|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$864.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health SBD |
$777.75
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
OP
|
$2,354.05
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,118.64 |
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,098.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,647.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| 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 Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$988.70
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$984.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Exchange |
$1,161.33
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
IP
|
$1,569.37
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$988.70 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,647.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,098.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
| Rate for Payer: Priority Health SBD |
$988.70
|
|
|
HC MR BREAST W CON
|
Facility
|
OP
|
$1,569.37
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$216.53 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna Medicare |
$1,177.02
|
| Rate for Payer: Aetna Medicare |
$784.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: BCBS Complete |
$627.75
|
| Rate for Payer: BCBS Complete |
$941.62
|
| Rate for Payer: BCBS Trust/PPO |
$465.82
|
| Rate for Payer: BCBS Trust/PPO |
$465.82
|
| Rate for Payer: BCCCP Commercial |
$318.72
|
| Rate for Payer: BCCCP Commercial |
$318.72
|
| Rate for Payer: BCN Commercial |
$465.82
|
| Rate for Payer: BCN Commercial |
$465.82
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,647.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,098.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.66
|
| Rate for Payer: Priority Health Narrow Network |
$216.53
|
| Rate for Payer: Priority Health Narrow Network |
$216.53
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
| Rate for Payer: Priority Health SBD |
$988.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.00
|
| Rate for Payer: UHC Exchange |
$1,742.00
|
| Rate for Payer: UHC Exchange |
$1,161.33
|
|
|
HC MR BREAST W CON
|
Facility
|
IP
|
$1,569.37
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$988.70 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,647.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,098.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
| Rate for Payer: Priority Health SBD |
$988.70
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.40
|
| 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 |
$283.51
|
| Rate for Payer: BCCCP Commercial |
$207.57
|
| Rate for Payer: BCN Commercial |
$283.51
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Cofinity Commercial |
$1,493.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,493.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| 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 |
$1,812.98
|
| 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 |
$1,812.98
|
| 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 |
$1,386.40
|
| 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 |
$1,343.74
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,578.36
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,343.74 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,493.04
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,493.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health SBD |
$1,343.74
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
IP
|
$1,568.76
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$988.32 |
| Max. Negotiated Rate |
$1,411.88 |
| Rate for Payer: Aetna Commercial |
$1,333.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.69
|
| Rate for Payer: Cash Price |
$1,255.01
|
| Rate for Payer: Cofinity Commercial |
$1,098.13
|
| Rate for Payer: Cofinity Commercial |
$1,349.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,098.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.01
|
| Rate for Payer: Healthscope Commercial |
$1,411.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.45
|
| Rate for Payer: PHP Commercial |
$1,333.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.69
|
| Rate for Payer: Priority Health SBD |
$988.32
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
OP
|
$1,568.76
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,411.88 |
| Rate for Payer: Aetna Commercial |
$1,333.45
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.69
|
| 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 |
$284.77
|
| Rate for Payer: BCCCP Commercial |
$201.08
|
| Rate for Payer: BCN Commercial |
$284.77
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,255.01
|
| Rate for Payer: Cash Price |
$1,255.01
|
| Rate for Payer: Cofinity Commercial |
$1,349.13
|
| Rate for Payer: Cofinity Commercial |
$1,098.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,098.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,411.88
|
| 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 |
$1,333.45
|
| 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 |
$1,333.45
|
| 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 |
$1,019.69
|
| 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 |
$988.32
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,160.88
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
IP
|
$2,153.63
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,356.79 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$1,507.54
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: PHP Commercial |
$1,830.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: Priority Health SBD |
$1,356.79
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
OP
|
$2,153.63
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,938.27 |
| Rate for Payer: Aetna Commercial |
$1,830.59
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.86
|
| 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 |
$334.43
|
| Rate for Payer: BCN Commercial |
$334.43
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$1,852.12
|
| Rate for Payer: Cofinity Commercial |
$1,507.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,507.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,938.27
|
| 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 |
$1,830.59
|
| 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 |
$1,830.59
|
| 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 |
$1,399.86
|
| 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 |
$1,356.79
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,593.69
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR CARDIAC MORP AND FUNC WO W CON
|
Facility
|
OP
|
$990.98
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,099.76 |
| Rate for Payer: Aetna Commercial |
$842.33
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.14
|
| 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 |
$477.76
|
| Rate for Payer: BCN Commercial |
$477.76
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$792.78
|
| Rate for Payer: Cash Price |
$792.78
|
| Rate for Payer: Cofinity Commercial |
$852.24
|
| Rate for Payer: Cofinity Commercial |
$693.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$891.88
|
| 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 |
$842.33
|
| 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 |
$842.33
|
| 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 |
$644.14
|
| 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 |
$624.32
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$733.33
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR CARDIAC MORP AND FUNC WO W CON
|
Facility
|
IP
|
$990.98
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$624.32 |
| Max. Negotiated Rate |
$891.88 |
| Rate for Payer: Aetna Commercial |
$842.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.14
|
| Rate for Payer: Cash Price |
$792.78
|
| Rate for Payer: Cofinity Commercial |
$693.69
|
| Rate for Payer: Cofinity Commercial |
$852.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.78
|
| Rate for Payer: Healthscope Commercial |
$891.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.33
|
| Rate for Payer: PHP Commercial |
$842.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.14
|
