|
HC MPCDS CELL SORTING BM
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$153.70 |
| Rate for Payer: Aetna Commercial |
$145.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.01
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$119.55
|
| Rate for Payer: Cofinity Commercial |
$146.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Healthscope Commercial |
$153.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: PHP Commercial |
$145.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: Priority Health SBD |
$107.59
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
IP
|
$53.78
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.96
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$37.65
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health SBD |
$33.88
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
OP
|
$53.78
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: Aetna Medicare |
$26.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.96
|
| Rate for Payer: BCBS Complete |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$33.47
|
| Rate for Payer: BCN Commercial |
$33.47
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$37.65
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health SBD |
$33.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.30
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
IP
|
$379.75
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$239.24 |
| Max. Negotiated Rate |
$341.78 |
| Rate for Payer: Aetna Commercial |
$322.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.84
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cofinity Commercial |
$265.82
|
| Rate for Payer: Cofinity Commercial |
$326.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.80
|
| Rate for Payer: Healthscope Commercial |
$341.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.79
|
| Rate for Payer: PHP Commercial |
$322.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.84
|
| Rate for Payer: Priority Health SBD |
$239.24
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
OP
|
$379.75
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$555.60 |
| Rate for Payer: Aetna Commercial |
$322.79
|
| Rate for Payer: Aetna Medicare |
$192.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: BCBS Complete |
$104.23
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$163.94
|
| Rate for Payer: BCN Commercial |
$163.94
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cofinity Commercial |
$265.82
|
| Rate for Payer: Cofinity Commercial |
$326.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$341.78
|
| Rate for Payer: Mclaren Medicaid |
$99.27
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: Meridian Medicaid |
$104.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.79
|
| Rate for Payer: Nomi Health Commercial |
$555.60
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$322.79
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.20
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health Narrow Network |
$148.16
|
| Rate for Payer: Priority Health SBD |
$239.24
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.24
|
| Rate for Payer: UHC Core |
$73.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.20
|
| Rate for Payer: UHC Exchange |
$73.82
|
| Rate for Payer: UHC Medicare Advantage |
$185.20
|
| Rate for Payer: UHCCP Medicaid |
$104.27
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
OP
|
$600.31
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.87 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$510.26
|
| Rate for Payer: Aetna Medicare |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.00
|
| Rate for Payer: BCBS Complete |
$168.84
|
| Rate for Payer: BCBS MAPPO |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$265.57
|
| Rate for Payer: BCN Commercial |
$265.57
|
| Rate for Payer: BCN Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$480.25
|
| Rate for Payer: Cash Price |
$480.25
|
| Rate for Payer: Cofinity Commercial |
$420.22
|
| Rate for Payer: Cofinity Commercial |
$516.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$540.28
|
| Rate for Payer: Mclaren Medicaid |
$160.80
|
| Rate for Payer: Mclaren Medicare |
$300.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.00
|
| Rate for Payer: Meridian Medicaid |
$168.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.26
|
| Rate for Payer: Nomi Health Commercial |
$900.00
|
| Rate for Payer: PACE Medicare |
$285.00
|
| Rate for Payer: PACE SWMI |
$300.00
|
| Rate for Payer: PHP Commercial |
$510.26
|
| Rate for Payer: PHP Medicare Advantage |
$300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.00
|
| Rate for Payer: Priority Health Medicare |
$300.00
|
| Rate for Payer: Priority Health Narrow Network |
$240.00
|
| Rate for Payer: Priority Health SBD |
$378.20
|
| Rate for Payer: Railroad Medicare Medicare |
$300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.00
|
| Rate for Payer: UHC Core |
$19.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.00
|
| Rate for Payer: UHC Exchange |
$19.87
|
| Rate for Payer: UHC Medicare Advantage |
$300.00
|
| Rate for Payer: UHCCP Medicaid |
$168.90
|
| Rate for Payer: VA VA |
$300.00
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
IP
|
$600.31
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$540.28 |
| Rate for Payer: Aetna Commercial |
