|
HC BRACE WAIST BELT
|
Facility
|
IP
|
$147.52
|
|
|
Service Code
|
HCPCS L5688
|
| Hospital Charge Code |
27400031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.94 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.89
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health SBD |
$92.94
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
IP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.68 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.46
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health SBD |
$213.68
|
|
|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.67 |
| Max. Negotiated Rate |
$1,057.60 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Medicare |
$169.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.46
|
| Rate for Payer: BCBS Complete |
$135.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,057.60
|
| Rate for Payer: BCN Commercial |
$1,057.60
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$291.69
|
| Rate for Payer: Cofinity Commercial |
$237.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$305.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: PHP Commercial |
$288.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.62
|
| Rate for Payer: Priority Health Narrow Network |
$312.50
|
| Rate for Payer: Priority Health SBD |
$213.68
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.13 |
| Max. Negotiated Rate |
$434.48 |
| Rate for Payer: Aetna Commercial |
$410.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.79
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$337.92
|
| Rate for Payer: Cofinity Commercial |
$415.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$434.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: PHP Commercial |
$410.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health SBD |
$304.13
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.10 |
| Max. Negotiated Rate |
$1,504.52 |
| Rate for Payer: Aetna Commercial |
$410.34
|
| Rate for Payer: Aetna Medicare |
$241.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.79
|
| Rate for Payer: BCBS Complete |
$193.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,504.52
|
| Rate for Payer: BCN Commercial |
$1,504.52
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$415.16
|
| Rate for Payer: Cofinity Commercial |
$337.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$434.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: PHP Commercial |
$410.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.68
|
| Rate for Payer: Priority Health Narrow Network |
$444.54
|
| Rate for Payer: Priority Health SBD |
$304.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.19
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$869.93 |
| Max. Negotiated Rate |
$2,944.17 |
| Rate for Payer: Aetna Commercial |
$1,968.09
|
| Rate for Payer: Aetna Medicare |
$1,157.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,505.01
|
| Rate for Payer: BCBS Complete |
$926.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,944.17
|
| Rate for Payer: BCN Commercial |
$2,944.17
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$1,991.24
|
| Rate for Payer: Cofinity Commercial |
$1,620.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,620.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,083.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: PHP Commercial |
$1,968.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.41
|
| Rate for Payer: Priority Health Narrow Network |
$869.93
|
| Rate for Payer: Priority Health SBD |
$1,458.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,274.30
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,458.70 |
| Max. Negotiated Rate |
$2,083.86 |
| Rate for Payer: Aetna Commercial |
$1,968.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,505.01
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$1,620.78
|
| Rate for Payer: Cofinity Commercial |
$1,991.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,620.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,083.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: PHP Commercial |
$1,968.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health SBD |
$1,458.70
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Aetna Commercial |
$130.08
|
| Rate for Payer: Aetna Medicare |
$76.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.48
|
| Rate for Payer: BCBS Complete |
$61.22
|
| Rate for Payer: BCBS Trust/PPO |
$217.67
|
| Rate for Payer: BCN Commercial |
$217.67
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$131.61
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: PHP Commercial |
$130.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.39
|
| Rate for Payer: Priority Health Narrow Network |
$64.31
|
| Rate for Payer: Priority Health SBD |
$96.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.21
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Aetna Commercial |
$130.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.48
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Commercial |
$131.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: PHP Commercial |
$130.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: Priority Health SBD |
$96.42
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.25 |
| Max. Negotiated Rate |
$201.79 |
| Rate for Payer: Aetna Commercial |
$190.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.74
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$156.95
|
| Rate for Payer: Cofinity Commercial |
$192.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Healthscope Commercial |
$201.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: PHP Commercial |
$190.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health SBD |
$141.25
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$201.79 |
| Rate for Payer: Aetna Commercial |
$190.58
|
| Rate for Payer: Aetna Medicare |
$35.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.00
|
| Rate for Payer: BCBS Complete |
$19.36
|
| Rate for Payer: BCBS MAPPO |
$34.40
|
| Rate for Payer: BCN Medicare Advantage |
$34.40
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$156.95
|
| Rate for Payer: Cofinity Commercial |
$192.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$201.79
|
| Rate for Payer: Mclaren Medicaid |
$18.44
|
| Rate for Payer: Mclaren Medicare |
$34.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.12
|
| Rate for Payer: Meridian Medicaid |
$19.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$103.20
|
| Rate for Payer: PACE Medicare |
$32.68
|
| Rate for Payer: PACE SWMI |
$34.40
|
| Rate for Payer: PHP Commercial |
$190.58
|
| Rate for Payer: PHP Medicare Advantage |
$34.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.13
|
| Rate for Payer: Priority Health Medicare |
$34.40
|
| Rate for Payer: Priority Health Narrow Network |
$86.50
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: Railroad Medicare Medicare |
$34.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.40
|
| Rate for Payer: UHC Medicare Advantage |
$34.40
|
| Rate for Payer: UHCCP Medicaid |
$19.37
|
| Rate for Payer: VA VA |
$34.40
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,125.72 |
| Max. Negotiated Rate |
$1,608.16 |
| Rate for Payer: Aetna Commercial |
$1,518.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,161.45
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,250.80
|
| Rate for Payer: Cofinity Commercial |
$1,536.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,250.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,608.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: PHP Commercial |
$1,518.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: Priority Health SBD |
$1,125.72
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.74 |
| Max. Negotiated Rate |
$1,608.16 |
| Rate for Payer: Aetna Commercial |
$1,518.82
|
| Rate for Payer: Aetna Medicare |
$893.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,161.45
|
| Rate for Payer: BCBS Complete |
$714.74
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,250.80
|
| Rate for Payer: Cofinity Commercial |
