|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
OP
|
$169.26
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$423.17 |
| Rate for Payer: Aetna Commercial |
$143.87
|
| Rate for Payer: Aetna Medicare |
$84.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.02
|
| Rate for Payer: BCBS Complete |
$67.70
|
| Rate for Payer: BCBS Trust/PPO |
$423.17
|
| Rate for Payer: BCCCP Commercial |
$134.52
|
| Rate for Payer: BCN Commercial |
$423.17
|
| Rate for Payer: Cash Price |
$135.41
|
| Rate for Payer: Cash Price |
$135.41
|
| Rate for Payer: Cash Price |
$135.41
|
| Rate for Payer: Cofinity Advantage |
$118.48
|
| Rate for Payer: Cofinity Commercial |
$145.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.41
|
| Rate for Payer: Healthscope Commercial |
$152.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.94
|
| Rate for Payer: PHP Commercial |
$143.87
|
| Rate for Payer: Priority Health SBD |
$106.63
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$219.05
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$400.62 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna Medicare |
$109.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.38
|
| Rate for Payer: BCBS Complete |
$87.62
|
| Rate for Payer: BCBS Trust/PPO |
$400.62
|
| Rate for Payer: BCCCP Commercial |
$58.15
|
| Rate for Payer: BCN Commercial |
$400.62
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cofinity Advantage |
$153.34
|
| Rate for Payer: Cofinity Commercial |
$188.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.24
|
| Rate for Payer: Healthscope Commercial |
$197.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.29
|
| Rate for Payer: PHP Commercial |
$186.19
|
| Rate for Payer: Priority Health SBD |
$138.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.38
|
| Rate for Payer: UHC Core |
$114.13
|
| Rate for Payer: UHC Exchange |
$86.09
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$219.05
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$197.15 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.38
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cofinity Advantage |
$153.34
|
| Rate for Payer: Cofinity Commercial |
$188.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.24
|
| Rate for Payer: Healthscope Commercial |
$197.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.29
|
| Rate for Payer: PHP Commercial |
$186.19
|
| Rate for Payer: Priority Health SBD |
$138.00
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
OP
|
$1,161.09
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$986.93
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$307.60
|
| Rate for Payer: BCCCP Commercial |
$96.42
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cofinity Advantage |
$812.76
|
| Rate for Payer: Cofinity Commercial |
$998.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,044.98
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.93
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.82
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$986.93
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$731.49
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.71
|
| Rate for Payer: UHC Core |
$604.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$456.31
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
IP
|
$1,161.09
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.49 |
| Max. Negotiated Rate |
$1,044.98 |
| Rate for Payer: Aetna Commercial |
$986.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.71
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cofinity Advantage |
$812.76
|
| Rate for Payer: Cofinity Commercial |
$998.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.87
|
| Rate for Payer: Healthscope Commercial |
$1,044.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.82
|
| Rate for Payer: PHP Commercial |
$986.93
|
| Rate for Payer: Priority Health SBD |
$731.49
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$76.19
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$64.76
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCCCP Commercial |
$53.08
|
| Rate for Payer: BCN Commercial |
$37.47
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Advantage |
$53.33
|
| Rate for Payer: Cofinity Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$68.57
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$64.76
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$48.00
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$76.19
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$68.57 |
| Rate for Payer: Aetna Commercial |
$64.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.52
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Advantage |
$53.33
|
| Rate for Payer: Cofinity Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$68.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: PHP Commercial |
$64.76
|
| Rate for Payer: Priority Health SBD |
$48.00
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$24.80
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Advantage |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.60
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health SBD |
$15.62
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$24.80
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.12
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCCCP Commercial |
$28.02
|
| Rate for Payer: BCN Commercial |
$14.77
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Advantage |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.60
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health SBD |
$15.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$12.62
|
| Rate for Payer: UHC Exchange |
$12.62
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
OP
|
$266.16
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$239.54 |
| Rate for Payer: Aetna Commercial |
$226.24
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$177.17
|
| Rate for Payer: BCCCP Commercial |
$160.49
|
| Rate for Payer: BCN Commercial |
$177.17
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cofinity Advantage |
$186.31
|
| Rate for Payer: Cofinity Commercial |
$228.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$239.54
|
| Rate for Payer: Mclaren Medicaid |
$27.15
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$54.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.24
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.62
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$226.24
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.92
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health SBD |
$167.68
|
| Rate for Payer: Priority Health Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.15
|
| Rate for Payer: UHC Core |
$80.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.15
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
IP
|
$266.16
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$167.68 |
| Max. Negotiated Rate |
$239.54 |
| Rate for Payer: Aetna Commercial |
$226.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.00
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cofinity Advantage |
$186.31
|
| Rate for Payer: Cofinity Commercial |
$228.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.93
|
| Rate for Payer: Healthscope Commercial |
$239.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.62
