicare Medicare |
$310.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,094.33
|
| Rate for Payer: UHC Core |
$1,038.37
|
| Rate for Payer: UHC Exchange |
$310.89
|
| Rate for Payer: UHC Medicaid |
$219.24
|
| Rate for Payer: UHC Medicare Advantage |
$310.89
|
| Rate for Payer: UHCCP Medicaid |
$219.24
|
| Rate for Payer: VA VA |
$310.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.67
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$552.11 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: BCBS Trust/PPO |
$655.15
|
| Rate for Payer: BCN Commercial |
$655.15
|
| Rate for Payer: Cash Price |
$634.61
|
| 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: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$206.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.89
|
| Rate for Payer: BCBS Complete |
$146.83
|
| Rate for Payer: BCBS MAPPO |
$198.31
|
| Rate for Payer: BCBS Trust/PPO |
$652.14
|
| Rate for Payer: BCN Commercial |
$652.14
|
| Rate for Payer: BCN Medicare Advantage |
$198.31
|
| Rate for Payer: Cash Price |
$634.61
|
| 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 |
$198.31
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Mclaren Medicaid |
$139.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.23
|
| Rate for Payer: Meridian Medicaid |
$146.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Senior Care Partners |
$188.40
|
| Rate for Payer: PACE SWMI |
$198.31
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$198.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Medicare |
$200.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: Railroad Medicare Medicare |
$198.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: UHC Exchange |
$198.31
|
| Rate for Payer: UHC Medicaid |
$139.85
|
| Rate for Payer: UHC Medicare Advantage |
$198.31
|
| Rate for Payer: UHCCP Medicaid |
$139.85
|
| Rate for Payer: VA VA |
$198.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$206.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.89
|
| Rate for Payer: BCBS Complete |
$146.83
|
| Rate for Payer: BCBS MAPPO |
$198.31
|
| Rate for Payer: BCBS Trust/PPO |
$652.14
|
| Rate for Payer: BCN Commercial |
$652.14
|
| Rate for Payer: BCN Medicare Advantage |
$198.31
|
| Rate for Payer: Cash Price |
$634.61
|
| 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 |
$198.31
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Mclaren Medicaid |
$139.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.23
|
| Rate for Payer: Meridian Medicaid |
$146.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Senior Care Partners |
$188.40
|
| Rate for Payer: PACE SWMI |
$198.31
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$198.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Medicare |
$200.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: Railroad Medicare Medicare |
$198.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: UHC Exchange |
$198.31
|
| Rate for Payer: UHC Medicaid |
$139.85
|
| Rate for Payer: UHC Medicare Advantage |
$198.31
|
| Rate for Payer: UHCCP Medicaid |
$139.85
|
| Rate for Payer: VA VA |
$198.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$552.11 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: BCBS Trust/PPO |
$655.15
|
| Rate for Payer: BCN Commercial |
$655.15
|
| Rate for Payer: Cash Price |
$634.61
|
| 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: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$552.11 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: BCBS Trust/PPO |
$655.15
|
| Rate for Payer: BCN Commercial |
$655.15
|
| Rate for Payer: Cash Price |
$634.61
|
| 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: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$713.93 |
| Rate for Payer: Aetna Commercial |
$674.27
|
| Rate for Payer: Aetna Medicare |
$206.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.89
|
| Rate for Payer: BCBS Complete |
$146.83
|
| Rate for Payer: BCBS MAPPO |
$198.31
|
| Rate for Payer: BCBS Trust/PPO |
$652.14
|
| Rate for Payer: BCN Commercial |
$652.14
|
| Rate for Payer: BCN Medicare Advantage |
$198.31
|
| Rate for Payer: Cash Price |
$634.61
|
| 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 |
$198.31
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.95
|
| Rate for Payer: Mclaren Medicaid |
$139.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.23
|
| Rate for Payer: Meridian Medicaid |
$146.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Senior Care Partners |
$188.40
|
| Rate for Payer: PACE SWMI |
$198.31
|
| Rate for Payer: PHP Commercial |
$674.27
|
| Rate for Payer: PHP Medicare Advantage |
$198.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$690.14
|
| Rate for Payer: Priority Health Medicare |
$200.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.11
|
| Rate for Payer: Railroad Medicare Medicare |