$510.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.20
|
| Rate for Payer: Cash Price |
$480.25
|
| Rate for Payer: Cofinity Commercial |
$420.22
|
| Rate for Payer: Cofinity Commercial |
$516.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.25
|
| Rate for Payer: Healthscope Commercial |
$540.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.26
|
| Rate for Payer: PHP Commercial |
$510.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.20
|
| Rate for Payer: Priority Health SBD |
$378.20
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
OP
|
$648.17
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$583.35 |
| Rate for Payer: Aetna Commercial |
$550.94
|
| Rate for Payer: Aetna Medicare |
$126.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.04
|
| Rate for Payer: BCBS Complete |
$68.45
|
| Rate for Payer: BCBS MAPPO |
$121.63
|
| Rate for Payer: BCBS Trust/PPO |
$107.67
|
| Rate for Payer: BCN Commercial |
$107.67
|
| Rate for Payer: BCN Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$518.54
|
| Rate for Payer: Cash Price |
$518.54
|
| Rate for Payer: Cofinity Commercial |
$453.72
|
| Rate for Payer: Cofinity Commercial |
$557.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$453.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.63
|
| Rate for Payer: Healthscope Commercial |
$583.35
|
| Rate for Payer: Mclaren Medicaid |
$65.19
|
| Rate for Payer: Mclaren Medicare |
$121.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.71
|
| Rate for Payer: Meridian Medicaid |
$68.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.94
|
| Rate for Payer: Nomi Health Commercial |
$364.89
|
| Rate for Payer: PACE Medicare |
$115.55
|
| Rate for Payer: PACE SWMI |
$121.63
|
| Rate for Payer: PHP Commercial |
$550.94
|
| Rate for Payer: PHP Medicare Advantage |
$121.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.13
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: Priority Health SBD |
$408.35
|
| Rate for Payer: Railroad Medicare Medicare |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.96
|
| Rate for Payer: UHC Core |
$113.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.63
|
| Rate for Payer: UHC Exchange |
$113.38
|
| Rate for Payer: UHC Medicare Advantage |
$121.63
|
| Rate for Payer: UHCCP Medicaid |
$68.48
|
| Rate for Payer: VA VA |
$121.63
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
IP
|
$648.17
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$408.35 |
| Max. Negotiated Rate |
$583.35 |
| Rate for Payer: Aetna Commercial |
$550.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.31
|
| Rate for Payer: Cash Price |
$518.54
|
| Rate for Payer: Cofinity Commercial |
$453.72
|
| Rate for Payer: Cofinity Commercial |
$557.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$453.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.54
|
| Rate for Payer: Healthscope Commercial |
$583.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.94
|
| Rate for Payer: PHP Commercial |
$550.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.31
|
| Rate for Payer: Priority Health SBD |
$408.35
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$259.56 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Aetna Commercial |
$350.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.80
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$288.40
|
| Rate for Payer: Cofinity Commercial |
$354.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.60
|
| Rate for Payer: Healthscope Commercial |
$370.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.20
|
| Rate for Payer: PHP Commercial |
$350.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health SBD |
$259.56
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Aetna Commercial |
$350.20
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: BCBS Complete |
$51.59
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$81.15
|
| Rate for Payer: BCN Commercial |
$81.15
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$288.40
|
| Rate for Payer: Cofinity Commercial |
$354.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$370.80
|
| Rate for Payer: Mclaren Medicaid |
$49.13
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$51.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.20
|
| Rate for Payer: Nomi Health Commercial |
$274.98
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$350.20
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.31
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$75.45
|
| Rate for Payer: Priority Health SBD |
$259.56
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.99
|
| Rate for Payer: UHC Core |
$164.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.66
|
| Rate for Payer: UHC Exchange |
$164.40
|
| Rate for Payer: UHC Medicare Advantage |
$91.66
|
| Rate for Payer: UHCCP Medicaid |
$51.60
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
OP
|
$2,364.72
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,128.25 |
| Rate for Payer: Aetna Commercial |
$2,010.01
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$434.39
|
| Rate for Payer: BCN Commercial |
$434.39
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,891.78
|
| Rate for Payer: Cash Price |
$1,891.78
|
| Rate for Payer: Cofinity Commercial |
$2,033.66
|
| Rate for Payer: Cofinity Commercial |
