|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,282.80
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,328.16 |
| Max. Negotiated Rate |
$4,754.52 |
| Rate for Payer: Aetna Commercial |
$4,490.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,433.82
|
| Rate for Payer: Cash Price |
$4,226.24
|
| Rate for Payer: Cofinity Advantage |
$3,697.96
|
| Rate for Payer: Cofinity Commercial |
$4,543.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,226.24
|
| Rate for Payer: Healthscope Commercial |
$4,754.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,490.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,962.10
|
| Rate for Payer: PHP Commercial |
$4,490.38
|
| Rate for Payer: Priority Health SBD |
$3,328.16
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,282.80
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$524.38 |
| Max. Negotiated Rate |
$4,754.52 |
| Rate for Payer: Aetna Commercial |
$4,490.38
|
| Rate for Payer: Aetna Medicare |
$2,641.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,433.82
|
| Rate for Payer: BCBS Complete |
$2,113.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,168.10
|
| Rate for Payer: BCCCP Commercial |
$524.38
|
| Rate for Payer: BCN Commercial |
$1,168.10
|
| Rate for Payer: Cash Price |
$4,226.24
|
| Rate for Payer: Cash Price |
$4,226.24
|
| Rate for Payer: Cash Price |
$4,226.24
|
| Rate for Payer: Cofinity Advantage |
$3,697.96
|
| Rate for Payer: Cofinity Commercial |
$4,543.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,226.24
|
| Rate for Payer: Healthscope Commercial |
$4,754.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,226.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,490.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,962.10
|
| Rate for Payer: PHP Commercial |
$4,490.38
|
| Rate for Payer: Priority Health SBD |
$3,328.16
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,743.75
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,358.56 |
| Max. Negotiated Rate |
$3,369.38 |
| Rate for Payer: Aetna Commercial |
$3,182.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.44
|
| Rate for Payer: Cash Price |
$2,995.00
|
| Rate for Payer: Cofinity Advantage |
$2,620.62
|
| Rate for Payer: Cofinity Commercial |
$3,219.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,995.00
|
| Rate for Payer: Healthscope Commercial |
$3,369.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,182.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,807.81
|
| Rate for Payer: PHP Commercial |
$3,182.19
|
| Rate for Payer: Priority Health SBD |
$2,358.56
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,743.75
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.68 |
| Max. Negotiated Rate |
$3,369.38 |
| Rate for Payer: Aetna Commercial |
$3,182.19
|
| Rate for Payer: Aetna Medicare |
$1,871.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.44
|
| Rate for Payer: BCBS Complete |
$1,497.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.59
|
| Rate for Payer: BCCCP Commercial |
$344.68
|
| Rate for Payer: BCN Commercial |
$1,201.59
|
| Rate for Payer: Cash Price |
$2,995.00
|
| Rate for Payer: Cash Price |
$2,995.00
|
| Rate for Payer: Cash Price |
$2,995.00
|
| Rate for Payer: Cofinity Advantage |
$2,620.62
|
| Rate for Payer: Cofinity Commercial |
$3,219.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,995.00
|
| Rate for Payer: Healthscope Commercial |
$3,369.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,995.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,182.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,807.81
|
| Rate for Payer: PHP Commercial |
$3,182.19
|
| Rate for Payer: Priority Health SBD |
$2,358.56
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
OP
|
$4,126.82
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.10 |
| Max. Negotiated Rate |
$3,714.14 |
| Rate for Payer: Aetna Commercial |
$3,507.80
|
| Rate for Payer: Aetna Medicare |
$2,063.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.43
|
| Rate for Payer: BCBS Complete |
$1,650.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.38
|
| Rate for Payer: BCCCP Commercial |
$338.10
|
| Rate for Payer: BCN Commercial |
$1,104.38
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cofinity Advantage |
$2,888.77
|
| Rate for Payer: Cofinity Commercial |
$3,549.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.46
|
| Rate for Payer: Healthscope Commercial |
$3,714.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,301.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,095.11
|
| Rate for Payer: PHP Commercial |
$3,507.80
|
| Rate for Payer: Priority Health SBD |
$2,599.90
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
IP
|
$4,126.82
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,599.90 |
| Max. Negotiated Rate |
$3,714.14 |
| Rate for Payer: Aetna Commercial |
$3,507.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.43
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cofinity Advantage |
$2,888.77
|
| Rate for Payer: Cofinity Commercial |
$3,549.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.46
|
| Rate for Payer: Healthscope Commercial |
$3,714.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,095.11
|
| Rate for Payer: PHP Commercial |
$3,507.80
|
| Rate for Payer: Priority Health SBD |
$2,599.90
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
OP
|
$3,158.79
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.36 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$2,684.97
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,053.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.32
|
| Rate for Payer: BCCCP Commercial |
$685.36
|
| Rate for Payer: BCN Commercial |
$1,053.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$2,527.03
|
| Rate for Payer: Cash Price |
$2,527.03
|
| Rate for Payer: Cash Price |
$2,527.03
|
| Rate for Payer: Cofinity Advantage |
$2,211.15
|
| Rate for Payer: Cofinity Commercial |
