|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
IP
|
$350.88
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.07 |
| Max. Negotiated Rate |
$350.88 |
| Rate for Payer: Aetna Commercial |
$315.79
|
| Rate for Payer: ASR ASR |
$340.35
|
| Rate for Payer: ASR Commercial |
$340.35
|
| Rate for Payer: BCBS Trust/PPO |
$285.93
|
| Rate for Payer: BCN Commercial |
$272.04
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$329.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$350.88
|
| Rate for Payer: Healthscope Whirlpool |
$340.35
|
| Rate for Payer: Mclaren Commercial |
$315.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.25
|
| Rate for Payer: Nomi Health Commercial |
$287.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.77
|
|
|
HC NM PARATHYROID SCAN
|
Facility
|
OP
|
$918.71
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
34100007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$918.71 |
| Rate for Payer: Aetna Commercial |
$826.84
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$891.15
|
| Rate for Payer: ASR Commercial |
$891.15
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$752.33
|
| Rate for Payer: BCN Commercial |
$712.28
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$863.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$918.71
|
| Rate for Payer: Healthscope Whirlpool |
$891.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$826.84
|
| 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 |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.00
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$730.40
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM PARATHYROID SCAN
|
Facility
|
IP
|
$918.71
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
34100007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$597.16 |
| Max. Negotiated Rate |
$918.71 |
| Rate for Payer: Aetna Commercial |
$826.84
|
| Rate for Payer: ASR ASR |
$891.15
|
| Rate for Payer: ASR Commercial |
$891.15
|
| Rate for Payer: BCBS Trust/PPO |
$748.66
|
| Rate for Payer: BCN Commercial |
$712.28
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$863.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Healthscope Commercial |
$918.71
|
| Rate for Payer: Healthscope Whirlpool |
$891.15
|
| Rate for Payer: Mclaren Commercial |
$826.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.46
|
|
|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
|
|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$610.24 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| 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 |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.66
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$286.15
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$670.88 |
| Max. Negotiated Rate |
$1,032.12 |
| Rate for Payer: Aetna Commercial |
$928.91
|
| Rate for Payer: ASR ASR |
$1,001.16
|
| Rate for Payer: ASR Commercial |
$1,001.16
|
| Rate for Payer: BCBS Trust/PPO |
$841.07
|
| Rate for Payer: BCN Commercial |
$800.20
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cofinity Commercial |
$970.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.70
|
| Rate for Payer: Healthscope Commercial |
$1,032.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,001.16
|
| Rate for Payer: Mclaren Commercial |
$928.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.30
|
| Rate for Payer: Nomi Health Commercial |
$846.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$908.27
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
OP
|
$1,032.12
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,032.12 |
| Rate for Payer: Aetna Commercial |
$928.91
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,001.16
|
| Rate for Payer: ASR Commercial |
$1,001.16
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$845.20
|
| Rate for Payer: BCN Commercial |
$800.20
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cofinity Commercial |
$970.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,032.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,001.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$928.91
|
| 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 |
$877.30
|
| Rate for Payer: Nomi Health Commercial |
$846.34
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$670.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.70
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$294.96
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$908.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$792.47 |
| Max. Negotiated Rate |
$1,219.18 |
| Rate for Payer: Aetna Commercial |
$1,097.26
|
| Rate for Payer: ASR ASR |
$1,182.60
|
| Rate for Payer: ASR Commercial |
$1,182.60
|
| Rate for Payer: BCBS Trust/PPO |
$993.51
|
| Rate for Payer: BCN Commercial |
$945.23
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,146.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Healthscope Commercial |
$1,219.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,182.60
|
| Rate for Payer: Mclaren Commercial |
$1,097.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.88
|
|
|
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 |
$211.02 |
| Max. Negotiated Rate |
$1,219.18 |
| Rate for Payer: Aetna Commercial |
$1,097.26
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,182.60
|
| Rate for Payer: ASR Commercial |
$1,182.60
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$998.39
|
| Rate for Payer: BCN Commercial |
$945.23
|
| 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 |
$1,146.03
|
| 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 |
$1,219.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,182.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,097.26
|
| 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 |
$999.73
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$1,068.25
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$854.65
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Trust/PPO |
$633.76
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$219.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| 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 |
$731.05
|
| 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 |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.60
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| 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 |
$637.72
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$241.56
|
| Rate for Payer: PHP Medicaid |
$117.71
|
| 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 |
$681.43
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$340.38
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP DNSP |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: VA VA |
$219.60
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$219.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| 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 |
$731.05
|
| 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 |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.60
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| 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 |
$637.72
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$241.56
|
| Rate for Payer: PHP Medicaid |
$117.71
|
| 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 |
$681.43
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$340.38
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP DNSP |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: VA VA |
$219.60
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Trust/PPO |
$633.76
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$219.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| 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 |
$731.05
|
| 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 |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.60
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| 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 |
$637.72
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$241.56
|
| Rate for Payer: PHP Medicaid |
$117.71
|
| 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 |
$491.91
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$393.53
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$340.38