$1,655.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,655.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,891.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,128.25
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,010.01
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,010.01
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,489.77
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,749.89
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR ABDOMEN W CON
|
Facility
|
IP
|
$2,364.72
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
61000043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,489.77 |
| Max. Negotiated Rate |
$2,128.25 |
| Rate for Payer: Aetna Commercial |
$2,010.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.07
|
| Rate for Payer: Cash Price |
$1,891.78
|
| Rate for Payer: Cofinity Commercial |
$1,655.30
|
| Rate for Payer: Cofinity Commercial |
$2,033.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,655.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,891.78
|
| Rate for Payer: Healthscope Commercial |
$2,128.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,010.01
|
| Rate for Payer: PHP Commercial |
$2,010.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.07
|
| Rate for Payer: Priority Health SBD |
$1,489.77
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
OP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$250.83
|
| Rate for Payer: BCN Commercial |
$250.83
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Cofinity Commercial |
$1,477.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,477.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,329.58
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,561.73
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR ABDOMEN WO CON
|
Facility
|
IP
|
$2,110.45
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
61000082
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,329.58 |
| Max. Negotiated Rate |
$1,899.40 |
| Rate for Payer: Aetna Commercial |
$1,793.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.79
|
| Rate for Payer: Cash Price |
$1,688.36
|
| Rate for Payer: Cofinity Commercial |
$1,477.32
|
| Rate for Payer: Cofinity Commercial |
$1,814.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,477.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,688.36
|
| Rate for Payer: Healthscope Commercial |
$1,899.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,793.88
|
| Rate for Payer: PHP Commercial |
$1,793.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.79
|
| Rate for Payer: Priority Health SBD |
$1,329.58
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
IP
|
$3,090.30
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,946.89 |
| Max. Negotiated Rate |
$2,781.27 |
| Rate for Payer: Aetna Commercial |
$2,626.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.70
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cofinity Commercial |
$2,163.21
|
| Rate for Payer: Cofinity Commercial |
$2,657.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,163.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.24
|
| Rate for Payer: Healthscope Commercial |
$2,781.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,626.76
|
| Rate for Payer: PHP Commercial |
$2,626.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,008.70
|
| Rate for Payer: Priority Health SBD |
$1,946.89
|
|
|
HC MR ABDOMEN WO W CON
|
Facility
|
OP
|
$3,090.30
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
61000044
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,781.27 |
| Rate for Payer: Aetna Commercial |
$2,626.76
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$462.04
|
| Rate for Payer: BCN Commercial |
$462.04
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cash Price |
$2,472.24
|
| Rate for Payer: Cofinity Commercial |
$2,657.66
|
| Rate for Payer: Cofinity Commercial |
$2,163.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,163.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,472.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,781.27
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,626.76
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,626.76
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,008.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,946.89
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$2,286.82
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MRA HEAD WO CON
|
Facility
|
OP
|
$1,809.20
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,628.28 |
| Rate for Payer: Aetna Commercial |
$1,537.82
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$312.43
|
| Rate for Payer: BCN Commercial |
$312.43
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cofinity Commercial |
$1,555.91
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,447.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,628.28
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.82
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,537.82
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,139.80
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,338.81
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MRA HEAD WO CON
|
Facility
|
IP
|
$1,809.20
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
61500001
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,139.80 |
| Max. Negotiated Rate |
$1,628.28 |
| Rate for Payer: Aetna Commercial |
