|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
IP
|
$1,522.83
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$959.38 |
| Max. Negotiated Rate |
$1,370.55 |
| Rate for Payer: Aetna Commercial |
$1,294.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.84
|
| Rate for Payer: Cash Price |
$1,218.26
|
| Rate for Payer: Cofinity Advantage |
$1,065.98
|
| Rate for Payer: Cofinity Commercial |
$1,309.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.26
|
| Rate for Payer: Healthscope Commercial |
$1,370.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.12
|
| Rate for Payer: PHP Commercial |
$1,294.41
|
| Rate for Payer: Priority Health SBD |
$959.38
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
OP
|
$1,522.83
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.97 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$1,294.41
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$339.97
|
| Rate for Payer: BCN Commercial |
$339.97
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$1,218.26
|
| Rate for Payer: Cash Price |
$1,218.26
|
| Rate for Payer: Cash Price |
$1,218.26
|
| Rate for Payer: Cofinity Advantage |
$1,065.98
|
| Rate for Payer: Cofinity Commercial |
$1,309.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$1,370.55
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.41
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.12
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$1,294.41
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$959.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC MANTIS CLIP
|
Facility
|
OP
|
$1,179.81
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,061.83 |
| Rate for Payer: Aetna Commercial |
$1,002.84
|
| Rate for Payer: Aetna Medicare |
$589.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.88
|
| Rate for Payer: BCBS Complete |
$471.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$943.85
|
| Rate for Payer: Cash Price |
$943.85
|
| Rate for Payer: Cofinity Advantage |
$825.87
|
| Rate for Payer: Cofinity Commercial |
$1,014.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.85
|
| Rate for Payer: Healthscope Commercial |
$1,061.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$943.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,002.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.86
|
| Rate for Payer: PHP Commercial |
$1,002.84
|
| Rate for Payer: Priority Health SBD |
$743.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$766.88
|
| Rate for Payer: UHC Core |
$614.68
|
| Rate for Payer: UHC Exchange |
$463.67
|
|
|
HC MANTIS CLIP
|
Facility
|
IP
|
$1,179.81
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$743.28 |
| Max. Negotiated Rate |
$1,061.83 |
| Rate for Payer: Aetna Commercial |
$1,002.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.88
|
| Rate for Payer: Cash Price |
$943.85
|
| Rate for Payer: Cofinity Advantage |
$825.87
|
| Rate for Payer: Cofinity Commercial |
$1,014.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.85
|
| Rate for Payer: Healthscope Commercial |
$1,061.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,002.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.86
|
| Rate for Payer: PHP Commercial |
$1,002.84
|
| Rate for Payer: Priority Health SBD |
$743.28
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.09
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$4.05
|
| Rate for Payer: BCN Commercial |
$4.05
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Advantage |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Mclaren Medicaid |
$1.99
|
| Rate for Payer: Mclaren Medicare |
$3.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: Meridian Medicaid |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$5.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.43
|
| Rate for Payer: PACE Medicare |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$40.15
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.80
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health SBD |
$29.76
|
| Rate for Payer: Priority Health Tiered Network |
$3.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$5.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.80
|
| Rate for Payer: UHC Exchange |
$5.70
|
| Rate for Payer: UHC Medicaid |
$1.99
|
| Rate for Payer: UHCCP Medicaid |
$1.99
|
| Rate for Payer: VA VA |
$3.80
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.71
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Advantage |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.43
|
| Rate for Payer: PHP Commercial |
$40.15
|
| Rate for Payer: Priority Health SBD |
$29.76
|
|
|
HC MAPLE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
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 MAPLE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
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 MAPPING W/INTRACARDIAC 3D
|
Facility
|
OP
|
$6,292.96
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$312.38 |
| Max. Negotiated Rate |
$5,663.66 |
| Rate for Payer: Aetna Commercial |
$5,349.02
|
| Rate for Payer: Aetna Medicare |
$3,146.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,090.42
|
| Rate for Payer: BCBS Complete |
$2,517.18
|
| Rate for Payer: BCBS Trust/PPO |
$312.38
|
| Rate for Payer: BCN Commercial |
$312.38
|
| Rate for Payer: Cash Price |
$5,034.37
|
| Rate for Payer: Cash Price |
$5,034.37
|
| Rate for Payer: Cofinity Advantage |
$4,405.07
|
| Rate for Payer: Cofinity Commercial |
$5,411.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,034.37
|
| Rate for Payer: Healthscope Commercial |
$5,663.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,034.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,349.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,719.72
|
| Rate for Payer: PHP Commercial |
$5,349.02
|
| Rate for Payer: Priority Health SBD |
$3,964.56
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
IP
|
$6,292.96
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,964.56 |
| Max. Negotiated Rate |
$5,663.66 |
| Rate for Payer: Aetna Commercial |
$5,349.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,090.42
|
| Rate for Payer: Cash Price |
$5,034.37
|
| Rate for Payer: Cofinity Advantage |
$4,405.07
|
| Rate for Payer: Cofinity Commercial |
$5,411.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,034.37
|
| Rate for Payer: Healthscope Commercial |