$1,536.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,250.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,608.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: PHP Commercial |
$1,518.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: Priority Health SBD |
$1,125.72
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$4,661.30 |
| Rate for Payer: Aetna Commercial |
$4,402.34
|
| Rate for Payer: Aetna Medicare |
$2,589.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,366.49
|
| Rate for Payer: BCBS Complete |
$2,071.69
|
| Rate for Payer: BCBS Trust/PPO |
$911.96
|
| Rate for Payer: BCCCP Commercial |
$524.38
|
| Rate for Payer: BCN Commercial |
$911.96
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$3,625.45
|
| Rate for Payer: Cofinity Commercial |
$4,454.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,625.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$4,661.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: PHP Commercial |
$4,402.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: Priority Health SBD |
$3,262.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,262.91 |
| Max. Negotiated Rate |
$4,661.30 |
| Rate for Payer: Aetna Commercial |
$4,402.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,366.49
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$3,625.45
|
| Rate for Payer: Cofinity Commercial |
$4,454.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,625.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$4,661.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: PHP Commercial |
$4,402.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: Priority Health SBD |
$3,262.91
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,670.34
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.65 |
| Max. Negotiated Rate |
$3,303.31 |
| Rate for Payer: Aetna Commercial |
$3,119.79
|
| Rate for Payer: Aetna Medicare |
$1,835.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,385.72
|
| Rate for Payer: BCBS Complete |
$1,468.14
|
| Rate for Payer: BCBS Trust/PPO |
$938.10
|
| Rate for Payer: BCCCP Commercial |
$344.68
|
| Rate for Payer: BCN Commercial |
$938.10
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cofinity Commercial |
$2,569.24
|
| Rate for Payer: Cofinity Commercial |
$3,156.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,569.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,936.27
|
| Rate for Payer: Healthscope Commercial |
$3,303.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,119.79
|
| Rate for Payer: PHP Commercial |
$3,119.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,385.72
|
| Rate for Payer: Priority Health SBD |
$2,312.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.65
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,670.34
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,312.31 |
| Max. Negotiated Rate |
$3,303.31 |
| Rate for Payer: Aetna Commercial |
$3,119.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,385.72
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cofinity Commercial |
$2,569.24
|
| Rate for Payer: Cofinity Commercial |
$3,156.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,569.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,936.27
|
| Rate for Payer: Healthscope Commercial |
$3,303.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,119.79
|
| Rate for Payer: PHP Commercial |
$3,119.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,385.72
|
| Rate for Payer: Priority Health SBD |
$2,312.31
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
OP
|
$4,045.90
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.02
|
| Rate for Payer: Aetna Medicare |
$2,022.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.84
|
| Rate for Payer: BCBS Complete |
$1,618.36
|
| Rate for Payer: BCBS Trust/PPO |
$862.20
|
| Rate for Payer: BCCCP Commercial |
$338.10
|
| Rate for Payer: BCN Commercial |
$862.20
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$2,832.13
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,832.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.02
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health SBD |
$2,548.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.64
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
IP
|
$4,045.90
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,548.92 |
| Max. Negotiated Rate |
$3,641.31 |
| Rate for Payer: Aetna Commercial |
$3,439.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.84
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$2,832.13
|
| Rate for Payer: Cofinity Commercial |
$3,479.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,832.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.02
|
| Rate for Payer: PHP Commercial |
$3,439.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health SBD |
$2,548.92
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
IP
|
$3,096.85
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,951.02 |
| Max. Negotiated Rate |
$2,787.16 |
| Rate for Payer: Aetna Commercial |
$2,632.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,012.95
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cofinity Commercial |
$2,167.80
|
| Rate for Payer: Cofinity Commercial |
$2,663.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,167.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,477.48
|
| Rate for Payer: Healthscope Commercial |
$2,787.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,632.32
|
| Rate for Payer: PHP Commercial |
$2,632.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.95
|
| Rate for Payer: Priority Health SBD |
$1,951.02
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
OP
|
$3,096.85
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.37 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$2,632.32
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,012.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$822.34
|
| Rate for Payer: BCCCP Commercial |
$685.36
|
| Rate for Payer: BCN Commercial |
$822.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cofinity Commercial |
$2,167.80
|
| Rate for Payer: Cofinity Commercial |
$2,663.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,167.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,477.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,787.16
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,632.32
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$2,632.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,951.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.37
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
IP
|
$3,740.54
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,356.54 |
| Max. Negotiated Rate |
$3,366.49 |
| Rate for Payer: Aetna Commercial |
$3,179.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cofinity Commercial |
$2,618.38
|
| Rate for Payer: Cofinity Commercial |
$3,216.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,618.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,992.43
|
| Rate for Payer: Healthscope Commercial |
$3,366.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,179.46
|
| Rate for Payer: PHP Commercial |
$3,179.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.35
|
| Rate for Payer: Priority Health SBD |
$2,356.54
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
OP
|
$3,740.54
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.83 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$3,179.46
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,431.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$598.39
|
| Rate for Payer: BCCCP Commercial |
$456.33
|
| Rate for Payer: BCN Commercial |
$598.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cofinity Commercial |
$2,618.38
|
| Rate for Payer: Cofinity Commercial |
$3,216.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,618.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,992.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$3,366.49
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,179.46
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$3,179.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$2,356.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.83
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