$1,537.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.98
|
| Rate for Payer: Cash Price |
$1,447.36
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Cofinity Commercial |
$1,555.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,447.36
|
| Rate for Payer: Healthscope Commercial |
$1,628.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.82
|
| Rate for Payer: PHP Commercial |
$1,537.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.98
|
| Rate for Payer: Priority Health SBD |
$1,139.80
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
IP
|
$3,052.80
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,923.26 |
| Max. Negotiated Rate |
$2,747.52 |
| Rate for Payer: Aetna Commercial |
$2,594.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.32
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,136.96
|
| Rate for Payer: Cofinity Commercial |
$2,625.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,136.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Healthscope Commercial |
$2,747.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: PHP Commercial |
$2,594.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: Priority Health SBD |
$1,923.26
|
|
|
HC MRA HEAD WO W CON
|
Facility
|
OP
|
$3,052.80
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,747.52 |
| Rate for Payer: Aetna Commercial |
$2,594.88
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$509.19
|
| Rate for Payer: BCN Commercial |
$509.19
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cash Price |
$2,442.24
|
| Rate for Payer: Cofinity Commercial |
$2,625.41
|
| Rate for Payer: Cofinity Commercial |
$2,136.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,136.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,747.52
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.88
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$2,594.88
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,923.26
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$2,259.07
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
IP
|
$1,412.55
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$889.91 |
| Max. Negotiated Rate |
$1,271.30 |
| Rate for Payer: Aetna Commercial |
$1,200.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.16
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cofinity Commercial |
$1,214.79
|
| Rate for Payer: Cofinity Commercial |
$988.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.04
|
| Rate for Payer: Healthscope Commercial |
$1,271.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.67
|
| Rate for Payer: PHP Commercial |
$1,200.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.16
|
| Rate for Payer: Priority Health SBD |
$889.91
|
|
|
HC MR BONE MARROW BLOOD SUPPLY
|
Facility
|
OP
|
$1,412.55
|
|
|
Service Code
|
CPT 77084
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,271.30 |
| Rate for Payer: Aetna Commercial |
$1,200.67
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$473.36
|
| Rate for Payer: BCN Commercial |
$473.36
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cash Price |
$1,130.04
|
| Rate for Payer: Cofinity Commercial |
$988.78
|
| Rate for Payer: Cofinity Commercial |
$1,214.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,271.30
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.67
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,200.67
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$889.91
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,045.29
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
OP
|
$1,857.93
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$424.26 |
| Max. Negotiated Rate |
$1,672.14 |
| Rate for Payer: Aetna Commercial |
$1,579.24
|
| Rate for Payer: Aetna Medicare |
$928.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.65
|
| Rate for Payer: BCBS Complete |
$743.17
|
| Rate for Payer: BCBS Trust/PPO |
$670.74
|
| Rate for Payer: BCN Commercial |
$670.74
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cofinity Commercial |
$1,300.55
|
| Rate for Payer: Cofinity Commercial |
$1,597.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,300.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.34
|
| Rate for Payer: Healthscope Commercial |
$1,672.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.24
|
| Rate for Payer: PHP Commercial |
$1,579.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.65
|
| Rate for Payer: Priority Health SBD |
$1,170.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.26
|
| Rate for Payer: UHC Exchange |
$1,374.87
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
IP
|
$1,857.93
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,170.50 |
| Max. Negotiated Rate |
$1,672.14 |
| Rate for Payer: Aetna Commercial |
$1,579.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.65
|
| Rate for Payer: Cash Price |
$1,486.34
|
| Rate for Payer: Cofinity Commercial |
$1,300.55
|
| Rate for Payer: Cofinity Commercial |
$1,597.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,300.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,486.34
|
| Rate for Payer: Healthscope Commercial |
$1,672.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,579.24
|
| Rate for Payer: PHP Commercial |
$1,579.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,207.65
|
| Rate for Payer: Priority Health SBD |
$1,170.50
|
|
