|
HC FNA BX 1ST LESION US GUIDE
|
Facility
|
OP
|
$890.46
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
36100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$801.41 |
| Rate for Payer: Aetna Commercial |
$756.89
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$677.59
|
| Rate for Payer: BCCCP Commercial |
$141.12
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$623.32
|
| Rate for Payer: Cofinity Commercial |
$765.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$801.41
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$756.89
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health SBD |
$560.99
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$70.73
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC FNA BX 1ST LESION US GUIDE
|
Facility
|
IP
|
$890.46
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
36100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.99 |
| Max. Negotiated Rate |
$801.41 |
| Rate for Payer: Aetna Commercial |
$756.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.80
|
| Rate for Payer: Cash Price |
$712.37
|
| Rate for Payer: Cofinity Commercial |
$765.80
|
| Rate for Payer: Cofinity Commercial |
$623.32
|
| Rate for Payer: Healthscope Commercial |
$801.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$756.89
|
| Rate for Payer: PHP Commercial |
$756.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.32
|
| Rate for Payer: Priority Health SBD |
$560.99
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
OP
|
$147.90
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.16 |
| Max. Negotiated Rate |
$937.77 |
| Rate for Payer: Aetna Commercial |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.14
|
| Rate for Payer: BCBS Complete |
$59.16
|
| Rate for Payer: BCBS Trust/PPO |
$937.77
|
| Rate for Payer: BCCCP Commercial |
$245.50
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$103.53
|
| Rate for Payer: Cofinity Commercial |
$127.19
|
| Rate for Payer: Healthscope Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: PHP Commercial |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health SBD |
$93.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.72
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
IP
|
$147.90
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$133.11 |
| Rate for Payer: Aetna Commercial |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.14
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$103.53
|
| Rate for Payer: Cofinity Commercial |
$127.19
|
| Rate for Payer: Healthscope Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: PHP Commercial |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health SBD |
$93.18
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
IP
|
$162.69
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.49 |
| Max. Negotiated Rate |
$146.42 |
| Rate for Payer: Aetna Commercial |
$138.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.75
|
| Rate for Payer: Cash Price |
$130.15
|
| Rate for Payer: Cofinity Commercial |
$113.88
|
| Rate for Payer: Cofinity Commercial |
$139.91
|
| Rate for Payer: Healthscope Commercial |
$146.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.29
|
| Rate for Payer: PHP Commercial |
$138.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.88
|
| Rate for Payer: Priority Health SBD |
$102.49
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
OP
|
$162.69
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$138.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.75
|
| Rate for Payer: BCBS Complete |
$65.08
|
| Rate for Payer: BCBS Trust/PPO |
$535.87
|
| Rate for Payer: BCCCP Commercial |
$149.11
|
| Rate for Payer: Cash Price |
$130.15
|
| Rate for Payer: Cash Price |
$130.15
|
| Rate for Payer: Cofinity Commercial |
$139.91
|
| Rate for Payer: Cofinity Commercial |
$113.88
|
| Rate for Payer: Healthscope Commercial |
$146.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.29
|
| Rate for Payer: PHP Commercial |
$138.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.88
|
| Rate for Payer: Priority Health SBD |
$102.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$49.77
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$195.23
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$175.71 |
| Rate for Payer: Aetna Commercial |
$165.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.90
|
| Rate for Payer: Cash Price |
$156.18
|
| Rate for Payer: Cofinity Commercial |
$136.66
|
| Rate for Payer: Cofinity Commercial |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$175.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.95
|
| Rate for Payer: PHP Commercial |
$165.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.66
|
| Rate for Payer: Priority Health SBD |
$122.99
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$195.23
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.46 |
| Max. Negotiated Rate |
$507.33 |
| Rate for Payer: Aetna Commercial |
$165.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.90
|
| Rate for Payer: BCBS Complete |
$78.09
|
| Rate for Payer: BCBS Trust/PPO |
$507.33
|
| Rate for Payer: BCCCP Commercial |
$62.74
|
| Rate for Payer: Cash Price |
$156.18
|
| Rate for Payer: Cash Price |
$156.18
|
| Rate for Payer: Cofinity Commercial |
$136.66
|
| Rate for Payer: Cofinity Commercial |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$175.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.95
|
| Rate for Payer: PHP Commercial |
$165.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.66
|
| Rate for Payer: Priority Health SBD |
$122.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.31
|
| Rate for Payer: UHC Exchange |
$48.46
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$73.24
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$65.92 |
| Rate for Payer: Aetna Commercial |
$62.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.61
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Cofinity Commercial |
$51.27
|
| Rate for Payer: Healthscope Commercial |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.25
|
| Rate for Payer: PHP Commercial |
$62.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.27
|
| Rate for Payer: Priority Health SBD |
$46.14
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$73.24
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$464.37 |
| Rate for Payer: Aetna Commercial |
$62.25
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$25.64
|
| Rate for Payer: BCCCP Commercial |
$56.11
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cash Price |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$51.27
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$65.92
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.25
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$62.25
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$464.37
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health Narrow Network |
$371.50
|
| Rate for Payer: Priority Health SBD |
$46.14
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.15
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$54.68
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$31.69 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$9.93
