|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
OP
|
$358.94
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$358.94 |
| Rate for Payer: Aetna Commercial |
$323.05
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$348.17
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$295.95
|
| Rate for Payer: BCN Commercial |
$295.95
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Cofinity Commercial |
$337.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$348.17
|
| Rate for Payer: Healthscope Whirlpool |
$358.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$323.05
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.10
|
| Rate for Payer: Nomi Health Commercial |
$294.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.20
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
OP
|
$357.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$357.90 |
| Rate for Payer: Aetna Commercial |
$322.11
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$347.16
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$295.09
|
| Rate for Payer: BCN Commercial |
$295.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$286.32
|
| Rate for Payer: Cash Price |
$286.32
|
| Rate for Payer: Cofinity Commercial |
$336.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$347.16
|
| Rate for Payer: Healthscope Whirlpool |
$357.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$322.11
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.21
|
| Rate for Payer: Nomi Health Commercial |
$293.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.43
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
IP
|
$357.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$268.43 |
| Max. Negotiated Rate |
$357.90 |
| Rate for Payer: Aetna Commercial |
$322.11
|
| Rate for Payer: ASR ASR |
$347.16
|
| Rate for Payer: BCBS Trust/PPO |
$293.91
|
| Rate for Payer: BCN Commercial |
$293.91
|
| Rate for Payer: Cash Price |
$286.32
|
| Rate for Payer: Cofinity Commercial |
$336.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.32
|
| Rate for Payer: Healthscope Commercial |
$347.16
|
| Rate for Payer: Healthscope Whirlpool |
$357.90
|
| Rate for Payer: Mclaren Commercial |
$322.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.21
|
| Rate for Payer: Nomi Health Commercial |
$293.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.95
|
|
|
HC NM PARATHYROID SCAN
|
Facility
|
IP
|
$937.08
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
34100007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$702.81 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$843.37
|
| Rate for Payer: ASR ASR |
$908.97
|
| Rate for Payer: BCBS Trust/PPO |
$769.53
|
| Rate for Payer: BCN Commercial |
$769.53
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$880.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Healthscope Commercial |
$908.97
|
| Rate for Payer: Healthscope Whirlpool |
$937.08
|
| Rate for Payer: Mclaren Commercial |
$843.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$768.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.63
|
|
|
HC NM PARATHYROID SCAN
|
Facility
|
OP
|
$937.08
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
34100007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,006.58 |
| Rate for Payer: Aetna Commercial |
$843.37
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$908.97
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$772.62
|
| Rate for Payer: BCN Commercial |
$772.62
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$880.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$908.97
|
| Rate for Payer: Healthscope Whirlpool |
$937.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$843.37
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$768.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,006.58
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$805.27
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$312.27 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Trust/PPO |
$341.91
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
|
|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$617.41 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$343.29
|
| Rate for Payer: BCN Commercial |
$343.29
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$364.81
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$291.87
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
IP
|
$1,052.76
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$789.57 |
| Max. Negotiated Rate |
$1,052.76 |
| Rate for Payer: Aetna Commercial |
$947.48
|
| Rate for Payer: ASR ASR |
$1,021.18
|
| Rate for Payer: BCBS Trust/PPO |
$864.53
|
| Rate for Payer: BCN Commercial |
$864.53
|
| Rate for Payer: Cash Price |
$842.21
|
| Rate for Payer: Cofinity Commercial |
$989.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.21
|
| Rate for Payer: Healthscope Commercial |
$1,021.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.76
|
| Rate for Payer: Mclaren Commercial |
$947.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.85
|
| Rate for Payer: Nomi Health Commercial |
$863.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$926.43
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
OP
|
$1,052.76
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,052.76 |
| Rate for Payer: Aetna Commercial |
$947.48
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,021.18
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$868.00
|
| Rate for Payer: BCN Commercial |
$868.00
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$842.21
|
| Rate for Payer: Cash Price |
$842.21
|
| Rate for Payer: Cofinity Commercial |
$989.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,021.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$947.48
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.85
|
| Rate for Payer: Nomi Health Commercial |
$863.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.57
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$406.50
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$325.20
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$926.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
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 |
$208.33 |
| Max. Negotiated Rate |
$1,243.56 |
| Rate for Payer: Aetna Commercial |
$1,119.20
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,206.25
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.32
|
| Rate for Payer: BCN Commercial |
$1,025.32
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Commercial |
$1,168.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,206.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,243.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,119.20