$5,663.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,349.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,719.72
|
| Rate for Payer: PHP Commercial |
$5,349.02
|
| Rate for Payer: Priority Health SBD |
$3,964.56
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
IP
|
$4,486.04
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,826.21 |
| Max. Negotiated Rate |
$4,037.44 |
| Rate for Payer: Aetna Commercial |
$3,813.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,915.93
|
| Rate for Payer: Cash Price |
$3,588.83
|
| Rate for Payer: Cofinity Advantage |
$3,140.23
|
| Rate for Payer: Cofinity Commercial |
$3,857.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,588.83
|
| Rate for Payer: Healthscope Commercial |
$4,037.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,813.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,364.53
|
| Rate for Payer: PHP Commercial |
$3,813.13
|
| Rate for Payer: Priority Health SBD |
$2,826.21
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
OP
|
$4,486.04
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$454.51 |
| Max. Negotiated Rate |
$4,037.44 |
| Rate for Payer: Aetna Commercial |
$3,813.13
|
| Rate for Payer: Aetna Medicare |
$2,243.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,915.93
|
| Rate for Payer: BCBS Complete |
$1,794.42
|
| Rate for Payer: BCBS Trust/PPO |
$454.51
|
| Rate for Payer: BCN Commercial |
$454.51
|
| Rate for Payer: Cash Price |
$3,588.83
|
| Rate for Payer: Cash Price |
$3,588.83
|
| Rate for Payer: Cofinity Advantage |
$3,140.23
|
| Rate for Payer: Cofinity Commercial |
$3,857.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,588.83
|
| Rate for Payer: Healthscope Commercial |
$4,037.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,588.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,813.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,364.53
|
| Rate for Payer: PHP Commercial |
$3,813.13
|
| Rate for Payer: Priority Health SBD |
$2,826.21
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
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 |
$1,830.86
|
| Rate for Payer: BCN Commercial |
$1,830.86
|
| 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 MARS BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
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 MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
OP
|
$8,219.16
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,076.72 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$6,986.29
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,342.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,076.72
|
| Rate for Payer: BCN Commercial |
$1,076.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Advantage |
$5,753.41
|
| Rate for Payer: Cofinity Commercial |
$7,068.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,397.24
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$6,986.29
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$5,178.07
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,342.45
|
| Rate for Payer: UHC Core |
$4,282.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,230.13
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC MARSUPIALIZ SUBLNGL SALIVARY CYST RANULA
|
Facility
|
IP
|
$8,219.16
|
|
|
Service Code
|
CPT 42409
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,178.07 |
| Max. Negotiated Rate |
$7,397.24 |
| Rate for Payer: Aetna Commercial |
$6,986.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,342.45
|
| Rate for Payer: Cash Price |
$6,575.33
|
| Rate for Payer: Cofinity Advantage |
$5,753.41
|
| Rate for Payer: Cofinity Commercial |
$7,068.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,575.33
|
| Rate for Payer: Healthscope Commercial |
$7,397.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,986.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,164.37
|
| Rate for Payer: PHP Commercial |
$6,986.29
|
| Rate for Payer: Priority Health SBD |
$5,178.07
|
|
|
HC MASSAGE THERAPY
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$13.12
|
| Rate for Payer: BCN Commercial |
$13.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.00
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Priority Health Tiered Network |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC Core |
$16.26
|
| Rate for Payer: UHC Exchange |
$12.27
|
|
|
HC MASSAGE THERAPY
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
42000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC MASTECTOMY SLEEVE EA $100
|
Facility
|
OP
|
$104.04
|
|
| Hospital Charge Code |
96000004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.63
|
| Rate for Payer: UHC Core |
$54.20
|
| Rate for Payer: UHC Exchange |
$40.89
|
|
|
HC MASTECTOMY SLEEVE EA $100
|
Facility
|
IP
|
$104.04
|
|
| Hospital Charge Code |
96000004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Advantage |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.03
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC MASTECTOMY SLEEVE EA $125
|
Facility
|
OP
|
$130.05
|
|
| Hospital Charge Code |
96000005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.53
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$51.11
|
|
|
HC MASTECTOMY SLEEVE EA $125
|
Facility
|
IP
|
$130.05
|
|
| Hospital Charge Code |
96000005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
|
|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
OP
|
$156.06
|
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.33 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.44
|
| Rate for Payer: UHC Core |
$81.31
|
| Rate for Payer: UHC Exchange |
$61.33
|
|
|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
IP
|
$156.06
|
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC MASTECTOMY SLEEVE EA $175
|
Facility
|
OP
|
$182.07
|
|
| Hospital Charge Code |
96000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.55 |
| Max. Negotiated Rate |
$163.86 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna Medicare |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.35
|
| Rate for Payer: BCBS Complete |
$72.83
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Advantage |
$127.45
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: Priority Health SBD |
$114.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.35
|
| Rate for Payer: UHC Core |
$94.86
|
| Rate for Payer: UHC Exchange |
$71.55
|
|