| Rate for Payer: Priority Health SBD |
$624.32
|
|
|
HC MR CARDIAC VELOCITY MAPPING
|
Facility
|
OP
|
$1,239.30
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$46.84 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna Medicare |
$619.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.54
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: BCBS Trust/PPO |
$66.00
|
| Rate for Payer: BCN Commercial |
$66.00
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Cofinity Commercial |
$867.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$867.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health SBD |
$780.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.84
|
| Rate for Payer: UHC Exchange |
$917.08
|
|
|
HC MR CARDIAC VELOCITY MAPPING
|
Facility
|
IP
|
$1,239.30
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$780.76 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.54
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Cofinity Commercial |
$867.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$867.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health SBD |
$780.76
|
|
|
HC MR CHEST W CON
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$385.01 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,983.05
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,516.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$572.06
|
| Rate for Payer: BCN Commercial |
$572.06
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$2,006.38
|
| Rate for Payer: Cofinity Commercial |
$1,633.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,633.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$2,099.70
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.05
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,983.05
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$1,469.79
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,726.42
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: VA VA |
$774.08
|
|
|
HC MR CHEST W CON
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,469.79 |
| Max. Negotiated Rate |
$2,099.70 |
| Rate for Payer: Aetna Commercial |
$1,983.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,516.45
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,633.10
|
| Rate for Payer: Cofinity Commercial |
$2,006.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,633.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.40
|
| Rate for Payer: Healthscope Commercial |
$2,099.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.05
|
| Rate for Payer: PHP Commercial |
$1,983.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: Priority Health SBD |
$1,469.79
|
|
|
HC MR CHEST WO CON
|
Facility
|
OP
|
$2,032.25
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,829.02 |
| Rate for Payer: Aetna Commercial |
$1,727.41
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.96
|
| 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 |
$526.79
|
| Rate for Payer: BCN Commercial |
$526.79
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,747.74
|
| Rate for Payer: Cofinity Commercial |
$1,422.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,829.02
|
| 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 |
$1,727.41
|
| 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 |
$1,727.41
|
| 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 |
$1,320.96
|
| 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 |
$1,280.32
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,503.86
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR CHEST WO CON
|
Facility
|
IP
|
$2,032.25
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
61000010
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,280.32 |
| Max. Negotiated Rate |
$1,829.02 |
| Rate for Payer: Aetna Commercial |
$1,727.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.96
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,422.58
|
| Rate for Payer: Cofinity Commercial |
$1,747.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.80
|
| Rate for Payer: Healthscope Commercial |
$1,829.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.41
|
| Rate for Payer: PHP Commercial |
$1,727.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.96
|
| Rate for Payer: Priority Health SBD |
$1,280.32
|
|
|
HC MR CHEST WO W CON
|
Facility
|
OP
|
$3,052.80
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
61000012
|
|
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 |
$715.38
|
| Rate for Payer: BCN Commercial |
$715.38
|
| 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) |
$486.18
|
| 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 CHEST WO W CON
|
Facility
|
IP
|
$3,052.80
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
61000012
|
|
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 MR ELASTOGRAPHY
|
Facility
|
IP
|
$359.98
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$226.79 |
| Max. Negotiated Rate |
$323.98 |
| Rate for Payer: Aetna Commercial |
$305.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.99
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$251.99
|
| Rate for Payer: Cofinity Commercial |
$309.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Healthscope Commercial |
$323.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.98
|
| Rate for Payer: PHP Commercial |
$305.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.99
|
| Rate for Payer: Priority Health SBD |
$226.79
|
|
|
HC MR ELASTOGRAPHY
|
Facility
|
OP
|
$359.98
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$305.98
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.99
|
| 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 |
$292.31
|
| Rate for Payer: BCN Commercial |
$292.31
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cash Price |
$287.98
|
| Rate for Payer: Cofinity Commercial |
$309.58
|
| Rate for Payer: Cofinity Commercial |
$251.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$323.98
|
| 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 |
$305.98
|
| 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 |
$305.98
|
| 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 |
$233.99
|
| 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 |
$226.79
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$266.39
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR GUIDANCE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,045.60
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100004
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$658.73 |
| Max. Negotiated Rate |
$941.04 |
| Rate for Payer: Aetna Commercial |
$888.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.64
|
| Rate for Payer: Cash Price |
$836.48
|
| Rate for Payer: Cofinity Commercial |
$731.92
|
| Rate for Payer: Cofinity Commercial |
$899.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$731.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.48
|
| Rate for Payer: Healthscope Commercial |
$941.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.76
|
| Rate for Payer: PHP Commercial |
$888.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.64
|
| Rate for Payer: Priority Health SBD |
$658.73
|
|
|
HC MR GUIDANCE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,045.60
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100004
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$418.24 |
| Max. Negotiated Rate |
$941.04 |
| Rate for Payer: Aetna Commercial |
$888.76
|
| Rate for Payer: Aetna Medicare |
$522.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.64
|
| Rate for Payer: BCBS Complete |
$418.24
|
| Rate for Payer: BCBS Trust/PPO |
$670.74
|
| Rate for Payer: BCN Commercial |
$670.74
|
| Rate for Payer: Cash Price |
$836.48
|
| Rate for Payer: Cash Price |
$836.48
|
| Rate for Payer: Cofinity Commercial |
$731.92
|
| Rate for Payer: Cofinity Commercial |
$899.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$731.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.48
|
| Rate for Payer: Healthscope Commercial |
$941.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.76
|
| Rate for Payer: PHP Commercial |
$888.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$679.64
|
| Rate for Payer: Priority Health SBD |
$658.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.26
|
| Rate for Payer: UHC Exchange |
$773.74
|
|