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.03
|
| Rate for Payer: Nomi Health Commercial |
$1,019.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.67
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,089.61
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$871.74
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,094.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
IP
|
$1,243.56
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$932.67 |
| Max. Negotiated Rate |
$1,243.56 |
| Rate for Payer: Aetna Commercial |
$1,119.20
|
| Rate for Payer: ASR ASR |
$1,206.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.21
|
| Rate for Payer: BCN Commercial |
$1,021.21
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Commercial |
$1,168.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Healthscope Commercial |
$1,206.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,243.56
|
| Rate for Payer: Mclaren Commercial |
$1,119.20
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,094.33
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$793.26 |
| Rate for Payer: Aetna Commercial |
$713.93
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: ASR ASR |
$769.46
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$654.04
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$745.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$769.46
|
| Rate for Payer: Healthscope Whirlpool |
$793.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$232.50
|
| Rate for Payer: Mclaren Commercial |
$713.93
|
| Rate for Payer: Mclaren Medicaid |
$232.50
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$127.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$255.75
|
| Rate for Payer: PHP Medicaid |
$124.62
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$695.05
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health Narrow Network |
$556.08
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$360.38
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP DNSP |
$232.50
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$594.95 |
| Max. Negotiated Rate |
$793.26 |
| Rate for Payer: Aetna Commercial |
$713.93
|
| Rate for Payer: ASR ASR |
$769.46
|
| Rate for Payer: BCBS Trust/PPO |
$651.43
|
| Rate for Payer: BCN Commercial |
$651.43
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$745.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$769.46
|
| Rate for Payer: Healthscope Whirlpool |
$793.26
|
| Rate for Payer: Mclaren Commercial |
$713.93
|
| 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: UHC All Payor (Choice/PPO) + Core |
$698.07
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$594.95 |
| Max. Negotiated Rate |
$793.26 |
| Rate for Payer: Aetna Commercial |
$713.93
|
| Rate for Payer: ASR ASR |
$769.46
|
| Rate for Payer: BCBS Trust/PPO |
$651.43
|
| Rate for Payer: BCN Commercial |
$651.43
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$745.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$769.46
|
| Rate for Payer: Healthscope Whirlpool |
$793.26
|
| Rate for Payer: Mclaren Commercial |
$713.93
|
| 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: UHC All Payor (Choice/PPO) + Core |
$698.07
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$793.26 |
| Rate for Payer: Aetna Commercial |
$713.93
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: ASR ASR |
$769.46
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$654.04
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$745.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$769.46
|
| Rate for Payer: Healthscope Whirlpool |
$793.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$232.50
|
| Rate for Payer: Mclaren Commercial |
$713.93
|
| Rate for Payer: Mclaren Medicaid |
$232.50
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$127.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$255.75
|
| Rate for Payer: PHP Medicaid |
$124.62
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$695.05
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health Narrow Network |
$556.08
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$360.38
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP DNSP |
$232.50
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$793.26
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$793.26 |
| Rate for Payer: Aetna Commercial |
$713.93
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: ASR ASR |
$769.46
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$654.04
|
| Rate for Payer: BCN Commercial |
$654.04
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$745.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$769.46
|
| Rate for Payer: Healthscope Whirlpool |
$793.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$232.50
|
| Rate for Payer: Mclaren Commercial |
$713.93
|
| Rate for Payer: Mclaren Medicaid |
$232.50
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$127.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.27
|
| Rate for Payer: Nomi Health Commercial |
$650.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.95
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$255.75
|
| Rate for Payer: PHP Medicaid |
$124.62
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$542.34
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health Narrow Network |
$433.87
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$360.38
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP DNSP |
$232.50
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: VA VA |
$232.50
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$793.26
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$594.95 |
| Max. Negotiated Rate |
$793.26 |
| Rate for Payer: Aetna Commercial |
$713.93
|
| Rate for Payer: ASR ASR |
$769.46
|
| Rate for Payer: BCBS Trust/PPO |
$651.43
|
| Rate for Payer: BCN Commercial |
$651.43
|
| Rate for Payer: Cash Price |
$634.61
|
| Rate for Payer: Cofinity Commercial |
$745.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.61
|
| Rate for Payer: Healthscope Commercial |
$769.46
|
| Rate for Payer: Healthscope Whirlpool |
$793.26
|
| Rate for Payer: Mclaren Commercial |
$713.93
|
| 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: UHC All Payor (Choice/PPO) + Core |
$698.07
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
OP
|
$1,388.07
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,388.07 |
| Rate for Payer: Aetna Commercial |
$1,249.26
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,346.43
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.46
|
| Rate for Payer: BCN Commercial |
$1,144.46
