|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,441.26
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.99 |
| Max. Negotiated Rate |
$1,297.13 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.82
|
| Rate for Payer: Cash Price |
$1,153.01
|
| Rate for Payer: Cofinity Commercial |
$1,008.88
|
| Rate for Payer: Cofinity Commercial |
$1,239.48
|
| Rate for Payer: Healthscope Commercial |
$1,297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.07
|
| Rate for Payer: PHP Commercial |
$1,225.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.88
|
| Rate for Payer: Priority Health SBD |
$907.99
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,441.26
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.50 |
| Max. Negotiated Rate |
$1,297.13 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.82
|
| Rate for Payer: BCBS Complete |
$576.50
|
| Rate for Payer: Cash Price |
$1,153.01
|
| Rate for Payer: Cofinity Commercial |
$1,008.88
|
| Rate for Payer: Cofinity Commercial |
$1,239.48
|
| Rate for Payer: Healthscope Commercial |
$1,297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.07
|
| Rate for Payer: PHP Commercial |
$1,225.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.88
|
| Rate for Payer: Priority Health SBD |
$907.99
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna Commercial |
$1,109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.25
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$1,122.30
|
| Rate for Payer: Cofinity Commercial |
$913.50
|
| Rate for Payer: Healthscope Commercial |
$1,174.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.25
|
| Rate for Payer: PHP Commercial |
$1,109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.50
|
| Rate for Payer: Priority Health SBD |
$822.15
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.15 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna Commercial |
$1,109.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.25
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$1,122.30
|
| Rate for Payer: Cofinity Commercial |
$913.50
|
| Rate for Payer: Healthscope Commercial |
$1,174.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.25
|
| Rate for Payer: PHP Commercial |
$1,109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.50
|
| Rate for Payer: Priority Health SBD |
$822.15
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$50.30
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.70
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$31.69
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$50.30
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.35
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicare |
$5.88
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PACE Medicare |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health SBD |
$31.69
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.06
|
| Rate for Payer: UHC Core |
$10.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicare Advantage |
$6.06
|
| Rate for Payer: VA VA |
$5.88
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health SBD |
$35.28
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$189.47
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.16
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health SBD |
$119.37
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$189.47
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.16
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$36.52
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health SBD |
$119.37
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health SBD |
$66.40
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$12.63
|
| Rate for Payer: BCN Medicare Advantage |
$16.13
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Mclaren Medicaid |
$8.82
|
| Rate for Payer: Mclaren Medicare |
$16.13
|
| Rate for Payer: Meridian Medicaid |
$9.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Medicare |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.13
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$16.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health Medicare |
$16.13
|
| Rate for Payer: Priority Health SBD |
$66.40
|
| Rate for Payer: Railroad Medicare Medicare |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.36
|
| Rate for Payer: UHC Core |
$27.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.13
|
| Rate for Payer: UHC Exchange |
$16.13
|
| Rate for Payer: UHC Medicare Advantage |
$16.61
|
| Rate for Payer: VA VA |
$16.13
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC TOMATO IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,922.57 |
| Max. Negotiated Rate |
$4,175.10 |
| Rate for Payer: Aetna Commercial |
$3,943.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,015.35
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$3,247.30
|
| Rate for Payer: Cofinity Commercial |
$3,989.54
|
| Rate for Payer: Healthscope Commercial |
$4,175.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,943.15
|
| Rate for Payer: PHP Commercial |
$3,943.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health SBD |
$2,922.57
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.08 |
| Max. Negotiated Rate |
$10,308.37 |
| Rate for Payer: Aetna Commercial |
$3,943.15
|
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,015.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$3,989.54
|
| Rate for Payer: Cofinity Commercial |
$3,247.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Healthscope Commercial |
$4,175.10
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,943.15
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Commercial |
$3,943.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,308.37
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,246.70
|
| Rate for Payer: Priority Health SBD |
$2,922.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
IP
|
$3,093.22
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,948.73 |
| Max. Negotiated Rate |
$2,783.90 |
| Rate for Payer: Aetna Commercial |
$2,629.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,010.59
|
| Rate for Payer: Cash Price |
$2,474.58
|
| Rate for Payer: Cofinity Commercial |
$2,165.25
|
| Rate for Payer: Cofinity Commercial |
$2,660.17
|
| Rate for Payer: Healthscope Commercial |
$2,783.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,629.24
|
| Rate for Payer: PHP Commercial |
$2,629.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,165.25
|
| Rate for Payer: Priority Health SBD |
$1,948.73
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,093.22
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.08 |
| Max. Negotiated Rate |
$10,308.37 |
| Rate for Payer: Aetna Commercial |
$2,629.24
|
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,010.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Cash Price |
$2,474.58
|
| Rate for Payer: Cash Price |
$2,474.58
|
| Rate for Payer: Cofinity Commercial |
$2,165.25
|
| Rate for Payer: Cofinity Commercial |
$2,660.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Healthscope Commercial |
$2,783.90
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,629.24
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Commercial |
$2,629.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,165.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,308.37
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,246.70
|
| Rate for Payer: Priority Health SBD |
$1,948.73
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.60
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.68
|
| Rate for Payer: BCBS Trust/PPO |
$150.43
|
| Rate for Payer: BCN Medicare Advantage |
$35.68
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.68
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$35.68
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$33.90
|
| Rate for Payer: PACE SWMI |
$35.68
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$35.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.83
|
| Rate for Payer: Priority Health Medicare |
$35.68
|
| Rate for Payer: Priority Health Narrow Network |
$81.46
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: Railroad Medicare Medicare |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.68
|
| Rate for Payer: UHC Exchange |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
| Rate for Payer: VA VA |
$35.68
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health SBD |
$35.28
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
IP
|
$57.47
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$51.72 |
| Rate for Payer: Aetna Commercial |
$48.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.36
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$40.23
|
| Rate for Payer: Cofinity Commercial |
$49.42
|
| Rate for Payer: Healthscope Commercial |
$51.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.85
|
| Rate for Payer: PHP Commercial |
$48.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.23
|
| Rate for Payer: Priority Health SBD |
$36.21
|
|
