|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
IP
|
$4,126.27
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,599.55 |
| Max. Negotiated Rate |
$3,713.64 |
| Rate for Payer: Aetna Commercial |
$3,507.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.08
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cofinity Commercial |
$2,888.39
|
| Rate for Payer: Cofinity Commercial |
$3,548.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,888.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.02
|
| Rate for Payer: Healthscope Commercial |
$3,713.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.33
|
| Rate for Payer: PHP Commercial |
$3,507.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,682.08
|
| Rate for Payer: Priority Health SBD |
$2,599.55
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
OP
|
$4,126.27
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.69 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$3,507.33
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.08
|
| 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 |
$523.62
|
| Rate for Payer: BCCCP Commercial |
$450.69
|
| Rate for Payer: BCN Commercial |
$523.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cofinity Commercial |
$2,888.39
|
| Rate for Payer: Cofinity Commercial |
$3,548.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,888.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$3,713.64
|
| 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 |
$3,507.33
|
| 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 |
$3,507.33
|
| 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 |
$2,682.08
|
| 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 |
$2,599.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.69
|
| 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 BREATH HYDROGEN/METHANE TEST
|
Facility
|
OP
|
$363.10
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$73.68 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$308.64
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$284.99
|
| Rate for Payer: BCN Commercial |
$284.99
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$290.48
|
| Rate for Payer: Cash Price |
$290.48
|
| Rate for Payer: Cash Price |
$290.48
|
| Rate for Payer: Cofinity Commercial |
$312.27
|
| Rate for Payer: Cofinity Commercial |
$254.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$326.79
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.64
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$308.64
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$228.75
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.68
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
IP
|
$363.10
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$228.75 |
| Max. Negotiated Rate |
$326.79 |
| Rate for Payer: Aetna Commercial |
$308.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.02
|
| Rate for Payer: Cash Price |
$290.48
|
| Rate for Payer: Cofinity Commercial |
$254.17
|
| Rate for Payer: Cofinity Commercial |
$312.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.48
|
| Rate for Payer: Healthscope Commercial |
$326.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.64
|
| Rate for Payer: PHP Commercial |
$308.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.02
|
| Rate for Payer: Priority Health SBD |
$228.75
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
OP
|
$25.74
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$120.87 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$19.19
|
| Rate for Payer: BCN Commercial |
$19.19
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: Nomi Health Commercial |
$115.38
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.87
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$96.70
|
| Rate for Payer: Priority Health SBD |
$16.22
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$19.05
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$21.65
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
IP
|
$25.74
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$23.17 |
| Rate for Payer: Aetna Commercial |
$21.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.73
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.59
|
| Rate for Payer: Healthscope Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.88
|
| Rate for Payer: PHP Commercial |
$21.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.73
|
| Rate for Payer: Priority Health SBD |
$16.22
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
OP
|
$258.03
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$103.21 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: Aetna Medicare |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.72
|
| Rate for Payer: BCBS Complete |
$103.21
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$180.62
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.72
|
| Rate for Payer: Priority Health SBD |
$162.56
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
IP
|
$258.03
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.72
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$180.62
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.72
|
| Rate for Payer: Priority Health SBD |
$162.56
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
IP
|
$3,103.68
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,955.32 |
| Max. Negotiated Rate |
$2,793.31 |
| Rate for Payer: Aetna Commercial |
$2,638.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,017.39
|
| Rate for Payer: Cash Price |
$2,482.94
|
| Rate for Payer: Cofinity Commercial |
$2,172.58
|
| Rate for Payer: Cofinity Commercial |
$2,669.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,482.94
|
| Rate for Payer: Healthscope Commercial |
$2,793.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.13
|
| Rate for Payer: PHP Commercial |
$2,638.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.39
|
| Rate for Payer: Priority Health SBD |
$1,955.32
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
OP
|
$3,103.68
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,241.47 |
| Max. Negotiated Rate |
$2,793.31 |
| Rate for Payer: Aetna Commercial |
$2,638.13
|
| Rate for Payer: Aetna Medicare |
$1,551.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,017.39
|
| Rate for Payer: BCBS Complete |
$1,241.47
|
| Rate for Payer: Cash Price |
$2,482.94
|
| Rate for Payer: Cofinity Commercial |
$2,172.58
|
| Rate for Payer: Cofinity Commercial |
$2,669.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,482.94
|
| Rate for Payer: Healthscope Commercial |
$2,793.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.13
|
| Rate for Payer: PHP Commercial |
$2,638.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.39
|
| Rate for Payer: Priority Health SBD |
$1,955.32
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
OP
|
$273.76
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$396.95 |
| Rate for Payer: Aetna Commercial |
$232.70
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$107.79
|
| Rate for Payer: BCN Commercial |
$107.79
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$219.01
|
| Rate for Payer: Cash Price |
$219.01
|
| Rate for Payer: Cofinity Commercial |
$235.43
|
| Rate for Payer: Cofinity Commercial |
$191.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$246.38
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.70
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$232.70
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$172.47
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$202.58
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
IP
|
$273.76
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$172.47 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Aetna Commercial |
