|
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 IV ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.16 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$218.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.24
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$123.02
|
| Rate for Payer: BCBS MAPPO |
$218.59
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: BCN Medicare Advantage |
$218.59
|
| 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 |
$218.59
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.59
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Mclaren Medicaid |
$117.16
|
| Rate for Payer: Mclaren Medicare |
$218.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.52
|
| Rate for Payer: Meridian Medicaid |
$123.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Medicare |
$207.66
|
| Rate for Payer: PACE SWMI |
$218.59
|
| Rate for Payer: PHP Commercial |
$240.45
|
| Rate for Payer: PHP Medicaid |
$117.16
|
| Rate for Payer: PHP Medicare Advantage |
$218.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.16
|
| 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 |
$218.59
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: Railroad Medicare Medicare |
$218.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.59
|
| Rate for Payer: UHC Exchange |
$338.81
|
| Rate for Payer: UHC Medicare Advantage |
$218.59
|
| Rate for Payer: UHCCP DNSP |
$218.59
|
| Rate for Payer: UHCCP Medicaid |
$117.16
|
| Rate for Payer: VA VA |
$218.59
|
|
|
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 |
$117.16 |
| Max. Negotiated Rate |
$777.71 |
| Rate for Payer: Aetna Commercial |
$699.94
|
| Rate for Payer: Aetna Medicare |
$218.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.24
|
| Rate for Payer: ASR ASR |
$754.38
|
| Rate for Payer: ASR Commercial |
$754.38
|
| Rate for Payer: BCBS Complete |
$123.02
|
| Rate for Payer: BCBS MAPPO |
$218.59
|
| Rate for Payer: BCBS Trust/PPO |
$636.87
|
| Rate for Payer: BCN Commercial |
$602.96
|
| Rate for Payer: BCN Medicare Advantage |
$218.59
|
| 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 |
$218.59
|
| Rate for Payer: Healthscope Commercial |
$777.71
|
| Rate for Payer: Healthscope Whirlpool |
$754.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$218.59
|
| Rate for Payer: Mclaren Commercial |
$699.94
|
| Rate for Payer: Mclaren Medicaid |
$117.16
|
| Rate for Payer: Mclaren Medicare |
$218.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.52
|
| Rate for Payer: Meridian Medicaid |
$123.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Medicare |
$207.66
|
| Rate for Payer: PACE SWMI |
$218.59
|
| Rate for Payer: PHP Commercial |
$240.45
|
| Rate for Payer: PHP Medicaid |
$117.16
|
| Rate for Payer: PHP Medicare Advantage |
$218.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.16
|
| 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 |
$218.59
|
| Rate for Payer: Priority Health Narrow Network |
$545.17
|
| Rate for Payer: Railroad Medicare Medicare |
$218.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.59
|
| Rate for Payer: UHC Exchange |
$338.81
|
| Rate for Payer: UHC Medicare Advantage |
$218.59
|
| Rate for Payer: UHCCP DNSP |
$218.59
|
| Rate for Payer: UHCCP Medicaid |
$117.16
|
| Rate for Payer: VA VA |
$218.59
|
|
|
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 |
$1,224.77
|
| 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 |
$1,224.77
|
| 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 |
$210.06 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Aetna Commercial |
$1,224.77
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,320.02
|
| Rate for Payer: ASR Commercial |
$1,320.02
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.40
|
| Rate for Payer: BCN Commercial |
$1,055.07
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,360.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,320.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,224.77
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| 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 |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$953.96
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,197.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$281.38 |
| Max. Negotiated Rate |
$1,326.66 |
| Rate for Payer: Aetna Commercial |
$1,193.99
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$1,286.86
|
| Rate for Payer: ASR Commercial |
$1,286.86
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.40
|
| Rate for Payer: BCN Commercial |
$1,028.56
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| 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 |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,326.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,286.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$1,193.99
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| 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 |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,162.42
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$929.99
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
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
|
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 |
$1,515.73
|
| 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 |
$1,515.73
|
| 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 RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
OP
|
$1,684.15
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,684.15 |
| Rate for Payer: Aetna Commercial |
$1,515.73
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$1,633.63
|
| Rate for Payer: ASR Commercial |
$1,633.63
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.15
|
| Rate for Payer: BCN Commercial |
$1,305.72
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| 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 |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,684.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,633.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$1,515.73
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| 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 |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,475.65
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,180.59
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,482.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$801.11 |
| Rate for Payer: Aetna Commercial |
$721.00
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$777.08
|
| Rate for Payer: ASR Commercial |
$777.08
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$656.03
|
| Rate for Payer: BCN Commercial |
$621.10
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$801.11
|
| Rate for Payer: Healthscope Whirlpool |
$777.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$721.00
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.94
|
| Rate for Payer: Nomi Health Commercial |
$656.91
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$561.58
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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 |
$210.06 |
| Max. Negotiated Rate |
$991.36 |
| Rate for Payer: Aetna Commercial |
$892.22
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$961.62
|
| Rate for Payer: ASR Commercial |
$961.62
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$811.82
|
| Rate for Payer: BCN Commercial |
$768.60
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| 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 |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$991.36
|
| Rate for Payer: Healthscope Whirlpool |
$961.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$892.22
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| 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 |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$694.94
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
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
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$442.78 |
| Max. Negotiated Rate |
$1,106.96 |