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP DNSP |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: VA VA |
$219.60
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Trust/PPO |
$633.76
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$731.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
|
|
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 |
$884.55 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Aetna Commercial |
$1,224.76
|
| Rate for Payer: ASR ASR |
$1,320.02
|
| Rate for Payer: ASR Commercial |
$1,320.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.96
|
| Rate for Payer: BCN Commercial |
$1,055.07
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$1,279.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Healthscope Commercial |
$1,360.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.02
|
| Rate for Payer: Mclaren Commercial |
$1,224.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: Nomi Health Commercial |
$1,115.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,197.55
|
|
|
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 |
$211.02 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Aetna Commercial |
$1,224.76
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,320.02
|
| Rate for Payer: ASR Commercial |
$1,320.02
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.40
|
| Rate for Payer: BCN Commercial |
$1,055.07
|
| 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 |
$1,279.20
|
| 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 |
$1,360.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,224.76
|
| 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 |
$1,115.90
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$1,192.38
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$953.96
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,197.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$282.68 |
| Max. Negotiated Rate |
$1,326.66 |
| Rate for Payer: Aetna Commercial |
$1,193.99
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$1,286.86
|
| Rate for Payer: ASR Commercial |
$1,286.86
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.40
|
| Rate for Payer: BCN Commercial |
$1,028.56
|
| 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 |
$1,247.06
|
| 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 |
$1,326.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,286.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,193.99
|
| 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 |
$1,087.86
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| 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 |
$1,191.34
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$953.07
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
|
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 |
$862.33 |
| Max. Negotiated Rate |
$1,326.66 |
| Rate for Payer: Aetna Commercial |
$1,193.99
|
| Rate for Payer: ASR ASR |
$1,286.86
|
| Rate for Payer: ASR Commercial |
$1,286.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.10
|
| Rate for Payer: BCN Commercial |
$1,028.56
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cofinity Commercial |
$1,247.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.33
|
| Rate for Payer: Healthscope Commercial |
$1,326.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,286.86
|
| Rate for Payer: Mclaren Commercial |
$1,193.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.66
|
| Rate for Payer: Nomi Health Commercial |
$1,087.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.46
|
|
|
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 |
$282.68 |
| Max. Negotiated Rate |
$1,684.15 |
| Rate for Payer: Aetna Commercial |
$1,515.74
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$1,633.63
|
| Rate for Payer: ASR Commercial |
$1,633.63
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.15
|
| Rate for Payer: BCN Commercial |
$1,305.72
|
| 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 |
$1,583.10
|
| 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 |
$1,684.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,633.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,515.74
|
| 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 |
$1,381.00
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| 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 |
$1,191.34
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$953.07
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,482.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
|
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 |
$1,094.70 |
| Max. Negotiated Rate |
$1,684.15 |
| Rate for Payer: Aetna Commercial |
$1,515.74
|
| Rate for Payer: ASR ASR |
$1,633.63
|
| Rate for Payer: ASR Commercial |
$1,633.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.41
|
| Rate for Payer: BCN Commercial |
$1,305.72
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,583.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.32
|
| Rate for Payer: Healthscope Commercial |
$1,684.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,633.63
|
| Rate for Payer: Mclaren Commercial |
$1,515.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.53
|
| Rate for Payer: Nomi Health Commercial |
$1,381.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,482.05
|
|
|
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 |
$211.02 |
| Max. Negotiated Rate |
$801.11 |
| Rate for Payer: Aetna Commercial |
$721.00
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$777.08
|
| Rate for Payer: ASR Commercial |
$777.08
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$656.03
|
| Rate for Payer: BCN Commercial |
$621.10
|
| 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: Cofinity Commercial |
$753.04
|
| 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 |
$801.11
|
| Rate for Payer: Healthscope Whirlpool |
$777.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$721.00
|
| 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 |
$656.91
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$701.93
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$561.58
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$520.72 |
| Max. Negotiated Rate |
$801.11 |
| Rate for Payer: Aetna Commercial |
$721.00
|
| Rate for Payer: ASR ASR |
$777.08
|
| Rate for Payer: ASR Commercial |
$777.08
|
| Rate for Payer: BCBS Trust/PPO |
$652.82
|
| Rate for Payer: BCN Commercial |
$621.10
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cofinity Commercial |
$753.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.89
|
| Rate for Payer: Healthscope Commercial |
$801.11
|
| Rate for Payer: Healthscope Whirlpool |
$777.08
|
| Rate for Payer: Mclaren Commercial |
$721.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.94
|
| Rate for Payer: Nomi Health Commercial |
$656.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.98
|
|
|
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 |
$211.02 |
| Max. Negotiated Rate |
$991.36 |
| Rate for Payer: Aetna Commercial |
$892.22
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$961.62
|
| Rate for Payer: ASR Commercial |
$961.62
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$811.82
|
| Rate for Payer: BCN Commercial |
$768.60
|
| 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: Cofinity Commercial |
$931.88
|
| 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 |
$991.36
|
| Rate for Payer: Healthscope Whirlpool |
$961.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$892.22
|
| 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 |
$812.92
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| 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 |
$868.63
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$694.94
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$644.38 |
| Max. Negotiated Rate |
$991.36 |
| Rate for Payer: Aetna Commercial |
$892.22
|
| Rate for Payer: ASR ASR |
$961.62
|
| Rate for Payer: ASR Commercial |
$961.62
|
| Rate for Payer: BCBS Trust/PPO |
$807.86
|
| Rate for Payer: BCN Commercial |
$768.60
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$931.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$991.36
|
| Rate for Payer: Healthscope Whirlpool |
$961.62
|
| Rate for Payer: Mclaren Commercial |
$892.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.40
|
|
