|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
IP
|
$1,011.19
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.39 |
| Max. Negotiated Rate |
$1,011.19 |
| Rate for Payer: Aetna Commercial |
$910.07
|
| Rate for Payer: ASR ASR |
$980.85
|
| Rate for Payer: BCBS Trust/PPO |
$830.39
|
| Rate for Payer: BCN Commercial |
$830.39
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Commercial |
$950.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$980.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.19
|
| Rate for Payer: Mclaren Commercial |
$910.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.85
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
OP
|
$1,011.19
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,011.19 |
| Rate for Payer: Aetna Commercial |
$910.07
|
| 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 |
$980.85
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$833.73
|
| Rate for Payer: BCN Commercial |
$833.73
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Commercial |
$950.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$980.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$910.07
|
| 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 |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$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 |
$886.00
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$708.84
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.85
|
| 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 TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$1,129.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$417.77 |
| Max. Negotiated Rate |
$1,129.10 |
| Rate for Payer: Aetna Commercial |
$1,016.19
|
| Rate for Payer: Aetna Medicare |
$417.77
|
| Rate for Payer: ASR ASR |
$1,095.23
|
| Rate for Payer: BCBS Complete |
$451.64
|
| Rate for Payer: BCBS Trust/PPO |
$930.94
|
| Rate for Payer: BCN Commercial |
$930.94
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cofinity Commercial |
$1,061.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.28
|
| Rate for Payer: Healthscope Commercial |
$1,095.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,129.10
|
| Rate for Payer: Mclaren Commercial |
$1,016.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$903.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Nomi Health Commercial |
$925.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$674.81
|
| Rate for Payer: Priority Health Narrow Network |
$539.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.61
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,129.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$846.83 |
| Max. Negotiated Rate |
$1,129.10 |
| Rate for Payer: Aetna Commercial |
$1,016.19
|
| Rate for Payer: ASR ASR |
$1,095.23
|
| Rate for Payer: BCBS Trust/PPO |
$927.22
|
| Rate for Payer: BCN Commercial |
$927.22
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cofinity Commercial |
$1,061.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.28
|
| Rate for Payer: Healthscope Commercial |
$1,095.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,129.10
|
| Rate for Payer: Mclaren Commercial |
$1,016.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Nomi Health Commercial |
$925.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$993.61
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,288.71
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$966.53 |
| Max. Negotiated Rate |
$1,288.71 |
| Rate for Payer: Aetna Commercial |
$1,159.84
|
| Rate for Payer: ASR ASR |
$1,250.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.29
|
| Rate for Payer: BCN Commercial |
$1,058.29
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cofinity Commercial |
$1,211.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.97
|
| Rate for Payer: Healthscope Commercial |
$1,250.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,288.71
|
| Rate for Payer: Mclaren Commercial |
$1,159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Nomi Health Commercial |
$1,056.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.06
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,288.71
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,288.71 |
| Rate for Payer: Aetna Commercial |
$1,159.84
|
| 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 |
$1,250.05
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.54
|
| Rate for Payer: BCN Commercial |
$1,062.54
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cofinity Commercial |
$1,211.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,250.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,288.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,159.84
|
| 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 |
$1,095.40
|
| Rate for Payer: Nomi Health Commercial |
$1,056.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PACE 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 |
$1,129.17
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$903.39
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.06
|
| 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 TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$2,025.10
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$2,025.10 |
| Rate for Payer: Aetna Commercial |
$1,822.59
|
| Rate for Payer: Aetna Medicare |
$1,289.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: ASR ASR |
$1,964.35
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.69
|
| Rate for Payer: BCN Commercial |
$1,669.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cofinity Commercial |
$1,903.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$1,964.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,025.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,289.99
|
| Rate for Payer: Mclaren Commercial |
$1,822.59
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$708.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Nomi Health Commercial |
$1,660.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,418.99
|
| Rate for Payer: PHP Medicaid |
$691.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,605.65
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,284.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,782.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$1,999.48
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP DNSP |
$1,289.99
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$2,025.10
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,518.83 |
| Max. Negotiated Rate |
$2,025.10 |
| Rate for Payer: Aetna Commercial |
$1,822.59
|
| Rate for Payer: ASR ASR |
$1,964.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.01