$232.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.94
|
| Rate for Payer: Cash Price |
$219.01
|
| Rate for Payer: Cofinity Commercial |
$191.63
|
| Rate for Payer: Cofinity Commercial |
$235.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.01
|
| Rate for Payer: Healthscope Commercial |
$246.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.70
|
| Rate for Payer: PHP Commercial |
$232.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.94
|
| Rate for Payer: Priority Health SBD |
$172.47
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
IP
|
$263.12
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$165.77 |
| Max. Negotiated Rate |
$236.81 |
| Rate for Payer: Aetna Commercial |
$223.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.03
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cofinity Commercial |
$184.18
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.50
|
| Rate for Payer: Healthscope Commercial |
$236.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.65
|
| Rate for Payer: PHP Commercial |
$223.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.03
|
| Rate for Payer: Priority Health SBD |
$165.77
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
OP
|
$263.12
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$396.95 |
| Rate for Payer: Aetna Commercial |
$223.65
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$169.82
|
| Rate for Payer: BCN Commercial |
$169.82
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Cofinity Commercial |
$184.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$236.81
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.65
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$223.65
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$165.77
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$194.71
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC BRONCHOSCOPY
|
Facility
|
OP
|
$2,564.80
|
|
| Hospital Charge Code |
36000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,025.92 |
| Max. Negotiated Rate |
$2,308.32 |
| Rate for Payer: Aetna Commercial |
$2,180.08
|
| Rate for Payer: Aetna Medicare |
$1,282.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,667.12
|
| Rate for Payer: BCBS Complete |
$1,025.92
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$1,795.36
|
| Rate for Payer: Cofinity Commercial |
$2,205.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,795.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: PHP Commercial |
$2,180.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health SBD |
$1,615.82
|
|
|
HC BRONCHOSCOPY
|
Facility
|
IP
|
$2,564.80
|
|
| Hospital Charge Code |
36000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,615.82 |
| Max. Negotiated Rate |
$2,308.32 |
| Rate for Payer: Aetna Commercial |
$2,180.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,667.12
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$1,795.36
|
| Rate for Payer: Cofinity Commercial |
$2,205.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,795.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,308.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: PHP Commercial |
$2,180.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health SBD |
$1,615.82
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
IP
|
$3,178.02
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,002.15 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Aetna Commercial |
$2,701.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,065.71
|
| Rate for Payer: Cash Price |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,224.61
|
| Rate for Payer: Cofinity Commercial |
$2,733.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,224.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,542.42
|
| Rate for Payer: Healthscope Commercial |
$2,860.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,701.32
|
| Rate for Payer: PHP Commercial |
$2,701.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.71
|
| Rate for Payer: Priority Health SBD |
$2,002.15
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
OP
|
$3,178.02
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,271.21 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Aetna Commercial |
$2,701.32
|
| Rate for Payer: Aetna Medicare |
$1,589.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,065.71
|
| Rate for Payer: BCBS Complete |
$1,271.21
|
| Rate for Payer: Cash Price |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,224.61
|
| Rate for Payer: Cofinity Commercial |
$2,733.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,224.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,542.42
|
| Rate for Payer: Healthscope Commercial |
$2,860.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,701.32
|
| Rate for Payer: PHP Commercial |
$2,701.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.71
|
| Rate for Payer: Priority Health SBD |
$2,002.15
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
IP
|
$708.68
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$446.47 |
| Max. Negotiated Rate |
$637.81 |
| Rate for Payer: Aetna Commercial |
$602.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.64
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cofinity Commercial |
$496.08
|
| Rate for Payer: Cofinity Commercial |
$609.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$496.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.94
|
| Rate for Payer: Healthscope Commercial |
$637.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.38
|
| Rate for Payer: PHP Commercial |
$602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.64
|
| Rate for Payer: Priority Health SBD |
$446.47
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
OP
|
$708.68
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$602.38
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$159.47
|
| Rate for Payer: BCN Commercial |
$159.47
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cofinity Commercial |
$609.46
|
| Rate for Payer: Cofinity Commercial |
$496.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$496.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$637.81
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.38
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$602.38
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$446.47
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$524.42
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC BRUCELLA ANTIBODY
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200236
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Mclaren Medicare |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$13.40
|
| Rate for Payer: PACE Medicare |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.19
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health Narrow Network |
$7.35
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$5.03
|
| Rate for Payer: VA VA |
$8.93
|
|
|
HC BRUCELLA ANTIBODY
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200236
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC BRUCELLA ANTIBODY CMPT
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200238
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Mclaren Medicare |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$13.40
|
| Rate for Payer: PACE Medicare |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.19
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health Narrow Network |
$7.35
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$5.03
|
| Rate for Payer: VA VA |
$8.93
|
|
|
HC BRUCELLA ANTIBODY CMPT
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200238
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC BRUCELLA ANTIBODY CONFIRMATION
|
Facility
|
IP
|
$53.04
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health SBD |
$33.42
|
|