|
| Rate for Payer: BCCCP Commercial |
$29.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.69
|
| Rate for Payer: UHC Core |
$13.39
|
| Rate for Payer: UHC Exchange |
$28.81
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
OP
|
$217.45
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$26.38 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna Medicare |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.28
|
| Rate for Payer: BCBS Complete |
$27.70
|
| Rate for Payer: BCBS MAPPO |
$48.22
|
| Rate for Payer: BCBS Trust/PPO |
$115.01
|
| Rate for Payer: BCCCP Commercial |
$163.43
|
| Rate for Payer: BCN Medicare Advantage |
$48.22
|
| Rate for Payer: Cash Price |
$173.96
|
| Rate for Payer: Cash Price |
$173.96
|
| Rate for Payer: Cofinity Commercial |
$187.01
|
| Rate for Payer: Cofinity Commercial |
$152.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$195.70
|
| Rate for Payer: Mclaren Medicaid |
$26.38
|
| Rate for Payer: Mclaren Medicare |
$48.22
|
| Rate for Payer: Meridian Medicaid |
$27.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.83
|
| Rate for Payer: PACE Medicare |
$45.81
|
| Rate for Payer: PACE SWMI |
$48.22
|
| Rate for Payer: PHP Commercial |
$184.83
|
| Rate for Payer: PHP Medicare Advantage |
$48.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.72
|
| Rate for Payer: Priority Health Medicare |
$48.22
|
| Rate for Payer: Priority Health Narrow Network |
$123.78
|
| Rate for Payer: Priority Health SBD |
$136.99
|
| Rate for Payer: Railroad Medicare Medicare |
$48.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.82
|
| Rate for Payer: UHC Core |
$44.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.22
|
| Rate for Payer: UHC Exchange |
$164.38
|
| Rate for Payer: UHC Medicare Advantage |
$49.67
|
| Rate for Payer: VA VA |
$48.22
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
IP
|
$217.45
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$136.99 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.34
|
| Rate for Payer: Cash Price |
$173.96
|
| Rate for Payer: Cofinity Commercial |
$152.22
|
| Rate for Payer: Cofinity Commercial |
$187.01
|
| Rate for Payer: Healthscope Commercial |
$195.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.83
|
| Rate for Payer: PHP Commercial |
$184.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.22
|
| Rate for Payer: Priority Health SBD |
$136.99
|
|
|
HC FOLATE SERUM
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.38
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCN Medicare Advantage |
$14.70
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Mclaren Medicare |
$14.70
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.70
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$14.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.64
|
| Rate for Payer: UHC Core |
$24.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.70
|
| Rate for Payer: UHC Exchange |
$14.70
|
| Rate for Payer: UHC Medicare Advantage |
$15.14
|
| Rate for Payer: VA VA |
$14.70
|
|
|
HC FOLATE SERUM
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
IP
|
$490.51
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.83
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health SBD |
$309.02
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
OP
|
$490.51
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.83
|
| Rate for Payer: BCBS Complete |
$196.20
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health SBD |
$309.02
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
IP
|
$64.26
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health SBD |
$40.48
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
OP
|
$64.26
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.22
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS MAPPO |
$18.58
|
| Rate for Payer: BCBS Trust/PPO |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.58
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Mclaren Medicaid |
$10.16
|
| Rate for Payer: Mclaren Medicare |
$18.58
|
| Rate for Payer: Meridian Medicaid |
$10.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PACE Medicare |
$17.65
|
| Rate for Payer: PACE SWMI |
$18.58
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: PHP Medicare Advantage |
$18.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health Medicare |
$18.58
|
| Rate for Payer: Priority Health SBD |
$40.48
|
| Rate for Payer: Railroad Medicare Medicare |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.30
|
| Rate for Payer: UHC Core |
$31.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.58
|
| Rate for Payer: UHC Exchange |
$18.58
|
| Rate for Payer: UHC Medicare Advantage |
$19.14
|
| Rate for Payer: VA VA |
$18.58
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
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 |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| 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 FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
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 FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$637.50
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$401.62 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Aetna Commercial |
$541.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.38
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cofinity Commercial |
$446.25
|
| Rate for Payer: Cofinity Commercial |
$548.25
|
| Rate for Payer: Healthscope Commercial |
$573.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.88
|
| Rate for Payer: PHP Commercial |
$541.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.25
|
| Rate for Payer: Priority Health SBD |
$401.62
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$637.50
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$2,072.17 |
| Rate for Payer: Aetna Commercial |
$541.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.38
|
| Rate for Payer: BCBS Complete |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,072.17
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cofinity Commercial |
$446.25
|
| Rate for Payer: Cofinity Commercial |
$548.25
|
| Rate for Payer: Healthscope Commercial |
$573.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.88
|
| Rate for Payer: PHP Commercial |
$541.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.25
|
| Rate for Payer: Priority Health SBD |
$401.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.67
|
| Rate for Payer: UHC Exchange |
$938.89
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$450.54
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.84 |
| Max. Negotiated Rate |
$405.49 |
| Rate for Payer: Aetna Commercial |
$382.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.85
|
| Rate for Payer: Cash Price |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Cofinity Commercial |
$387.46
|
| Rate for Payer: Healthscope Commercial |
$405.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.96
|
| Rate for Payer: PHP Commercial |
$382.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.38
|
| Rate for Payer: Priority Health SBD |
$283.84
|
|