$2,716.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,527.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,842.91
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,684.97
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,369.09
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$2,684.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,990.04
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
IP
|
$3,158.79
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,990.04 |
| Max. Negotiated Rate |
$2,842.91 |
| Rate for Payer: Aetna Commercial |
$2,684.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,053.21
|
| Rate for Payer: Cash Price |
$2,527.03
|
| Rate for Payer: Cofinity Advantage |
$2,211.15
|
| Rate for Payer: Cofinity Commercial |
$2,716.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,527.03
|
| Rate for Payer: Healthscope Commercial |
$2,842.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,684.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,369.09
|
| Rate for Payer: PHP Commercial |
$2,684.97
|
| Rate for Payer: Priority Health SBD |
$1,990.04
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
IP
|
$3,815.35
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,403.67 |
| Max. Negotiated Rate |
$3,433.82 |
| Rate for Payer: Aetna Commercial |
$3,243.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,479.98
|
| Rate for Payer: Cash Price |
$3,052.28
|
| Rate for Payer: Cofinity Advantage |
$2,670.74
|
| Rate for Payer: Cofinity Commercial |
$3,281.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,052.28
|
| Rate for Payer: Healthscope Commercial |
$3,433.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,243.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,861.51
|
| Rate for Payer: PHP Commercial |
$3,243.05
|
| Rate for Payer: Priority Health SBD |
$2,403.67
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
OP
|
$3,815.35
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.33 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$3,243.05
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,479.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$766.46
|
| Rate for Payer: BCCCP Commercial |
$456.33
|
| Rate for Payer: BCN Commercial |
$766.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$3,052.28
|
| Rate for Payer: Cash Price |
$3,052.28
|
| Rate for Payer: Cash Price |
$3,052.28
|
| Rate for Payer: Cofinity Advantage |
$2,670.74
|
| Rate for Payer: Cofinity Commercial |
$3,281.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,052.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$3,433.82
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,243.05
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,861.51
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$3,243.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$2,403.67
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
IP
|
$4,208.80
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,651.54 |
| Max. Negotiated Rate |
$3,787.92 |
| Rate for Payer: Aetna Commercial |
$3,577.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,735.72
|
| Rate for Payer: Cash Price |
$3,367.04
|
| Rate for Payer: Cofinity Advantage |
$2,946.16
|
| Rate for Payer: Cofinity Commercial |
$3,619.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,367.04
|
| Rate for Payer: Healthscope Commercial |
$3,787.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,577.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,156.60
|
| Rate for Payer: PHP Commercial |
$3,577.48
|
| Rate for Payer: Priority Health SBD |
$2,651.54
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
OP
|
$4,208.80
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$450.69 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$3,577.48
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,735.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$670.69
|
| Rate for Payer: BCCCP Commercial |
$450.69
|
| Rate for Payer: BCN Commercial |
$670.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$3,367.04
|
| Rate for Payer: Cash Price |
$3,367.04
|
| Rate for Payer: Cash Price |
$3,367.04
|
| Rate for Payer: Cofinity Advantage |
$2,946.16
|
| Rate for Payer: Cofinity Commercial |
$3,619.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,367.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$3,787.92
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,577.48
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,156.60
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$3,577.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$2,651.54
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
OP
|
$370.36
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$314.81
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$248.73
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$296.29
|
| Rate for Payer: Cash Price |
$296.29
|
| Rate for Payer: Cofinity Advantage |
$259.25
|
| Rate for Payer: Cofinity Commercial |
$318.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$333.32
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.81
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.77
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$314.81
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$233.33
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
IP
|
$370.36
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$233.33 |
| Max. Negotiated Rate |
$333.32 |
| Rate for Payer: Aetna Commercial |
$314.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.73
|
| Rate for Payer: Cash Price |
$296.29
|
| Rate for Payer: Cofinity Advantage |
$259.25
|
| Rate for Payer: Cofinity Commercial |
$318.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.29
|
| Rate for Payer: Healthscope Commercial |
$333.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.77
|
| Rate for Payer: PHP Commercial |
$314.81
|
| Rate for Payer: Priority Health SBD |
$233.33
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
IP
|
$25.97
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$16.36