| Rate for Payer: Aetna Commercial |
$996.26
|
| Rate for Payer: Aetna Medicare |
$553.48
|
| Rate for Payer: ASR ASR |
$1,073.75
|
| Rate for Payer: ASR Commercial |
$1,073.75
|
| Rate for Payer: BCBS Complete |
$442.78
|
| Rate for Payer: BCBS Trust/PPO |
$906.49
|
| Rate for Payer: BCN Commercial |
$858.23
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$1,040.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$1,106.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.75
|
| Rate for Payer: Mclaren Commercial |
$996.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: Nomi Health Commercial |
$907.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$969.92
|
| Rate for Payer: Priority Health Narrow Network |
$775.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.12
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$719.52 |
| Max. Negotiated Rate |
$1,106.96 |
| Rate for Payer: Aetna Commercial |
$996.26
|
| Rate for Payer: ASR ASR |
$1,073.75
|
| Rate for Payer: ASR Commercial |
$1,073.75
|
| Rate for Payer: BCBS Trust/PPO |
$902.06
|
| Rate for Payer: BCN Commercial |
$858.23
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$1,040.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$1,106.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.75
|
| Rate for Payer: Mclaren Commercial |
$996.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: Nomi Health Commercial |
$907.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.12
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$821.24 |
| Max. Negotiated Rate |
$1,263.44 |
| Rate for Payer: Aetna Commercial |
$1,137.10
|
| Rate for Payer: ASR ASR |
$1,225.54
|
| Rate for Payer: ASR Commercial |
$1,225.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.58
|
| Rate for Payer: BCN Commercial |
$979.55
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,187.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Healthscope Commercial |
$1,263.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.54
|
| Rate for Payer: Mclaren Commercial |
$1,137.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,036.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.83
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,263.44 |
| Rate for Payer: Aetna Commercial |
$1,137.10
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$1,225.54
|
| Rate for Payer: ASR Commercial |
$1,225.54
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.63
|
| Rate for Payer: BCN Commercial |
$979.55
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,187.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,263.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$1,137.10
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,036.02
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.03
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$885.67
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$1,985.39 |
| Rate for Payer: Aetna Commercial |
$1,786.85
|
| Rate for Payer: Aetna Medicare |
$1,273.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: ASR ASR |
$1,925.83
|
| Rate for Payer: ASR Commercial |
$1,925.83
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,625.84
|
| Rate for Payer: BCN Commercial |
$1,539.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,866.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$1,985.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,925.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,273.21
|
| Rate for Payer: Mclaren Commercial |
$1,786.85
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$1,628.02
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,400.53
|
| Rate for Payer: PHP Medicaid |
$682.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,739.60
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,391.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,747.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,973.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP DNSP |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$682.44
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,290.50 |
| Max. Negotiated Rate |
$1,985.39 |
| Rate for Payer: Aetna Commercial |
$1,786.85
|
| Rate for Payer: ASR ASR |
$1,925.83
|
| Rate for Payer: ASR Commercial |
$1,925.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,617.89
|
| Rate for Payer: BCN Commercial |
$1,539.27
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,866.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Healthscope Commercial |
$1,985.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,925.83
|
| Rate for Payer: Mclaren Commercial |
$1,786.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$1,628.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,747.14
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,284.22 |
| Max. Negotiated Rate |
$1,975.72 |
| Rate for Payer: Aetna Commercial |
$1,778.15
|
| Rate for Payer: ASR ASR |
$1,916.45
|
| Rate for Payer: ASR Commercial |
$1,916.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,610.01
|
| Rate for Payer: BCN Commercial |
$1,531.78
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,857.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Healthscope Commercial |
$1,975.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,916.45
|
| Rate for Payer: Mclaren Commercial |
$1,778.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,738.63
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$1,975.72 |
| Rate for Payer: Aetna Commercial |
$1,778.15
|
| Rate for Payer: Aetna Medicare |
$1,273.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: ASR ASR |
$1,916.45
|
| Rate for Payer: ASR Commercial |
$1,916.45
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,617.92
|
| Rate for Payer: BCN Commercial |
$1,531.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,857.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$1,975.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,916.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,273.21
|
| Rate for Payer: Mclaren Commercial |
$1,778.15
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,400.53
|
| Rate for Payer: PHP Medicaid |
$682.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,731.13
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,384.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,738.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,973.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP DNSP |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$682.44
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.17 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$1,581.46
|
| Rate for Payer: Aetna Medicare |
$5,690.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: ASR ASR |
$1,704.46
|
| Rate for Payer: ASR Commercial |
$1,704.46
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.95
|
| Rate for Payer: BCN Commercial |
$1,362.34
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,651.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$1,757.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$1,581.46
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$6,259.14
|
| Rate for Payer: PHP Medicaid |
$3,049.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.64
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,546.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$8,819.70
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP DNSP |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.17 |
| Max. Negotiated Rate |
$1,757.18 |
| Rate for Payer: Aetna Commercial |
$1,581.46
|
| Rate for Payer: ASR ASR |
$1,704.46
|
| Rate for Payer: ASR Commercial |
$1,704.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,431.93
|
| Rate for Payer: BCN Commercial |
$1,362.34
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,651.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Healthscope Commercial |
$1,757.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.46
|
| Rate for Payer: Mclaren Commercial |
$1,581.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,546.32
|
|
