|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
IP
|
$1,032.12
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$454.13 |
| Max. Negotiated Rate |
$928.91 |
| Rate for Payer: Aetna American Axle |
$670.88
|
| Rate for Payer: Aetna Commercial |
$877.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.88
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cofinity Commercial |
$722.48
|
| Rate for Payer: Cofinity Commercial |
$887.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$722.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.70
|
| Rate for Payer: Healthscope Commercial |
$928.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$722.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.30
|
| Rate for Payer: PHP Commercial |
$877.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.88
|
| Rate for Payer: Priority Health SBD |
$650.24
|
| Rate for Payer: UMR Bronson Commercial |
$454.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.09
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
IP
|
$1,219.18
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$536.44 |
| Max. Negotiated Rate |
$1,097.26 |
| Rate for Payer: Aetna American Axle |
$792.47
|
| Rate for Payer: Aetna Commercial |
$1,036.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.47
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,048.49
|
| Rate for Payer: Cofinity Commercial |
$853.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$853.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Healthscope Commercial |
$1,097.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$853.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: PHP Commercial |
$1,036.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: Priority Health SBD |
$768.08
|
| Rate for Payer: UMR Bronson Commercial |
$536.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.38
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
OP
|
$1,219.18
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna American Axle |
$792.47
|
| Rate for Payer: Aetna Commercial |
$1,036.30
|
| Rate for Payer: Aetna Medicare |
$409.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$309.25
|
| Rate for Payer: BCN Commercial |
$309.25
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$853.43
|
| Rate for Payer: Cofinity Commercial |
$1,048.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$853.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,097.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$853.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$1,181.10
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$1,036.30
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.41
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$989.93
|
| Rate for Payer: Priority Health SBD |
$768.08
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.77
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$167.06
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: UMR Bronson Commercial |
$451.10
|
| Rate for Payer: VA VA |
$393.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.38
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$342.19 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna American Axle |
$505.51
|
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: UMR Bronson Commercial |
$342.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna American Axle |
$505.51
|
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$228.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$108.10
|
| Rate for Payer: BCN Commercial |
$108.10
|
| Rate for Payer: BCN Medicare Advantage |
$219.60
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$117.71
|
| Rate for Payer: Mclaren Medicare |
$219.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.58
|
| Rate for Payer: Meridian Medicaid |
$123.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$658.80
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$219.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.18
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$552.14
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.83
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$122.57
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: UMR Bronson Commercial |
$287.75
|
| Rate for Payer: VA VA |
$219.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$110.15 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna American Axle |
$505.51
|
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$228.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$110.15
|
| Rate for Payer: BCN Commercial |
$110.15
|
| Rate for Payer: BCN Medicare Advantage |
$219.60
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$117.71
|
| Rate for Payer: Mclaren Medicare |
$219.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.58
|
| Rate for Payer: Meridian Medicaid |
$123.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$658.80
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$219.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.18
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$552.14
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.19
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$136.54
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: UMR Bronson Commercial |
$287.75
|
| Rate for Payer: VA VA |
$219.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$342.19 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna American Axle |
$505.51
|
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: UMR Bronson Commercial |
$342.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$342.19 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna American Axle |
$505.51
|
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: UMR Bronson Commercial |
$342.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$105.36 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna American Axle |
$505.51
|
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$228.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$105.36
|
| Rate for Payer: BCN Commercial |
$105.36
|
| Rate for Payer: BCN Medicare Advantage |
$219.60
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Cofinity Commercial |
$544.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$117.71
|
| Rate for Payer: Mclaren Medicare |
$219.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.58
|
| Rate for Payer: Meridian Medicaid |
$123.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$658.80
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$219.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.18
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$552.14
|
| Rate for Payer: Priority Health SBD |
$489.96
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.20
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$125.64
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: UMR Bronson Commercial |
$287.75
|
| Rate for Payer: VA VA |
$219.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
IP
|
$1,360.85
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$598.77 |
| Max. Negotiated Rate |
$1,224.76 |
| Rate for Payer: Aetna American Axle |
$884.55
|
| Rate for Payer: Aetna Commercial |
$1,156.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.55
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$1,170.33
|
| Rate for Payer: Cofinity Commercial |
$952.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$952.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Healthscope Commercial |
$1,224.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$952.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: PHP Commercial |
$1,156.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: Priority Health SBD |
$857.34
|
| Rate for Payer: UMR Bronson Commercial |
$598.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.64
