|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$132.19
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.92
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cofinity Commercial |
$113.68
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Healthscope Commercial |
$118.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.36
|
| Rate for Payer: PHP Commercial |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.53
|
| Rate for Payer: Priority Health SBD |
$83.28
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$219.81
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.48 |
| Max. Negotiated Rate |
$197.83 |
| Rate for Payer: Aetna Commercial |
$186.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.88
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cofinity Commercial |
$153.87
|
| Rate for Payer: Cofinity Commercial |
$189.04
|
| Rate for Payer: Healthscope Commercial |
$197.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: PHP Commercial |
$186.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: Priority Health SBD |
$138.48
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$219.81
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$197.83 |
| Rate for Payer: Aetna Commercial |
$186.84
|
| Rate for Payer: Aetna Medicare |
$33.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.80
|
| Rate for Payer: BCBS Complete |
$18.75
|
| Rate for Payer: BCBS MAPPO |
$32.64
|
| Rate for Payer: BCN Medicare Advantage |
$32.64
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cash Price |
$175.85
|
| Rate for Payer: Cofinity Commercial |
$189.04
|
| Rate for Payer: Cofinity Commercial |
$153.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$197.83
|
| Rate for Payer: Mclaren Medicaid |
$17.85
|
| Rate for Payer: Mclaren Medicare |
$32.64
|
| Rate for Payer: Meridian Medicaid |
$18.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.84
|
| Rate for Payer: PACE Medicare |
$31.01
|
| Rate for Payer: PACE SWMI |
$32.64
|
| Rate for Payer: PHP Commercial |
$186.84
|
| Rate for Payer: PHP Medicare Advantage |
$32.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.89
|
| Rate for Payer: Priority Health Medicare |
$32.64
|
| Rate for Payer: Priority Health Narrow Network |
$84.71
|
| Rate for Payer: Priority Health SBD |
$138.48
|
| Rate for Payer: Railroad Medicare Medicare |
$32.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.64
|
| Rate for Payer: UHC Exchange |
$62.38
|
| Rate for Payer: UHC Medicare Advantage |
$33.62
|
| Rate for Payer: VA VA |
$32.64
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,751.81
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.72 |
| Max. Negotiated Rate |
$1,576.63 |
| Rate for Payer: Aetna Commercial |
$1,489.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.68
|
| Rate for Payer: BCBS Complete |
$700.72
|
| Rate for Payer: Cash Price |
$1,401.45
|
| Rate for Payer: Cofinity Commercial |
$1,226.27
|
| Rate for Payer: Cofinity Commercial |
$1,506.56
|
| Rate for Payer: Healthscope Commercial |
$1,576.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,489.04
|
| Rate for Payer: PHP Commercial |
$1,489.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.27
|
| Rate for Payer: Priority Health SBD |
$1,103.64
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,751.81
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,103.64 |
| Max. Negotiated Rate |
$1,576.63 |
| Rate for Payer: Aetna Commercial |
$1,489.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.68
|
| Rate for Payer: Cash Price |
$1,401.45
|
| Rate for Payer: Cofinity Commercial |
$1,226.27
|
| Rate for Payer: Cofinity Commercial |
$1,506.56
|
| Rate for Payer: Healthscope Commercial |
$1,576.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,489.04
|
| Rate for Payer: PHP Commercial |
$1,489.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.27
|
| Rate for Payer: Priority Health SBD |
$1,103.64
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,077.67
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$4,569.90 |
| Rate for Payer: Aetna Commercial |
$4,316.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,300.49
|
| Rate for Payer: BCBS Complete |
$2,031.07
|
| Rate for Payer: BCBS Trust/PPO |
$885.60
|
| Rate for Payer: BCCCP Commercial |
$613.86
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cofinity Commercial |
$3,554.37
|
| Rate for Payer: Cofinity Commercial |
$4,366.80
|
| Rate for Payer: Healthscope Commercial |
$4,569.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,316.02
|
| Rate for Payer: PHP Commercial |
$4,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,554.37
|
| Rate for Payer: Priority Health SBD |
$3,198.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.37
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$85.79
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,077.67
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,198.93 |
| Max. Negotiated Rate |
$4,569.90 |
| Rate for Payer: Aetna Commercial |
$4,316.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,300.49
|
| Rate for Payer: Cash Price |
$4,062.14
|
| Rate for Payer: Cofinity Commercial |
$3,554.37
|
| Rate for Payer: Cofinity Commercial |
$4,366.80
|
| Rate for Payer: Healthscope Commercial |
$4,569.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,316.02
|
| Rate for Payer: PHP Commercial |
$4,316.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,554.37
|
| Rate for Payer: Priority Health SBD |
$3,198.93
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,598.37
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.59 |
| Max. Negotiated Rate |
$3,238.53 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,338.94
|
| Rate for Payer: BCBS Complete |