|
| Rate for Payer: BCN Commercial |
$1,663.01
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cofinity Commercial |
$1,903.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.08
|
| Rate for Payer: Healthscope Commercial |
$1,964.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,025.10
|
| Rate for Payer: Mclaren Commercial |
$1,822.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Nomi Health Commercial |
$1,660.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,782.09
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$2,015.23
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$2,651.11 |
| Rate for Payer: Aetna Commercial |
$1,813.71
|
| 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 |
$1,954.77
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.56
|
| Rate for Payer: BCN Commercial |
$1,661.56
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Commercial |
$1,894.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,954.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,015.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,813.71
|
| 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 |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,652.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PACE 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 |
$2,651.11
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,120.89
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,773.40
|
| 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 TUMOR SCAN SPECT
|
Facility
|
IP
|
$2,015.23
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,511.42 |
| Max. Negotiated Rate |
$2,015.23 |
| Rate for Payer: Aetna Commercial |
$1,813.71
|
| Rate for Payer: ASR ASR |
$1,954.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,654.91
|
| Rate for Payer: BCN Commercial |
$1,654.91
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Commercial |
$1,894.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Healthscope Commercial |
$1,954.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,015.23
|
| Rate for Payer: Mclaren Commercial |
$1,813.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,652.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,773.40
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,792.32
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,256.42 |
| Max. Negotiated Rate |
$9,336.87 |
| Rate for Payer: Aetna Commercial |
$1,613.09
|
| Rate for Payer: Aetna Medicare |
$6,023.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: ASR ASR |
$1,738.55
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.77
|
| Rate for Payer: BCN Commercial |
$1,477.77
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cofinity Commercial |
$1,684.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Healthscope Commercial |
$1,738.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,792.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,023.79
|
| Rate for Payer: Mclaren Commercial |
$1,613.09
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$3,308.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.47
|
| Rate for Payer: Nomi Health Commercial |
$1,469.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.24
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Commercial |
$6,626.17
|
| Rate for Payer: PHP Medicaid |
$3,228.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,570.43
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,256.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Exchange |
$9,336.87
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP DNSP |
$6,023.79
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,792.32
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,344.24 |
| Max. Negotiated Rate |
$1,792.32 |
| Rate for Payer: Aetna Commercial |
$1,613.09
|
| Rate for Payer: ASR ASR |
$1,738.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.85
|
| Rate for Payer: BCN Commercial |
$1,471.85
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cofinity Commercial |
$1,684.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.86
|
| Rate for Payer: Healthscope Commercial |
$1,738.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,792.32
|
| Rate for Payer: Mclaren Commercial |
$1,613.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.47
|
| Rate for Payer: Nomi Health Commercial |
$1,469.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.24
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,699.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,274.76 |
| Max. Negotiated Rate |
$1,699.68 |
| Rate for Payer: Aetna Commercial |
$1,529.71
|
| Rate for Payer: ASR ASR |
$1,648.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.78
|
| Rate for Payer: BCN Commercial |
$1,395.78
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Commercial |
$1,597.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Healthscope Commercial |
$1,648.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,699.68
|
| Rate for Payer: Mclaren Commercial |
$1,529.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,393.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,495.72
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,699.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,699.68 |
| Rate for Payer: Aetna Commercial |
$1,529.71
|
| 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 |
$1,648.69
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.39
|
| Rate for Payer: BCN Commercial |
$1,401.39
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Commercial |
$1,597.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,648.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,699.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,529.71
|
| 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 |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,393.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| 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 |
$785.65
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$628.52
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,495.72
|
| 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 VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,243.56
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
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 VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,243.56
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
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 |
$1,032.60
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$826.08
|
| 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 VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,699.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,274.76 |