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
OP
|
$25.97
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.24
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$10.21
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
OP
|
$263.19
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$236.87 |
| Rate for Payer: Aetna Commercial |
$223.71
|
| Rate for Payer: Aetna Medicare |
$131.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.07
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: Cash Price |
$210.55
|
| Rate for Payer: Cofinity Advantage |
$184.23
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.55
|
| Rate for Payer: Healthscope Commercial |
$236.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.39
|
| Rate for Payer: PHP Commercial |
$223.71
|
| Rate for Payer: Priority Health SBD |
$165.81
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
IP
|
$263.19
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$236.87 |
| Rate for Payer: Aetna Commercial |
$223.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.07
|
| Rate for Payer: Cash Price |
$210.55
|
| Rate for Payer: Cofinity Advantage |
$184.23
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.55
|
| Rate for Payer: Healthscope Commercial |
$236.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.39
|
| Rate for Payer: PHP Commercial |
$223.71
|
| Rate for Payer: Priority Health SBD |
$165.81
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
IP
|
$3,165.75
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,994.42 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Aetna Commercial |
$2,690.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,057.74
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: Cofinity Advantage |
$2,216.03
|
| Rate for Payer: Cofinity Commercial |
$2,722.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.60
|
| Rate for Payer: Healthscope Commercial |
$2,849.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,374.31
|
| Rate for Payer: PHP Commercial |
$2,690.89
|
| Rate for Payer: Priority Health SBD |
$1,994.42
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
OP
|
$3,165.75
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,266.30 |
| Max. Negotiated Rate |
$2,849.18 |
| Rate for Payer: Aetna Commercial |
$2,690.89
|
| Rate for Payer: Aetna Medicare |
$1,582.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,057.74
|
| Rate for Payer: BCBS Complete |
$1,266.30
|
| Rate for Payer: Cash Price |
$2,532.60
|
| Rate for Payer: Cofinity Advantage |
$2,216.03
|
| Rate for Payer: Cofinity Commercial |
$2,722.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,532.60
|
| Rate for Payer: Healthscope Commercial |
$2,849.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,532.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,690.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,374.31
|
| Rate for Payer: PHP Commercial |
$2,690.89
|
| Rate for Payer: Priority Health SBD |
$1,994.42
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
OP
|
$279.24
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$237.35
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$109.55
|
| Rate for Payer: BCN Commercial |
$109.55
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$223.39
|
| Rate for Payer: Cash Price |
$223.39
|
| Rate for Payer: Cofinity Advantage |
$195.47
|
| Rate for Payer: Cofinity Commercial |
$240.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$251.32
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.35
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.43
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$237.35
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$175.92
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.51
|
| Rate for Payer: UHC Core |
$145.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$109.74
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
IP
|
$279.24
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$175.92 |
| Max. Negotiated Rate |
$251.32 |
| Rate for Payer: Aetna Commercial |
$237.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.51
|
| Rate for Payer: Cash Price |
$223.39
|
| Rate for Payer: Cofinity Advantage |
$195.47
|
| Rate for Payer: Cofinity Commercial |
$240.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.39
|
| Rate for Payer: Healthscope Commercial |
$251.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.43
|
| Rate for Payer: PHP Commercial |
$237.35
|
| Rate for Payer: Priority Health SBD |
$175.92
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
OP
|
$268.38
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$228.12
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$168.78
|
| Rate for Payer: BCN Commercial |
$168.78
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$214.70
|
| Rate for Payer: Cash Price |
$214.70
|
| Rate for Payer: Cofinity Advantage |
$187.87
|
| Rate for Payer: Cofinity Commercial |
$230.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$241.54
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.12
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.28
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$228.12
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$169.08
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.45
|
| Rate for Payer: UHC Core |
$139.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$105.47
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
IP
|
$268.38
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$169.08 |
| Max. Negotiated Rate |
$241.54 |
| Rate for Payer: Aetna Commercial |
$228.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.45
|
| Rate for Payer: Cash Price |
$214.70
|
| Rate for Payer: Cofinity Advantage |
$187.87
|
| Rate for Payer: Cofinity Commercial |
$230.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.70
|
| Rate for Payer: Healthscope Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.28
|
| Rate for Payer: PHP Commercial |
$228.12
|
| Rate for Payer: Priority Health SBD |
$169.08
|
|