|
| Rate for Payer: PHP Commercial |
$226.24
|
| Rate for Payer: Priority Health SBD |
$167.68
|
|
|
HC FOLATE SERUM
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
|
HC FOLATE SERUM
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| 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 |
$8.07
|
| Rate for Payer: BCBS MAPPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$15.68
|
| Rate for Payer: BCN Commercial |
$15.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.70
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$7.69
|
| Rate for Payer: Mclaren Medicare |
$14.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.44
|
| Rate for Payer: Meridian Medicaid |
$15.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.70
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$14.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.70
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Priority Health Tiered Network |
$11.76
|
| Rate for Payer: Railroad Medicare Medicare |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.05
|
| Rate for Payer: UHC Core |
$22.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.70
|
| Rate for Payer: UHC Exchange |
$22.05
|
| Rate for Payer: UHC Medicaid |
$7.69
|
| Rate for Payer: UHCCP Medicaid |
$7.69
|
| Rate for Payer: VA VA |
$14.70
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
IP
|
$510.33
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.51 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health SBD |
$321.51
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
OP
|
$510.33
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$255.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: BCBS Complete |
$204.13
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Advantage |
$46.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: Priority Health SBD |
$42.12
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
OP
|
$66.86
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.23
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$18.58
|
| Rate for Payer: BCBS Trust/PPO |
$19.82
|
| Rate for Payer: BCN Commercial |
$19.82
|
| Rate for Payer: BCN Medicare Advantage |
$18.58
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Advantage |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$18.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.51
|
| Rate for Payer: Meridian Medicaid |
$19.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$27.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PACE Medicare |
$17.65
|
| Rate for Payer: PACE SWMI |
$18.58
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.58
|
| Rate for Payer: Priority Health Medicare |
$18.58
|
| Rate for Payer: Priority Health SBD |
$42.12
|
| Rate for Payer: Priority Health Tiered Network |
$14.86
|
| Rate for Payer: Railroad Medicare Medicare |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.87
|
| Rate for Payer: UHC Core |
$27.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.58
|
| Rate for Payer: UHC Exchange |
$27.87
|
| Rate for Payer: UHC Medicaid |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$18.58
|
|
|
HC FOLLOWUP EVAL OF FOOT PT LOP
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$338.30
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$30.30
|
| Rate for Payer: BCN Commercial |
$30.30
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Advantage |
$278.60
|
| Rate for Payer: Cofinity Commercial |
$342.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$358.20
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.30
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.50
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$338.30
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$250.74
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.70
|
| Rate for Payer: UHC Core |
$207.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$156.41
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC FOLLOWUP EVAL OF FOOT PT LOP
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$250.74 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Aetna Commercial |
$338.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.70
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Advantage |
$278.60
|
| Rate for Payer: Cofinity Commercial |
$342.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.40
|
| Rate for Payer: Healthscope Commercial |
$358.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.50
|
| Rate for Payer: PHP Commercial |
$338.30
|
| Rate for Payer: Priority Health SBD |
$250.74
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| 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 |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$663.26
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$417.85 |
| Max. Negotiated Rate |
$596.93 |
| Rate for Payer: Aetna Commercial |
$563.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.12
|
| Rate for Payer: Cash Price |
$530.61
|
| Rate for Payer: Cofinity Advantage |
$464.28
|
| Rate for Payer: Cofinity Commercial |
$570.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.61
|
| Rate for Payer: Healthscope Commercial |
$596.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.44
|
| Rate for Payer: PHP Commercial |
$563.77
|
| Rate for Payer: Priority Health SBD |
$417.85
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$663.26
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.66 |
| Max. Negotiated Rate |
$2,082.66 |
| Rate for Payer: Aetna Commercial |
$563.77
|
| Rate for Payer: Aetna Medicare |
$331.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.12
|
| Rate for Payer: BCBS Complete |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.66
|
| Rate for Payer: BCN Commercial |
$2,082.66
|
| Rate for Payer: Cash Price |
$530.61
|
| Rate for Payer: Cash Price |
$530.61
|
| Rate for Payer: Cofinity Advantage |
$464.28
|
| Rate for Payer: Cofinity Commercial |
$570.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.61
|
| Rate for Payer: Healthscope Commercial |
$596.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$530.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.44
|
| Rate for Payer: PHP Commercial |
$563.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$764.22
|
| Rate for Payer: Priority Health SBD |
$417.85
|
| Rate for Payer: Priority Health Tiered Network |
$611.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.12
|
| Rate for Payer: UHC Core |
$345.56
|
| Rate for Payer: UHC Exchange |
$260.66
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$468.74
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna Medicare |
$234.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.68
|
| Rate for Payer: BCBS Complete |
$187.50
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Advantage |
$328.12
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: Priority Health SBD |
$295.31
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$468.74
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.31 |
| Max. Negotiated Rate |
$421.87 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.68
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Advantage |
$328.12
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$421.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PHP Commercial |
$398.43
|
| Rate for Payer: Priority Health SBD |
$295.31
|
|