$198.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.07
|
| Rate for Payer: UHC Core |
$662.37
|
| Rate for Payer: UHC Exchange |
$198.31
|
| Rate for Payer: UHC Medicaid |
$139.85
|
| Rate for Payer: UHC Medicare Advantage |
$198.31
|
| Rate for Payer: UHCCP Medicaid |
$139.85
|
| Rate for Payer: VA VA |
$198.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.95
|
|
|
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 |
$966.10 |
| Max. Negotiated Rate |
$1,249.26 |
| Rate for Payer: Aetna Commercial |
$1,179.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.41
|
| Rate for Payer: BCN Commercial |
$1,146.41
|
| Rate for Payer: Cash Price |
$1,110.46
|
| 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: Lakeland Regional Health Systems Commercial |
$1,041.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.86
|
| Rate for Payer: Nomi Health Commercial |
$1,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.05
|
| Rate for Payer: PHP Commercial |
$1,179.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,207.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$966.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,221.50
|
| Rate for Payer: UHC Core |
$1,159.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,041.05
|
|
|
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 |
$244.72 |
| Max. Negotiated Rate |
$1,249.26 |
| Rate for Payer: Aetna Commercial |
$1,179.86
|
| Rate for Payer: Aetna Medicare |
$360.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$433.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$433.77
|
| Rate for Payer: BCBS Complete |
$256.93
|
| Rate for Payer: BCBS MAPPO |
$347.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.13
|
| Rate for Payer: BCN Commercial |
$1,141.13
|
| Rate for Payer: BCN Medicare Advantage |
$347.02
|
| Rate for Payer: Cash Price |
$1,110.46
|
| 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 |
$347.02
|
| Rate for Payer: Healthscope Commercial |
$1,249.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,041.05
|
| Rate for Payer: Mclaren Medicaid |
$244.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.37
|
| Rate for Payer: Meridian Medicaid |
$256.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$381.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.86
|
| Rate for Payer: Nomi Health Commercial |
$1,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.05
|
| Rate for Payer: PACE Senior Care Partners |
$329.67
|
| Rate for Payer: PACE SWMI |
$347.02
|
| Rate for Payer: PHP Commercial |
$1,179.86
|
| Rate for Payer: PHP Medicare Advantage |
$347.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,207.62
|
| Rate for Payer: Priority Health Medicare |
$350.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$966.10
|
| Rate for Payer: Railroad Medicare Medicare |
$347.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,221.50
|
| Rate for Payer: UHC Core |
$1,159.04
|
| Rate for Payer: UHC Exchange |
$347.02
|
| Rate for Payer: UHC Medicaid |
$244.72
|
| Rate for Payer: UHC Medicare Advantage |
$347.02
|
| Rate for Payer: UHCCP Medicaid |
$244.72
|
| Rate for Payer: VA VA |
$347.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,041.05
|
|
|
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 |
$238.57 |
| Max. Negotiated Rate |
$1,217.87 |
| Rate for Payer: Aetna Commercial |
$1,150.21
|
| Rate for Payer: Aetna Medicare |
$351.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.87
|
| Rate for Payer: BCBS Complete |
$250.48
|
| Rate for Payer: BCBS MAPPO |
$338.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.46
|
| Rate for Payer: BCN Commercial |
$1,112.46
|
| Rate for Payer: BCN Medicare Advantage |
$338.30
|
| Rate for Payer: Cash Price |
$1,082.55
|
| 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 |
$338.30
|
| Rate for Payer: Healthscope Commercial |
$1,217.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,014.89
|
| Rate for Payer: Mclaren Medicaid |
$238.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.21
|
| Rate for Payer: Meridian Medicaid |
$250.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$372.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.21
|
| Rate for Payer: Nomi Health Commercial |
$1,109.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.89
|
| Rate for Payer: PACE Senior Care Partners |
$321.38
|
| Rate for Payer: PACE SWMI |
$338.30
|
| Rate for Payer: PHP Commercial |
$1,150.21
|
| Rate for Payer: PHP Medicare Advantage |
$338.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,177.28
|
| Rate for Payer: Priority Health Medicare |
$341.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.82
|
| Rate for Payer: Railroad Medicare Medicare |
$338.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.81
|
| Rate for Payer: UHC Core |
$1,129.91
|
| Rate for Payer: UHC Exchange |
$338.30
|
| Rate for Payer: UHC Medicaid |