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,110.46
|
| Rate for Payer: Cash Price |
$1,110.46
|
| Rate for Payer: Cofinity Commercial |
$1,304.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,346.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,388.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,249.26
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.86
|
| Rate for Payer: Nomi Health Commercial |
$1,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.05
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,216.23
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$973.04
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,221.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
IP
|
$1,388.07
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,041.05 |
| Max. Negotiated Rate |
$1,388.07 |
| Rate for Payer: Aetna Commercial |
$1,249.26
|
| Rate for Payer: ASR ASR |
$1,346.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.88
|
| Rate for Payer: BCN Commercial |
$1,139.88
|
| Rate for Payer: Cash Price |
$1,110.46
|
| Rate for Payer: Cofinity Commercial |
$1,304.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.46
|
| Rate for Payer: Healthscope Commercial |
$1,346.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,388.07
|
| Rate for Payer: Mclaren Commercial |
$1,249.26
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,221.50
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
OP
|
$1,353.19
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,353.19 |
| Rate for Payer: Aetna Commercial |
$1,217.87
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$1,312.59
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,115.71
|
| Rate for Payer: BCN Commercial |
$1,115.71
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,082.55
|
| Rate for Payer: Cash Price |
$1,082.55
|
| Rate for Payer: Cofinity Commercial |
$1,272.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,312.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,217.87
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.21
|
| Rate for Payer: Nomi Health Commercial |
$1,109.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.89
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,313.46
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,050.76
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
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 |
$1,014.89 |
| Max. Negotiated Rate |
$1,353.19 |
| Rate for Payer: Aetna Commercial |
$1,217.87
|
| Rate for Payer: ASR ASR |
$1,312.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.24
|
| Rate for Payer: BCN Commercial |
$1,111.24
|
| Rate for Payer: Cash Price |
$1,082.55
|
| Rate for Payer: Cofinity Commercial |
$1,272.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.55
|
| Rate for Payer: Healthscope Commercial |
$1,312.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.19
|
| Rate for Payer: Mclaren Commercial |
$1,217.87
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,190.81
|
|
|
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 |
$1,288.37 |
| Max. Negotiated Rate |
$1,717.83 |
| Rate for Payer: Aetna Commercial |
$1,546.05
|
| Rate for Payer: ASR ASR |
$1,666.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,410.68
|
| Rate for Payer: BCN Commercial |
$1,410.68
|
| Rate for Payer: Cash Price |
$1,374.26
|
| Rate for Payer: Cofinity Commercial |
$1,614.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.26
|
| Rate for Payer: Healthscope Commercial |
$1,666.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,717.83
|
| Rate for Payer: Mclaren Commercial |
$1,546.05
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,511.69
|
|
|
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 |
$282.95 |
| Max. Negotiated Rate |
$1,717.83 |
| Rate for Payer: Aetna Commercial |
$1,546.05
|
| Rate for Payer: Aetna Medicare |
$541.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: ASR ASR |
$1,666.30
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,416.35
|
| Rate for Payer: BCN Commercial |
$1,416.35
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,374.26
|
| Rate for Payer: Cash Price |
$1,374.26
|
| Rate for Payer: Cofinity Commercial |
$1,614.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,666.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,717.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,546.05
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$297.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,460.16
|
| Rate for Payer: Nomi Health Commercial |
$1,408.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,288.37
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$595.12
|
| Rate for Payer: PHP Medicaid |
$289.99
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,313.46
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,050.76
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,511.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$838.58
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP DNSP |
$541.02
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
|
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 |
$612.85 |
| Max. Negotiated Rate |
$817.13 |
| Rate for Payer: Aetna Commercial |
$735.42
|
| Rate for Payer: ASR ASR |
$792.62
|
| Rate for Payer: BCBS Trust/PPO |
$671.03
|
| Rate for Payer: BCN Commercial |
$671.03
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cofinity Commercial |
$768.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.70
|
| Rate for Payer: Healthscope Commercial |
$792.62
|
| Rate for Payer: Healthscope Whirlpool |
$817.13
|
| Rate for Payer: Mclaren Commercial |
$735.42
|
| 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: UHC All Payor (Choice/PPO) + Core |
$719.07
|
|
|
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 |
$208.33 |
| Max. Negotiated Rate |
$817.13 |
| Rate for Payer: Aetna Commercial |
$735.42
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$792.62
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$673.72
|
| Rate for Payer: BCN Commercial |
$673.72
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cofinity Commercial |
$768.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$792.62
|
| Rate for Payer: Healthscope Whirlpool |
$817.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$735.42
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.56
|
| Rate for Payer: Nomi Health Commercial |
$670.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.85
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$715.97
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$572.81
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$719.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
