|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
IP
|
$23.21
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$20.89 |
| Rate for Payer: Aetna Commercial |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.09
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Cofinity Advantage |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.41
|
| Rate for Payer: PHP Commercial |
$19.73
|
| Rate for Payer: Priority Health SBD |
$14.62
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,175.67
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,630.67 |
| Max. Negotiated Rate |
$3,758.10 |
| Rate for Payer: Aetna Commercial |
$3,549.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,714.19
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Advantage |
$2,922.97
|
| Rate for Payer: Cofinity Commercial |
$3,591.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Healthscope Commercial |
$3,758.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: PHP Commercial |
$3,549.32
|
| Rate for Payer: Priority Health SBD |
$2,630.67
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,175.67
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,238.73 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$3,549.32
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,714.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.73
|
| Rate for Payer: BCN Commercial |
$1,238.73
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Advantage |
$2,922.97
|
| Rate for Payer: Cofinity Commercial |
$3,591.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$3,758.10
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,549.32
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$2,630.67
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,714.19
|
| Rate for Payer: UHC Core |
$2,175.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$1,641.04
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,620.60
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,580.98 |
| Max. Negotiated Rate |
$12,258.54 |
| Rate for Payer: Aetna Commercial |
$11,577.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,853.39
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Advantage |
$9,534.42
|
| Rate for Payer: Cofinity Commercial |
$11,713.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Healthscope Commercial |
$12,258.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PHP Commercial |
$11,577.51
|
| Rate for Payer: Priority Health SBD |
$8,580.98
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
OP
|
$13,620.60
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Commercial |
$11,577.51
|
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,853.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,616.68
|
| Rate for Payer: BCN Commercial |
$2,616.68
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Advantage |
$9,534.42
|
| Rate for Payer: Cofinity Commercial |
$11,713.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$12,258.54
|
| Rate for Payer: Mclaren Medicaid |
$2,606.87
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$11,577.51
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health SBD |
$8,580.98
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,853.39
|
| Rate for Payer: UHC Core |
$7,096.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Exchange |
$5,352.90
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,105.80 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,985.86
|
| Rate for Payer: BCN Commercial |
$1,985.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,267.89
|
| Rate for Payer: UHC Core |
$4,222.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$3,185.04
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$13,620.60
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Commercial |
$11,577.51
|
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,853.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,159.63
|
| Rate for Payer: BCN Commercial |
$3,159.63
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Advantage |
$9,534.42
|
| Rate for Payer: Cofinity Commercial |
$11,713.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$12,258.54
|
| Rate for Payer: Mclaren Medicaid |
$2,606.87
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$11,577.51
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health SBD |
$8,580.98
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,853.39
|
| Rate for Payer: UHC Core |
$7,096.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Exchange |
$5,352.90
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$13,620.60
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,580.98 |
| Max. Negotiated Rate |
$12,258.54 |
| Rate for Payer: Aetna Commercial |
$11,577.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,853.39
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Advantage |
$9,534.42
|
| Rate for Payer: Cofinity Commercial |
$11,713.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Healthscope Commercial |
$12,258.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PHP Commercial |
$11,577.51
|
| Rate for Payer: Priority Health SBD |
$8,580.98
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,620.60
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,580.98 |
| Max. Negotiated Rate |
$12,258.54 |
| Rate for Payer: Aetna Commercial |
$11,577.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,853.39
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Advantage |
$9,534.42
|
| Rate for Payer: Cofinity Commercial |
$11,713.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Healthscope Commercial |
$12,258.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PHP Commercial |
$11,577.51
|
| Rate for Payer: Priority Health SBD |
$8,580.98