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
OP
|
$1,360.85
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna American Axle |
$884.55
|
| Rate for Payer: Aetna Commercial |
$1,156.72
|
| Rate for Payer: Aetna Medicare |
$409.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$283.25
|
| Rate for Payer: BCN Commercial |
$283.25
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$952.60
|
| Rate for Payer: Cofinity Commercial |
$1,170.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$952.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,224.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$952.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.64
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: Nomi Health Commercial |
$1,181.10
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$1,156.72
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.41
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$989.93
|
| Rate for Payer: Priority Health SBD |
$857.34
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.87
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$143.52
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: UMR Bronson Commercial |
$503.51
|
| Rate for Payer: VA VA |
$393.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.64
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
OP
|
$1,326.66
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$195.89 |
| Max. Negotiated Rate |
$1,657.56 |
| Rate for Payer: Aetna American Axle |
$862.33
|
| Rate for Payer: Aetna Commercial |
$1,127.66
|
| Rate for Payer: Aetna Medicare |
$548.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$352.35
|
| Rate for Payer: BCN Commercial |
$352.35
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cofinity Commercial |
$928.66
|
| Rate for Payer: Cofinity Commercial |
$1,140.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$928.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,193.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$928.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.00
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.66
|
| Rate for Payer: Nomi Health Commercial |
$1,582.17
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$1,127.66
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,657.56
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,326.05
|
| Rate for Payer: Priority Health SBD |
$835.80
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.48
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$195.89
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: UMR Bronson Commercial |
$490.86
|
| Rate for Payer: VA VA |
$527.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.00
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
IP
|
$1,326.66
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$583.73 |
| Max. Negotiated Rate |
$1,193.99 |
| Rate for Payer: Aetna American Axle |
$862.33
|
| Rate for Payer: Aetna Commercial |
$1,127.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.33
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cofinity Commercial |
$1,140.93
|
| Rate for Payer: Cofinity Commercial |
$928.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$928.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.33
|
| Rate for Payer: Healthscope Commercial |
$1,193.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$928.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.66
|
| Rate for Payer: PHP Commercial |
$1,127.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.33
|
| Rate for Payer: Priority Health SBD |
$835.80
|
| Rate for Payer: UMR Bronson Commercial |
$583.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.00
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
IP
|
$1,684.15
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$741.03 |
| Max. Negotiated Rate |
$1,515.74 |
| Rate for Payer: Aetna American Axle |
$1,094.70
|
| Rate for Payer: Aetna Commercial |
$1,431.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.70
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,178.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,178.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.32
|
| Rate for Payer: Healthscope Commercial |
$1,515.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,178.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.53
|
| Rate for Payer: PHP Commercial |
$1,431.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.70
|
| Rate for Payer: Priority Health SBD |
$1,061.01
|
| Rate for Payer: UMR Bronson Commercial |
$741.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.11
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
OP
|
$1,684.15
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.99 |
| Max. Negotiated Rate |
$1,657.56 |
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: Aetna American Axle |
$1,094.70
|
| Rate for Payer: Aetna Commercial |
$1,431.53
|
| Rate for Payer: Aetna Medicare |
$548.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$246.31
|
| Rate for Payer: BCN Commercial |
$246.31
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,448.37
|
| Rate for Payer: Cofinity Commercial |
$1,178.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,178.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,515.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,178.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.11
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.53
|
| Rate for Payer: Nomi Health Commercial |
$1,582.17
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$1,431.53
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,657.56
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,326.05
|
| Rate for Payer: Priority Health SBD |
$1,061.01
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Exchange |
$160.99
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: UMR Bronson Commercial |
$623.14
|
| Rate for Payer: VA VA |
$527.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.11
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
OP
|
$801.11
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.92 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna American Axle |
$520.72
|
| Rate for Payer: Aetna Commercial |
$680.94
|
| Rate for Payer: Aetna Medicare |
$409.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$146.62
|
| Rate for Payer: BCN Commercial |
$146.62
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cofinity Commercial |
$560.78
|
| Rate for Payer: Cofinity Commercial |
$688.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$560.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$721.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.83
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.94
|
| Rate for Payer: Nomi Health Commercial |
$1,181.10
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$680.94
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.41
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$989.93
|
| Rate for Payer: Priority Health SBD |
$504.70
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.01
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$30.92
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: UMR Bronson Commercial |
$296.41
|
| Rate for Payer: VA VA |
$393.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.83
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
IP
|
$801.11
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$352.49 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna American Axle |
$520.72
|
| Rate for Payer: Aetna Commercial |
$680.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.72
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cofinity Commercial |
$560.78
|
| Rate for Payer: Cofinity Commercial |
$688.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$560.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.89