$238.57
|
| Rate for Payer: UHC Medicare Advantage |
$338.30
|
| Rate for Payer: UHCCP Medicaid |
$238.57
|
| Rate for Payer: VA VA |
$338.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.89
|
|
|
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 |
$941.82 |
| Max. Negotiated Rate |
$1,217.87 |
| Rate for Payer: Aetna Commercial |
$1,150.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.60
|
| Rate for Payer: BCN Commercial |
$1,117.60
|
| Rate for Payer: Cash Price |
$1,082.55
|
| 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: Lakeland Regional Health Systems Commercial |
$1,014.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.21
|
| Rate for Payer: Nomi Health Commercial |
$1,109.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.89
|
| Rate for Payer: PHP Commercial |
$1,150.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,177.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.81
|
| Rate for Payer: UHC Core |
$1,129.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.89
|
|
|
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 |
$1,195.61 |
| Max. Negotiated Rate |
$1,546.05 |
| Rate for Payer: Aetna Commercial |
$1,460.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,418.76
|
| Rate for Payer: BCN Commercial |
$1,418.76
|
| Rate for Payer: Cash Price |
$1,374.26
|
| 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: Lakeland Regional Health Systems Commercial |
$1,288.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,460.16
|
| Rate for Payer: Nomi Health Commercial |
$1,408.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,288.37
|
| Rate for Payer: PHP Commercial |
$1,460.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,494.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,195.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,511.69
|
| Rate for Payer: UHC Core |
$1,434.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,288.37
|
|
|
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 |
$302.85 |
| Max. Negotiated Rate |
$1,546.05 |
| Rate for Payer: Aetna Commercial |
$1,460.16
|
| Rate for Payer: Aetna Medicare |
$446.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$536.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$536.82
|
| Rate for Payer: BCBS Complete |
$317.97
|
| Rate for Payer: BCBS MAPPO |
$429.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.23
|
| Rate for Payer: BCN Commercial |
$1,412.23
|
| Rate for Payer: BCN Medicare Advantage |
$429.46
|
| Rate for Payer: Cash Price |
$1,374.26
|
| 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 |
$429.46
|
| Rate for Payer: Healthscope Commercial |
$1,546.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,288.37
|
| Rate for Payer: Mclaren Medicaid |
$302.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$450.93
|
| Rate for Payer: Meridian Medicaid |
$317.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$472.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,460.16
|
| Rate for Payer: Nomi Health Commercial |
$1,408.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,288.37
|
| Rate for Payer: PACE Senior Care Partners |
$407.98
|
| Rate for Payer: PACE SWMI |
$429.46
|
| Rate for Payer: PHP Commercial |
$1,460.16
|
| Rate for Payer: PHP Medicare Advantage |
$429.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,494.51
|
| Rate for Payer: Priority Health Medicare |
$433.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,195.61
|
| Rate for Payer: Railroad Medicare Medicare |
$429.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,511.69
|
| Rate for Payer: UHC Core |
$1,434.39
|
| Rate for Payer: UHC Exchange |
$429.46
|
| Rate for Payer: UHC Medicaid |
$302.85
|
| Rate for Payer: UHC Medicare Advantage |
$429.46
|
| Rate for Payer: UHCCP Medicaid |
$302.85
|
| Rate for Payer: VA VA |
$429.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,288.37
|
|
|
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 |
$568.72 |
| Max. Negotiated Rate |
$735.42 |
| Rate for Payer: Aetna Commercial |
$694.56
|
| Rate for Payer: BCBS Trust/PPO |
$674.87
|
| Rate for Payer: BCN Commercial |
$674.87
|
| Rate for Payer: Cash Price |
$653.70
|
| 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: Lakeland Regional Health Systems Commercial |
$612.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.56
|
| Rate for Payer: Nomi Health Commercial |
$670.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.85
|
| Rate for Payer: PHP Commercial |
$694.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$710.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$568.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.07
|
| Rate for Payer: UHC Core |
$682.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.85
|
|
|
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 |
$144.06 |
| Max. Negotiated Rate |
$735.42 |
| Rate for Payer: Aetna Commercial |