$1,439.35
|
| Rate for Payer: BCBS Trust/PPO |
$910.99
|
| Rate for Payer: BCCCP Commercial |
$400.24
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cofinity Commercial |
$3,094.60
|
| Rate for Payer: Cofinity Commercial |
$2,518.86
|
| Rate for Payer: Healthscope Commercial |
$3,238.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,058.61
|
| Rate for Payer: PHP Commercial |
$3,058.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.86
|
| Rate for Payer: Priority Health SBD |
$2,266.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.45
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$78.59
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,598.37
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,266.97 |
| Max. Negotiated Rate |
$3,238.53 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,338.94
|
| Rate for Payer: Cash Price |
$2,878.70
|
| Rate for Payer: Cofinity Commercial |
$2,518.86
|
| Rate for Payer: Cofinity Commercial |
$3,094.60
|
| Rate for Payer: Healthscope Commercial |
$3,238.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,058.61
|
| Rate for Payer: PHP Commercial |
$3,058.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.86
|
| Rate for Payer: Priority Health SBD |
$2,266.97
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
IP
|
$3,966.57
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,498.94 |
| Max. Negotiated Rate |
$3,569.91 |
| Rate for Payer: Aetna Commercial |
$3,371.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.27
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cofinity Commercial |
$2,776.60
|
| Rate for Payer: Cofinity Commercial |
$3,411.25
|
| Rate for Payer: Healthscope Commercial |
$3,569.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,371.58
|
| Rate for Payer: PHP Commercial |
$3,371.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,776.60
|
| Rate for Payer: Priority Health SBD |
$2,498.94
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
OP
|
$3,966.57
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$3,569.91 |
| Rate for Payer: Aetna Commercial |
$3,371.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.27
|
| Rate for Payer: BCBS Complete |
$1,586.63
|
| Rate for Payer: BCBS Trust/PPO |
$837.29
|
| Rate for Payer: BCCCP Commercial |
$394.27
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cofinity Commercial |
$3,411.25
|
| Rate for Payer: Cofinity Commercial |
$2,776.60
|
| Rate for Payer: Healthscope Commercial |
$3,569.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,371.58
|
| Rate for Payer: PHP Commercial |
$3,371.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,776.60
|
| Rate for Payer: Priority Health SBD |
$2,498.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.40
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$74.00
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
OP
|
$3,036.13
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$172.23 |
| Max. Negotiated Rate |
$4,496.47 |
| Rate for Payer: Aetna Commercial |
$2,580.71
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$798.58
|
| Rate for Payer: BCCCP Commercial |
$791.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$2,428.90
|
| Rate for Payer: Cash Price |
$2,428.90
|
| Rate for Payer: Cofinity Commercial |
$2,611.07
|
| Rate for Payer: Cofinity Commercial |
$2,125.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$2,732.52
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.71
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$2,580.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,496.47
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.18
|
| Rate for Payer: Priority Health SBD |
$1,912.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.45
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$172.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
IP
|
$3,036.13
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,912.76 |
| Max. Negotiated Rate |
$2,732.52 |
| Rate for Payer: Aetna Commercial |
$2,580.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.48
|
| Rate for Payer: Cash Price |
$2,428.90
|
| Rate for Payer: Cofinity Commercial |
$2,125.29
|
| Rate for Payer: Cofinity Commercial |
$2,611.07
|
| Rate for Payer: Healthscope Commercial |
$2,732.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.71
|
| Rate for Payer: PHP Commercial |
$2,580.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.29
|
| Rate for Payer: Priority Health SBD |
$1,912.76
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
IP
|
$3,667.20
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,310.34 |
| Max. Negotiated Rate |
$3,300.48 |
| Rate for Payer: Aetna Commercial |
$3,117.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,383.68
|
| Rate for Payer: Cash Price |
$2,933.76
|
| Rate for Payer: Cofinity Commercial |
$2,567.04
|
| Rate for Payer: Cofinity Commercial |
$3,153.79
|
| Rate for Payer: Healthscope Commercial |
$3,300.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,117.12
|
| Rate for Payer: PHP Commercial |
$3,117.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,567.04
|
| Rate for Payer: Priority Health SBD |
$2,310.34
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
OP
|
$3,667.20
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$4,496.47 |
| Rate for Payer: Aetna Commercial |
$3,117.12
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,383.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$581.10
|
| Rate for Payer: BCCCP Commercial |
$519.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$2,933.76
|
| Rate for Payer: Cash Price |
$2,933.76
|
| Rate for Payer: Cofinity Commercial |
$3,153.79
|
| Rate for Payer: Cofinity Commercial |
