|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$396.58
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$356.92 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.78
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Cofinity Commercial |
$341.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Healthscope Commercial |
$356.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: PHP Commercial |
$337.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: Priority Health SBD |
$249.85
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,786.59
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$2,368.60
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$1,950.61
|
| Rate for Payer: Cofinity Commercial |
$2,396.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,950.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,507.93
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$2,368.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$1,755.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,786.59
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,755.55 |
| Max. Negotiated Rate |
$2,507.93 |
| Rate for Payer: Aetna Commercial |
$2,368.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.28
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$1,950.61
|
| Rate for Payer: Cofinity Commercial |
$2,396.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,950.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Healthscope Commercial |
$2,507.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: PHP Commercial |
$2,368.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health SBD |
$1,755.55
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,177.28
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.91 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Aetna Commercial |
$1,000.69
|
| Rate for Payer: Aetna Medicare |
$588.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: BCBS Complete |
$470.91
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,012.46
|
| Rate for Payer: Cofinity Commercial |
$824.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$824.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,059.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: PHP Commercial |
$1,000.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health SBD |
$741.69
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,177.28
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.69 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Aetna Commercial |
$1,000.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,012.46
|
| Rate for Payer: Cofinity Commercial |
$824.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$824.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,059.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: PHP Commercial |
$1,000.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health SBD |
$741.69
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$372.79
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$149.12 |
| Max. Negotiated Rate |
$335.51 |
| Rate for Payer: Aetna Commercial |
$316.87
|
| Rate for Payer: Aetna Medicare |
$186.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.31
|
| Rate for Payer: BCBS Complete |
$149.12
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$260.95
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: PHP Commercial |
$316.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health SBD |
$234.86
|
| Rate for Payer: UHC Core |
$275.86
|
| Rate for Payer: UHC Exchange |
$275.86
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$372.79
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$234.86 |
| Max. Negotiated Rate |
$335.51 |
| Rate for Payer: Aetna Commercial |
$316.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.31
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$260.95
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: PHP Commercial |
$316.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health SBD |
$234.86
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$592.06
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$373.00 |
| Max. Negotiated Rate |
$532.85 |
| Rate for Payer: Aetna Commercial |
$503.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.84
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cofinity Commercial |
$414.44
|
| Rate for Payer: Cofinity Commercial |
$509.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.65
|
| Rate for Payer: Healthscope Commercial |
$532.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.25
|
| Rate for Payer: PHP Commercial |
$503.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.84
|
| Rate for Payer: Priority Health SBD |
$373.00
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$592.06
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$663.58 |
| Rate for Payer: Aetna Commercial |
$503.25
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cofinity Commercial |
$509.17
|
| Rate for Payer: Cofinity Commercial |
$414.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$532.85
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.25
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$503.25
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.84
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$373.00
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$438.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$438.12
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
OP
|
$714.47
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$663.58 |
| Rate for Payer: Aetna Commercial |
$607.30
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$500.13
|
| Rate for Payer: Cofinity Commercial |
$614.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$643.02
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.30
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$607.30
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.41
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$450.12
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$528.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$528.71
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$714.47
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$450.12 |
| Max. Negotiated Rate |
$643.02 |
| Rate for Payer: Aetna Commercial |
$607.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.41
|
| Rate for Payer: Cash Price |
$571.58
|
| Rate for Payer: Cofinity Commercial |
$500.13
|
| Rate for Payer: Cofinity Commercial |
$614.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$500.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.58
|
| Rate for Payer: Healthscope Commercial |
$643.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.30
|
| Rate for Payer: PHP Commercial |
$607.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.41
|
| Rate for Payer: Priority Health SBD |
$450.12
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
OP
|
$84.15
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Aetna Commercial |
$71.53
|
| Rate for Payer: Aetna Medicare |
$42.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.70
|
| Rate for Payer: BCBS Complete |
$33.66
|
| Rate for Payer: Cash Price |
$67.32
|
| Rate for Payer: Cofinity Commercial |
$58.91
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.32
|
| Rate for Payer: Healthscope Commercial |
$75.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.53
|
| Rate for Payer: PHP Commercial |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.70
|
| Rate for Payer: Priority Health SBD |
$53.01
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
IP
|
$84.15
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Aetna Commercial |
$71.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.70
|
| Rate for Payer: Cash Price |
$67.32
|
| Rate for Payer: Cofinity Commercial |
$58.91
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.32
|
| Rate for Payer: Healthscope Commercial |
$75.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.53
|
| Rate for Payer: PHP Commercial |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.70
|
| Rate for Payer: Priority Health SBD |
$53.01
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Cofinity Commercial |
$2,856.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,856.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$2,570.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,856.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health SBD |
$2,570.40
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Cofinity Commercial |
$345.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.22
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$311.34
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.22
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$345.93
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.22
|
| Rate for Payer: Priority Health SBD |
$311.34
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
IP
|
$1,492.97
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$940.57 |
| Max. Negotiated Rate |
$1,343.67 |
| Rate for Payer: Aetna Commercial |
$1,269.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.43
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cofinity Commercial |
$1,045.08
|
| Rate for Payer: Cofinity Commercial |
$1,283.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,194.38
|
| Rate for Payer: Healthscope Commercial |
$1,343.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.02
|
| Rate for Payer: PHP Commercial |
$1,269.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.43
|
| Rate for Payer: Priority Health SBD |
$940.57
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
OP
|
$1,492.97
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Commercial |
$1,269.02
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cash Price |
$1,194.38
|
| Rate for Payer: Cofinity Commercial |
$1,283.95
|
| Rate for Payer: Cofinity Commercial |
$1,045.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,194.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,343.67
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.02
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$1,269.02
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.43
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$940.57
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$366.50
|
| Rate for Payer: VA VA |
$650.97
|
|
|
HC MANTIS CLIP
|
Facility
|
OP
|
$1,156.68
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.67 |
| Max. Negotiated Rate |
$1,041.01 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna Medicare |
$578.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.84
|
| Rate for Payer: BCBS Complete |
$462.67
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cofinity Commercial |
$809.68
|
| Rate for Payer: Cofinity Commercial |
$994.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$809.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.34
|
| Rate for Payer: Healthscope Commercial |
$1,041.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.18
|
| Rate for Payer: PHP Commercial |
$983.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.84
|
| Rate for Payer: Priority Health SBD |
$728.71
|
|
|
HC MANTIS CLIP
|
Facility
|
IP
|
$1,156.68
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$1,041.01 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.84
|
| Rate for Payer: Cash Price |
$925.34
|
| Rate for Payer: Cofinity Commercial |
$809.68
|
| Rate for Payer: Cofinity Commercial |
$994.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$809.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.34
|
| Rate for Payer: Healthscope Commercial |
$1,041.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.18
|
| Rate for Payer: PHP Commercial |
$983.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.84
|
| Rate for Payer: Priority Health SBD |
$728.71
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$29.18
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| 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 |
$2.14
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Mclaren Medicaid |
$2.04
|
| 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 |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: PACE Medicare |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health SBD |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.80
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$2.14
|
| Rate for Payer: VA VA |
$3.80
|
|
|
HC MAPLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC MAPLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