$694.56
|
| Rate for Payer: Aetna Medicare |
$212.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.35
|
| Rate for Payer: BCBS Complete |
$151.25
|
| Rate for Payer: BCBS MAPPO |
$204.28
|
| Rate for Payer: BCBS Trust/PPO |
$671.76
|
| Rate for Payer: BCN Commercial |
$671.76
|
| Rate for Payer: BCN Medicare Advantage |
$204.28
|
| Rate for Payer: Cash Price |
$653.70
|
| 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 |
$204.28
|
| Rate for Payer: Healthscope Commercial |
$735.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.85
|
| Rate for Payer: Mclaren Medicaid |
$144.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.50
|
| Rate for Payer: Meridian Medicaid |
$151.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$224.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.56
|
| Rate for Payer: Nomi Health Commercial |
$670.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.85
|
| Rate for Payer: PACE Senior Care Partners |
$194.07
|
| Rate for Payer: PACE SWMI |
$204.28
|
| Rate for Payer: PHP Commercial |
$694.56
|
| Rate for Payer: PHP Medicare Advantage |
$204.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$710.90
|
| Rate for Payer: Priority Health Medicare |
$206.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$568.72
|
| Rate for Payer: Railroad Medicare Medicare |
$204.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.07
|
| Rate for Payer: UHC Core |
$682.30
|
| Rate for Payer: UHC Exchange |
$204.28
|
| Rate for Payer: UHC Medicaid |
$144.06
|
| Rate for Payer: UHC Medicare Advantage |
$204.28
|
| Rate for Payer: UHCCP Medicaid |
$144.06
|
| Rate for Payer: VA VA |
$204.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.85
|
|
|
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 |
$178.27 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: Aetna Medicare |
$262.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$316.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$316.00
|
| Rate for Payer: BCBS Complete |
$187.17
|
| Rate for Payer: BCBS MAPPO |
$252.80
|
| Rate for Payer: BCBS Trust/PPO |
$831.30
|
| Rate for Payer: BCN Commercial |
$831.30
|
| Rate for Payer: BCN Medicare Advantage |
$252.80
|
| Rate for Payer: Cash Price |
$808.95
|
| 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 |
$252.80
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.39
|
| Rate for Payer: Mclaren Medicaid |
$178.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.44
|
| Rate for Payer: Meridian Medicaid |
$187.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$278.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PACE Senior Care Partners |
$240.16
|
| Rate for Payer: PACE SWMI |
$252.80
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: PHP Medicare Advantage |
$252.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$879.74
|
| Rate for Payer: Priority Health Medicare |
$255.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$703.79
|
| Rate for Payer: Railroad Medicare Medicare |
$252.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.85
|
| Rate for Payer: UHC Core |
$844.34
|
| Rate for Payer: UHC Exchange |
$252.80
|
| Rate for Payer: UHC Medicaid |
$178.27
|
| Rate for Payer: UHC Medicare Advantage |
$252.80
|
| Rate for Payer: UHCCP Medicaid |
$178.27
|
| Rate for Payer: VA VA |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.39
|
|
|
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 |
$703.79 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: BCBS Trust/PPO |
$835.14
|
| Rate for Payer: BCN Commercial |
$835.14
|
| Rate for Payer: Cash Price |
$808.95
|
| 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: Lakeland Regional Health Systems Commercial |
$758.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$879.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$703.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.85
|
| Rate for Payer: UHC Core |
$844.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.39
|
|
|
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 |
$199.06 |
| Max. Negotiated Rate |
$1,016.19 |
| Rate for Payer: Aetna Commercial |
$959.74
|
| Rate for Payer: Aetna Medicare |
$293.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$352.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$352.84
|
| Rate for Payer: BCBS Complete |
$209.00
|
| Rate for Payer: BCBS MAPPO |
$282.27
|
| Rate for Payer: BCBS Trust/PPO |
$928.23
|
| Rate for Payer: BCN Commercial |
$928.23
|
| Rate for Payer: BCN Medicare Advantage |
$282.27
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cofinity Commercial |
$971.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.27
|
| Rate for Payer: Healthscope Commercial |
$1,016.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.83
|
| Rate for Payer: Mclaren Medicaid |
$199.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.39