|
| Rate for Payer: Healthscope Commercial |
$721.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.94
|
| Rate for Payer: PHP Commercial |
$680.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.72
|
| Rate for Payer: Priority Health SBD |
$504.70
|
| Rate for Payer: UMR Bronson Commercial |
$352.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.83
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
IP
|
$991.36
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.20 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna American Axle |
$644.38
|
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.38
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$693.95
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health SBD |
$624.56
|
| Rate for Payer: UMR Bronson Commercial |
$436.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.52
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
OP
|
$991.36
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.92 |
| Max. Negotiated Rate |
$1,237.41 |
| Rate for Payer: Aetna American Axle |
$644.38
|
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: Aetna Medicare |
$409.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$146.62
|
| Rate for Payer: BCN Commercial |
$146.62
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$693.95
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.52
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$1,181.10
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.41
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$989.93
|
| Rate for Payer: Priority Health SBD |
$624.56
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.01
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$30.92
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: UMR Bronson Commercial |
$366.80
|
| Rate for Payer: VA VA |
$393.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.52
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$487.06 |
| Max. Negotiated Rate |
$996.26 |
| Rate for Payer: Aetna American Axle |
$719.52
|
| Rate for Payer: Aetna Commercial |
$940.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.52
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$774.87
|
| Rate for Payer: Cofinity Commercial |
$951.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$774.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$996.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$774.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: PHP Commercial |
$940.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: Priority Health SBD |
$697.38
|
| Rate for Payer: UMR Bronson Commercial |
$487.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.22
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$409.58 |
| Max. Negotiated Rate |
$996.26 |
| Rate for Payer: Aetna American Axle |
$719.52
|
| Rate for Payer: Aetna Commercial |
$940.92
|
| Rate for Payer: Aetna Medicare |
$553.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.52
|
| Rate for Payer: BCBS Complete |
$442.78
|
| Rate for Payer: BCBS Trust/PPO |
$638.45
|
| Rate for Payer: BCN Commercial |
$638.45
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$774.87
|
| Rate for Payer: Cofinity Commercial |
$951.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$774.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$996.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$774.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: PHP Commercial |
$940.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: Priority Health SBD |
$697.38
|
| Rate for Payer: UMR Bronson Commercial |
$409.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.22
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$555.91 |
| Max. Negotiated Rate |
$1,137.10 |
| Rate for Payer: Aetna American Axle |
$821.24
|
| Rate for Payer: Aetna Commercial |
$1,073.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.24
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,086.56
|
| Rate for Payer: Cofinity Commercial |
$884.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$884.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Healthscope Commercial |
$1,137.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$884.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: PHP Commercial |
$1,073.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: Priority Health SBD |
$795.97
|
| Rate for Payer: UMR Bronson Commercial |
$555.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.58
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.34 |
| Max. Negotiated Rate |
$1,657.56 |
| Rate for Payer: Aetna American Axle |
$821.24
|
| Rate for Payer: Aetna Commercial |
$1,073.92
|
| Rate for Payer: Aetna Medicare |
$548.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$504.92
|
| Rate for Payer: BCN Commercial |
$504.92
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$884.41
|
| Rate for Payer: Cofinity Commercial |
$1,086.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$884.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,137.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$884.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.58
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,582.17
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$1,073.92
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,657.56
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,326.05
|
| Rate for Payer: Priority Health SBD |
$795.97
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.07
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$257.34
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: UMR Bronson Commercial |
$467.47
|
| Rate for Payer: VA VA |
$527.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.58
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$873.57 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna American Axle |
$1,290.50
|
| Rate for Payer: Aetna Commercial |
$1,687.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,290.50
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,389.77
|
| Rate for Payer: Cofinity Commercial |
$1,707.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,389.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,389.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: PHP Commercial |
$1,687.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: Priority Health SBD |
$1,250.80
|
| Rate for Payer: UMR Bronson Commercial |
$873.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.04
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$589.13 |
| Max. Negotiated Rate |
$4,020.13 |
| Rate for Payer: Aetna American Axle |
$1,290.50
|
| Rate for Payer: Aetna Commercial |
$1,687.58
|
| Rate for Payer: Aetna Medicare |
$1,330.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,290.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.48
|
| Rate for Payer: BCN Commercial |
$1,164.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,707.44
|
| Rate for Payer: Cofinity Commercial |
$1,389.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,389.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,389.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.04
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$3,837.24
|
| Rate for Payer: PACE Medicare |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$1,687.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,020.13
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,216.10
|
| Rate for Payer: Priority Health SBD |
$1,250.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.04
|
| Rate for Payer: UHC Core |
$832.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$589.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: UMR Bronson Commercial |
$734.59
|
| Rate for Payer: VA VA |
$1,279.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.04
|
|