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
OP
|
$13,620.60
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,399.84 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: VA VA |
$4,984.46
|
| Rate for Payer: Aetna Commercial |
$11,577.51
|
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,853.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,399.84
|
| Rate for Payer: BCN Commercial |
$2,399.84
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cash Price |
$10,896.48
|
| Rate for Payer: Cofinity Advantage |
$9,534.42
|
| Rate for Payer: Cofinity Commercial |
$11,713.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,896.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$12,258.54
|
| Rate for Payer: Mclaren Medicaid |
$2,606.87
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,577.51
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,215.45
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$11,577.51
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health SBD |
$8,580.98
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,853.39
|
| Rate for Payer: UHC Core |
$7,096.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Exchange |
$5,352.90
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,175.67
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,630.67 |
| Max. Negotiated Rate |
$3,758.10 |
| Rate for Payer: Aetna Commercial |
$3,549.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,714.19
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Advantage |
$2,922.97
|
| Rate for Payer: Cofinity Commercial |
$3,591.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Healthscope Commercial |
$3,758.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: PHP Commercial |
$3,549.32
|
| Rate for Payer: Priority Health SBD |
$2,630.67
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,175.67
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,641.04 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$3,549.32
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,714.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.16
|
| Rate for Payer: BCN Commercial |
$2,373.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cash Price |
$3,340.54
|
| Rate for Payer: Cofinity Advantage |
$2,922.97
|
| Rate for Payer: Cofinity Commercial |
$3,591.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,340.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$3,758.10
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,549.32
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,131.75
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,549.32
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$2,630.67
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,714.19
|
| Rate for Payer: UHC Core |
$2,175.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$1,641.04
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$107.78
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna Commercial |
$91.61
|
| Rate for Payer: Aetna Medicare |
$53.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.06
|
| Rate for Payer: BCBS Complete |
$43.11
|
| Rate for Payer: BCBS Trust/PPO |
$81.93
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Advantage |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$92.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PHP Commercial |
$91.61
|
| Rate for Payer: Priority Health SBD |
$67.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.50
|
| Rate for Payer: UHC Core |
$199.50
|
| Rate for Payer: UHC Exchange |
$199.50
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$107.78
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$91.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.06
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Advantage |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$92.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PHP Commercial |
$91.61
|
| Rate for Payer: Priority Health SBD |
$67.90
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$12,420.34
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,212.05 |
| Max. Negotiated Rate |
$11,178.31 |
| Rate for Payer: Aetna Commercial |
$10,557.29
|
| Rate for Payer: Aetna Medicare |
$2,410.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,073.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,896.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,896.88
|
| Rate for Payer: BCBS Complete |
$1,272.77
|
| Rate for Payer: BCBS MAPPO |
$2,317.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,262.12
|
| Rate for Payer: BCN Commercial |
$7,262.12
|
| Rate for Payer: BCN Medicare Advantage |
$2,317.50
|
| Rate for Payer: Cash Price |
$9,936.27
|
| Rate for Payer: Cash Price |
$9,936.27
|
| Rate for Payer: Cofinity Advantage |
$8,694.24
|
| Rate for Payer: Cofinity Commercial |
$10,681.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,936.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,317.50
|
| Rate for Payer: Healthscope Commercial |
$11,178.31
|
| Rate for Payer: Mclaren Medicaid |
$1,212.05
|
| Rate for Payer: Mclaren Medicare |
$2,317.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,433.38
|
| Rate for Payer: Meridian Medicaid |
$2,433.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,665.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,549.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,557.29
|
| Rate for Payer: Nomi Health Commercial |
$6,952.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,315.25
|
| Rate for Payer: PACE Medicare |
$2,201.62
|
| Rate for Payer: PACE SWMI |
$2,317.50
|
| Rate for Payer: PHP Commercial |
$10,557.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,317.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,212.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,309.32
