|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,093.79
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,579.09 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.96
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$2,865.65
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,865.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health SBD |
$2,579.09
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Cofinity Commercial |
$2,865.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,865.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$2,579.09
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,412.72 |
| Max. Negotiated Rate |
$12,018.18 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,710.52
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Cofinity Commercial |
$5,561.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,561.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$5,005.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,005.68 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.59
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$5,561.87
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,561.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health SBD |
$5,005.68
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,412.72 |
| Max. Negotiated Rate |
$12,018.18 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,710.52
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,412.72 |
| Max. Negotiated Rate |
$12,018.18 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,552.11 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna Medicare |
$5,007.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,679.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$9,347.47
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,347.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Priority Health SBD |
$8,412.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,552.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,710.52
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,579.09 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.96
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$2,865.65
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,865.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health SBD |
$2,579.09
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Cofinity Commercial |
$2,865.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,865.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$2,579.09
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$66.57 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health SBD |
$66.57
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$52.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health SBD |
$66.57
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,112.10 |
| Max. Negotiated Rate |
$10,959.12 |
| Rate for Payer: Aetna Commercial |
$10,350.28
|
| Rate for Payer: Aetna Medicare |
$2,157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,914.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,593.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,593.51
|
| Rate for Payer: BCBS Complete |
$1,167.70
|
| Rate for Payer: BCBS MAPPO |
$2,074.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,074.81
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$10,472.05
|
| Rate for Payer: Cofinity Commercial |
$8,523.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,523.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,074.81
|
| Rate for Payer: Healthscope Commercial |
$10,959.12
|
| Rate for Payer: Mclaren Medicaid |
$1,112.10
|
| Rate for Payer: Mclaren Medicare |
$2,074.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,178.55
|
| Rate for Payer: Meridian Medicaid |
$1,167.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,386.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: PACE Medicare |
$1,971.07
|
| Rate for Payer: PACE SWMI |
$2,074.81
|
| Rate for Payer: PHP Commercial |
$10,350.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,074.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health Medicare |
$2,074.81
|
| Rate for Payer: Priority Health SBD |
$7,671.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,074.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,840.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,074.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,074.81
|
| Rate for Payer: UHCCP Medicaid |
$1,168.12
|
| Rate for Payer: VA VA |
$2,074.81
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
IP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,671.38 |
| Max. Negotiated Rate |
$10,959.12 |
| Rate for Payer: Aetna Commercial |
$10,350.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,914.92
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$10,472.05
|
| Rate for Payer: Cofinity Commercial |
$8,523.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,523.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Healthscope Commercial |
$10,959.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: PHP Commercial |
$10,350.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health SBD |
$7,671.38
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
IP
|
$74.94
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$47.21 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna Commercial |
$63.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.71
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$64.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.95
|
| Rate for Payer: Healthscope Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: PHP Commercial |
$63.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.71
|
| Rate for Payer: Priority Health SBD |
$47.21
|
|
|
HC I-131 CAP (DX) PER MCI
|
Facility
|
OP
|
$74.94
|
|
|
Service Code
|
HCPCS A9528
|
| Hospital Charge Code |
34300011
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Aetna Commercial |
$63.70
|
| Rate for Payer: Aetna Medicare |
$37.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.71
|
| Rate for Payer: BCBS Complete |
$29.98
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$64.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.95
|
| Rate for Payer: Healthscope Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: PHP Commercial |
$63.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.71
|
| Rate for Payer: Priority Health SBD |
$47.21
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
OP
|
$68.13
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$65.11 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Aetna Medicare |
$24.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.91
|
| Rate for Payer: BCBS Complete |
$13.02
|
| Rate for Payer: BCBS MAPPO |
$23.13
|
| Rate for Payer: BCN Medicare Advantage |
$23.13
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cofinity Commercial |
$58.59
|
| Rate for Payer: Cofinity Commercial |
$47.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.13
|
| Rate for Payer: Healthscope Commercial |
$61.32
|
| Rate for Payer: Mclaren Medicaid |
$12.40
|
| Rate for Payer: Mclaren Medicare |
$23.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.29
|
| Rate for Payer: Meridian Medicaid |
$13.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.91
|
| Rate for Payer: PACE Medicare |
$21.97
|
| Rate for Payer: PACE SWMI |
$23.13
|
| Rate for Payer: PHP Commercial |
$57.91
|
| Rate for Payer: PHP Medicare Advantage |
$23.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.28
|
| Rate for Payer: Priority Health Medicare |
$23.13
|
| Rate for Payer: Priority Health SBD |
$42.92
|
| Rate for Payer: Railroad Medicare Medicare |
$23.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.13
|
| Rate for Payer: UHC Medicare Advantage |
$23.13
|
| Rate for Payer: UHCCP Medicaid |
$13.02
|
| Rate for Payer: VA VA |
$23.13
|
|
|
HC I-131 CAP (TX) PER MCI
|
Facility
|
IP
|
$68.13
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34400001
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$61.32 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.28
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cofinity Commercial |
$47.69
|
| Rate for Payer: Cofinity Commercial |
$58.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.50
|
| Rate for Payer: Healthscope Commercial |
$61.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.91
|
| Rate for Payer: PHP Commercial |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.28
|
| Rate for Payer: Priority Health SBD |
$42.92
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
HC I-131 SOD IODIDE DIAG PER UCI
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
HCPCS A9531
|
| Hospital Charge Code |
34300031
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
IP
|
$47.87
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC I-131 SOL (DX) PER MCI
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS A9529
|
| Hospital Charge Code |
34300012
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health SBD |
$30.16
|
|
|
HC I-131 SOL (TX) PER MCI
|
Facility
|
OP
|
$47.87
|
|
|
Service Code
|
HCPCS A9530
|
| Hospital Charge Code |
34400002
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$58.78 |
| Rate for Payer: Aetna Commercial |
$40.69
|
| Rate for Payer: Aetna Medicare |
$21.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.10
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: BCBS MAPPO |
$20.88
|
| Rate for Payer: BCN Medicare Advantage |
$20.88
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cash Price |
$38.30
|
| Rate for Payer: Cofinity Commercial |
$41.17
|
| Rate for Payer: Cofinity Commercial |
$33.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$43.08
|
| Rate for Payer: Mclaren Medicaid |
$11.19
|
| Rate for Payer: Mclaren Medicare |
$20.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.92
|
| Rate for Payer: Meridian Medicaid |
$11.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.69
|
| Rate for Payer: PACE Medicare |
$19.84
|
| Rate for Payer: PACE SWMI |
$20.88
|
| Rate for Payer: PHP Commercial |
$40.69
|
| Rate for Payer: PHP Medicare Advantage |
$20.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.12
|
| Rate for Payer: Priority Health Medicare |
$20.88
|
| Rate for Payer: Priority Health SBD |
$30.16
|
| Rate for Payer: Railroad Medicare Medicare |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.88
|
| Rate for Payer: UHC Medicare Advantage |
$20.88
|
| Rate for Payer: UHCCP Medicaid |
$11.76
|
| Rate for Payer: VA VA |
$20.88
|
|