| Max. Negotiated Rate |
$1,699.68 |
| Rate for Payer: Aetna Commercial |
$1,529.71
|
| Rate for Payer: ASR ASR |
$1,648.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.78
|
| Rate for Payer: BCN Commercial |
$1,395.78
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Commercial |
$1,597.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Healthscope Commercial |
$1,648.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,699.68
|
| Rate for Payer: Mclaren Commercial |
$1,529.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,393.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,495.72
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,699.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,699.68 |
| Rate for Payer: Aetna Commercial |
$1,529.71
|
| 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 |
$1,648.69
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.39
|
| Rate for Payer: BCN Commercial |
$1,401.39
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Commercial |
$1,597.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,648.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,699.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$541.02
|
| Rate for Payer: Mclaren Commercial |
$1,529.71
|
| 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 |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,393.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| 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 |
$1,489.26
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,191.48
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,495.72
|
| 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 VOID CYSTO
|
Facility
|
OP
|
$1,090.67
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,090.67 |
| Rate for Payer: Aetna Commercial |
$981.60
|
| 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 |
$1,057.95
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$899.26
|
| Rate for Payer: BCN Commercial |
$899.26
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cofinity Commercial |
$1,025.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,057.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,090.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$981.60
|
| 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 |
$927.07
|
| Rate for Payer: Nomi Health Commercial |
$894.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.00
|
| 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 |
$955.65
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$764.56
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$959.79
|
| 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 VOID CYSTO
|
Facility
|
IP
|
$1,090.67
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$818.00 |
| Max. Negotiated Rate |
$1,090.67 |
| Rate for Payer: Aetna Commercial |
$981.60
|
| Rate for Payer: ASR ASR |
$1,057.95
|
| Rate for Payer: BCBS Trust/PPO |
$895.66
|
| Rate for Payer: BCN Commercial |
$895.66
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cofinity Commercial |
$1,025.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.54
|
| Rate for Payer: Healthscope Commercial |
$1,057.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,090.67
|
| Rate for Payer: Mclaren Commercial |
$981.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.07
|
| Rate for Payer: Nomi Health Commercial |
$894.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$959.79
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,978.67
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,484.00 |
| Max. Negotiated Rate |
$1,978.67 |
| Rate for Payer: Aetna Commercial |
$1,780.80
|
| Rate for Payer: ASR ASR |
$1,919.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,624.88
|
| Rate for Payer: BCN Commercial |
$1,624.88
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cofinity Commercial |
$1,859.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.94
|
| Rate for Payer: Healthscope Commercial |
$1,919.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,978.67
|
| Rate for Payer: Mclaren Commercial |
$1,780.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.87
|
| Rate for Payer: Nomi Health Commercial |
$1,622.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,741.23
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,978.67
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$1,978.67 |
| Rate for Payer: Aetna Commercial |
$1,780.80
|
| 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 |
$1,919.31
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.41
|
| Rate for Payer: BCN Commercial |
$1,631.41
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cofinity Commercial |
$1,859.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$1,919.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,978.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$232.50
|
| Rate for Payer: Mclaren Commercial |
$1,780.80
|
| 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 |
$1,681.87
|
| Rate for Payer: Nomi Health Commercial |
$1,622.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.00
|
| 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 |
$1,733.71
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.05
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,741.23
|
| 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 NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$1.04
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: BCN Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$1.04
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.91
|
| Rate for Payer: Priority Health Narrow Network |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$89.05
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$80.14
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: ASR ASR |
$86.38
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cofinity Commercial |
$83.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$86.38
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.22
|
| Rate for Payer: Mclaren Commercial |
$80.14
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.69
|
| Rate for Payer: Nomi Health Commercial |
$73.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.79
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$40.94
|
| Rate for Payer: PHP Medicaid |
$19.95
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.03
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Narrow Network |
$62.42
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$57.69
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP DNSP |
$37.22
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