|
| Rate for Payer: Priority Health Medicare |
$2,317.50
|
| Rate for Payer: Priority Health SBD |
$7,824.81
|
| Rate for Payer: Priority Health Tiered Network |
$5,847.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,317.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,823.88
|
| Rate for Payer: UHC Core |
$3,823.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,317.50
|
| Rate for Payer: UHC Exchange |
$3,823.88
|
| Rate for Payer: UHC Medicaid |
$1,212.05
|
| Rate for Payer: UHCCP Medicaid |
$1,212.05
|
| Rate for Payer: VA VA |
$2,317.50
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
IP
|
$12,420.34
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,824.81 |
| Max. Negotiated Rate |
$11,178.31 |
| Rate for Payer: Aetna Commercial |
$10,557.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,073.22
|
| Rate for Payer: Cash Price |
$9,936.27
|
| Rate for Payer: Cofinity Advantage |
$8,694.24
|
| Rate for Payer: Cofinity Commercial |
$10,681.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,936.27
|
| Rate for Payer: Healthscope Commercial |
$11,178.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,557.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,315.25
|
| Rate for Payer: PHP Commercial |
$10,557.29
|
| Rate for Payer: Priority Health SBD |
$7,824.81
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$161.28 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$217.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.40
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Advantage |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: PHP Commercial |
$217.60
|
| Rate for Payer: Priority Health SBD |
$161.28
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$217.60
|
| Rate for Payer: Aetna Medicare |
$128.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.40
|
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: BCBS Trust/PPO |
$177.70
|
| Rate for Payer: BCN Commercial |
$177.70
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Advantage |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$230.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: PHP Commercial |
$217.60
|
| Rate for Payer: Priority Health SBD |
$161.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.92
|
| Rate for Payer: UHC Core |
$160.92
|
| Rate for Payer: UHC Exchange |
$160.92
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$69.49
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$75.91 |
| Rate for Payer: Aetna Commercial |
$59.07
|
| Rate for Payer: Aetna Medicare |
$25.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.09
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS MAPPO |
$24.07
|
| Rate for Payer: BCBS Trust/PPO |
$32.88
|
| Rate for Payer: BCN Commercial |
$32.88
|
| Rate for Payer: BCN Medicare Advantage |
$24.07
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cofinity Advantage |
$48.64
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.07
|
| Rate for Payer: Healthscope Commercial |
$62.54
|
| Rate for Payer: Mclaren Medicaid |
$12.59
|
| Rate for Payer: Mclaren Medicare |
$24.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.27
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.07
|
| Rate for Payer: Nomi Health Commercial |
$72.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.12
|
| Rate for Payer: PACE Medicare |
$22.87
|
| Rate for Payer: PACE SWMI |
$24.07
|
| Rate for Payer: PHP Commercial |
$59.07
|
| Rate for Payer: PHP Medicare Advantage |
$24.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75.91
|
| Rate for Payer: Priority Health Medicare |
$24.07
|
| Rate for Payer: Priority Health SBD |
$43.78
|
| Rate for Payer: Priority Health Tiered Network |
$60.73
|
| Rate for Payer: Railroad Medicare Medicare |
$24.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.72
|
| Rate for Payer: UHC Core |
$39.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.07
|
| Rate for Payer: UHC Exchange |
$39.72
|
| Rate for Payer: UHC Medicaid |
$12.59
|
| Rate for Payer: UHCCP Medicaid |
$12.59
|
| Rate for Payer: VA VA |
$24.07
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$69.49
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$62.54 |
| Rate for Payer: Aetna Commercial |
$59.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.17
|
| Rate for Payer: Cash Price |
$55.59
|
| Rate for Payer: Cofinity Advantage |
$48.64
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.59
|
| Rate for Payer: Healthscope Commercial |
$62.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.12
|
| Rate for Payer: PHP Commercial |
$59.07
|
| Rate for Payer: Priority Health SBD |
$43.78
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.73
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Advantage |
$34.17
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: Priority Health SBD |
$30.76
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$48.82
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.73
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$15.00
|
| Rate for Payer: BCN Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Advantage |
$34.17
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: UHC Exchange |
$7.16
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.74
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.68
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Advantage |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: Priority Health SBD |
$30.76
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.74
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Advantage |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: Priority Health SBD |
$30.76
|
|