$2,567.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$3,300.48
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,117.12
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$3,117.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,567.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,496.47
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.18
|
| Rate for Payer: Priority Health SBD |
$2,310.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.52
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$156.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
IP
|
$4,045.36
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,548.58 |
| Max. Negotiated Rate |
$3,640.82 |
| Rate for Payer: Aetna Commercial |
$3,438.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.48
|
| Rate for Payer: Cash Price |
$3,236.29
|
| Rate for Payer: Cofinity Commercial |
$2,831.75
|
| Rate for Payer: Cofinity Commercial |
$3,479.01
|
| Rate for Payer: Healthscope Commercial |
$3,640.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,438.56
|
| Rate for Payer: PHP Commercial |
$3,438.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,831.75
|
| Rate for Payer: Priority Health SBD |
$2,548.58
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
OP
|
$4,045.36
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$4,496.47 |
| Rate for Payer: Aetna Commercial |
$3,438.56
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$508.49
|
| Rate for Payer: BCCCP Commercial |
$518.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$3,236.29
|
| Rate for Payer: Cash Price |
$3,236.29
|
| Rate for Payer: Cofinity Commercial |
$2,831.75
|
| Rate for Payer: Cofinity Commercial |
$3,479.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$3,640.82
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,438.56
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$3,438.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,831.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,496.47
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.18
|
| Rate for Payer: Priority Health SBD |
$2,548.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.16
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$148.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$302.58
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$342.32
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$284.78
|
| Rate for Payer: Cash Price |
$284.78
|
| Rate for Payer: Cofinity Commercial |
$249.19
|
| Rate for Payer: Cofinity Commercial |
$306.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$320.38
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.58
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$302.58
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$224.27
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.96
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$72.69
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$224.27 |
| Max. Negotiated Rate |
$320.38 |
| Rate for Payer: Aetna Commercial |
$302.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.39
|
| Rate for Payer: Cash Price |
$284.78
|
| Rate for Payer: Cofinity Commercial |
$249.19
|
| Rate for Payer: Cofinity Commercial |
$306.14
|
| Rate for Payer: Healthscope Commercial |
$320.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.58
|
| Rate for Payer: PHP Commercial |
$302.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.19
|
| Rate for Payer: Priority Health SBD |
$224.27
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
OP
|
$24.13
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.60
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.96
|
| Rate for Payer: BCN Medicare Advantage |
$35.68
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.68
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$35.68
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.51
|
| Rate for Payer: PACE Medicare |
$33.90
|
| Rate for Payer: PACE SWMI |
$35.68
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: PHP Medicare Advantage |
$35.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.40
|
| Rate for Payer: Priority Health Medicare |
$35.68
|
| Rate for Payer: Priority Health Narrow Network |
$84.32
|
| Rate for Payer: Priority Health SBD |
$15.20
|
| Rate for Payer: Railroad Medicare Medicare |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.68
|
| Rate for Payer: UHC Exchange |
$4.58
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
| Rate for Payer: VA VA |
$35.68
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
IP
|
$24.13
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.51
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.89
|
| Rate for Payer: Priority Health SBD |
$15.20
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
IP
|
$252.97
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$159.37 |
| Max. Negotiated Rate |
$227.67 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.43
|
| Rate for Payer: Cash Price |
$202.38
|
| Rate for Payer: Cofinity Commercial |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Healthscope Commercial |
$227.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.08
|
| Rate for Payer: Priority Health SBD |
$159.37
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
OP
|
$252.97
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.19 |
| Max. Negotiated Rate |
$227.67 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.43
|
| Rate for Payer: BCBS Complete |
$101.19
|
| Rate for Payer: Cash Price |
$202.38
|
| Rate for Payer: Cofinity Commercial |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Healthscope Commercial |
$227.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.08
|
| Rate for Payer: Priority Health SBD |
$159.37
|
|