|
| Rate for Payer: Meridian Medicaid |
$209.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$310.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Nomi Health Commercial |
$925.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: PACE Senior Care Partners |
$268.16
|
| Rate for Payer: PACE SWMI |
$282.27
|
| Rate for Payer: PHP Commercial |
$959.74
|
| Rate for Payer: PHP Medicare Advantage |
$282.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$982.32
|
| Rate for Payer: Priority Health Medicare |
$285.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$785.85
|
| Rate for Payer: Railroad Medicare Medicare |
$282.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.61
|
| Rate for Payer: UHC Core |
$942.80
|
| Rate for Payer: UHC Exchange |
$282.27
|
| Rate for Payer: UHC Medicaid |
$199.06
|
| Rate for Payer: UHC Medicare Advantage |
$282.27
|
| Rate for Payer: UHCCP Medicaid |
$199.06
|
| Rate for Payer: VA VA |
$282.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.83
|
|
|
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 |
$785.85 |
| Max. Negotiated Rate |
$1,016.19 |
| Rate for Payer: Aetna Commercial |
$959.74
|
| Rate for Payer: BCBS Trust/PPO |
$932.52
|
| Rate for Payer: BCN Commercial |
$932.52
|
| Rate for Payer: Cash Price |
$903.28
|
| 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: Lakeland Regional Health Systems Commercial |
$846.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Nomi Health Commercial |
$925.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: PHP Commercial |
$959.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$982.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$785.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.61
|
| Rate for Payer: UHC Core |
$942.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.83
|
|
|
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 |
$227.20 |
| Max. Negotiated Rate |
$1,159.84 |
| Rate for Payer: Aetna Commercial |
$1,095.40
|
| Rate for Payer: Aetna Medicare |
$335.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$402.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$402.72
|
| Rate for Payer: BCBS Complete |
$238.54
|
| Rate for Payer: BCBS MAPPO |
$322.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.45
|
| Rate for Payer: BCN Commercial |
$1,059.45
|
| Rate for Payer: BCN Medicare Advantage |
$322.18
|
| Rate for Payer: Cash Price |
$1,030.97
|
| 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 |
$322.18
|
| Rate for Payer: Healthscope Commercial |
$1,159.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.53
|
| Rate for Payer: Mclaren Medicaid |
$227.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.29
|
| Rate for Payer: Meridian Medicaid |
$238.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$354.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Nomi Health Commercial |
$1,056.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PACE Senior Care Partners |
$306.07
|
| Rate for Payer: PACE SWMI |
$322.18
|
| Rate for Payer: PHP Commercial |
$1,095.40
|
| Rate for Payer: PHP Medicare Advantage |
$322.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,121.18
|
| Rate for Payer: Priority Health Medicare |
$325.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$896.94
|
| Rate for Payer: Railroad Medicare Medicare |
$322.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.06
|
| Rate for Payer: UHC Core |
$1,076.07
|
| Rate for Payer: UHC Exchange |
$322.18
|
| Rate for Payer: UHC Medicaid |
$227.20
|
| Rate for Payer: UHC Medicare Advantage |
$322.18
|
| Rate for Payer: UHCCP Medicaid |
$227.20
|
| Rate for Payer: VA VA |
$322.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.53
|
|
|
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 |
$896.94 |
| Max. Negotiated Rate |
$1,159.84 |
| Rate for Payer: Aetna Commercial |
$1,095.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,064.35
|
| Rate for Payer: BCN Commercial |
$1,064.35
|
| Rate for Payer: Cash Price |
$1,030.97
|
| 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: Lakeland Regional Health Systems Commercial |
$966.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Nomi Health Commercial |
$1,056.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PHP Commercial |
$1,095.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,121.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$896.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.06
|
| Rate for Payer: UHC Core |
$1,076.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.53
|
|
|
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 |
$357.03 |
| Max. Negotiated Rate |
$1,822.59 |
| Rate for Payer: Aetna Commercial |
$1,721.34
|
| Rate for Payer: Aetna Medicare |
$526.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$632.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$632.84
|
| Rate for Payer: BCBS Complete |
$374.85
|
| Rate for Payer: BCBS MAPPO |
$506.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.83
|
| Rate for Payer: BCN Commercial |
$1,664.83
|
| Rate for Payer: BCN Medicare Advantage |
$506.27
|
| Rate for Payer: Cash Price |
$1,620.08
|
| 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 |
$506.27
|
| Rate for Payer: Healthscope Commercial |
$1,822.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.83
|
| Rate for Payer: Mclaren Medicaid |
$357.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.59
|
| Rate for Payer: Meridian Medicaid |
$374.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$582.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$556.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Nomi Health Commercial |
$1,660.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PACE Senior Care Partners |
$480.96
|
| Rate for Payer: PACE SWMI |
$506.27
|
| Rate for Payer: PHP Commercial |
$1,721.34
|
| Rate for Payer: PHP Medicare Advantage |
$506.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,761.84
|
| Rate for Payer: Priority Health Medicare |
$511.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,409.47
|
| Rate for Payer: Railroad Medicare Medicare |
$506.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,782.09
|
| Rate for Payer: UHC Core |
$1,690.96
|
| Rate for Payer: UHC Exchange |
$506.27
|
| Rate for Payer: UHC Medicaid |
$357.03
|
| Rate for Payer: UHC Medicare Advantage |
$506.27
|
| Rate for Payer: UHCCP Medicaid |
$357.03
|
| Rate for Payer: VA VA |
$506.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.83
|
|
|
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 |
$1,409.47 |
| Max. Negotiated Rate |
$1,822.59 |
| Rate for Payer: Aetna Commercial |
$1,721.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.53
|
| Rate for Payer: BCN Commercial |
$1,672.53
|
| Rate for Payer: Cash Price |
$1,620.08
|
| 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: Lakeland Regional Health Systems Commercial |
$1,518.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Nomi Health Commercial |
$1,660.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PHP Commercial |
$1,721.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,761.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,409.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,782.09
|
| Rate for Payer: UHC Core |
$1,690.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.83
|
|
|
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 |
$1,402.60 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.38
|
| Rate for Payer: BCN Commercial |
$1,664.38
|
| Rate for Payer: Cash Price |
$1,612.18
|
| 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: Lakeland Regional Health Systems Commercial |
$1,511.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,652.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,753.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,402.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.40
|
| Rate for Payer: UHC Core |
$1,682.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.42
|
|
|
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 |
$355.29 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna Medicare |
$523.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$629.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$629.76
|
| Rate for Payer: BCBS Complete |
$373.02
|
| Rate for Payer: BCBS MAPPO |
$503.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.72
|
| Rate for Payer: BCN Commercial |
$1,656.72
|
| Rate for Payer: BCN Medicare Advantage |
$503.81
|
| Rate for Payer: Cash Price |
$1,612.18
|
| 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 |
$503.81
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.42
|
| Rate for Payer: Mclaren Medicaid |
$355.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$529.00
|
| Rate for Payer: Meridian Medicaid |
$373.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$554.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,652.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PACE Senior Care Partners |
$478.62
|
| Rate for Payer: PACE SWMI |
$503.81
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: PHP Medicare Advantage |
$503.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,753.25
|
| Rate for Payer: Priority Health Medicare |
$508.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,402.60
|
| Rate for Payer: Railroad Medicare Medicare |
$503.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,773.40
|
| Rate for Payer: UHC Core |
$1,682.72
|
| Rate for Payer: UHC Exchange |
$503.81
|
| Rate for Payer: UHC Medicaid |
$355.29
|
| Rate for Payer: UHC Medicare Advantage |
$503.81
|
| Rate for Payer: UHCCP Medicaid |
$355.29
|
| Rate for Payer: VA VA |
$503.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.42
|
|
