|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
OP
|
$9,503.13
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,734.73 |
| Max. Negotiated Rate |
$8,552.82 |
| Rate for Payer: Aetna Commercial |
$8,077.66
|
| Rate for Payer: Aetna Medicare |
$4,751.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,177.03
|
| Rate for Payer: BCBS Complete |
$3,801.25
|
| Rate for Payer: Cash Price |
$7,602.50
|
| Rate for Payer: Cofinity Advantage |
$6,652.19
|
| Rate for Payer: Cofinity Commercial |
$8,172.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,602.50
|
| Rate for Payer: Healthscope Commercial |
$8,552.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,602.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,077.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,127.35
|
| Rate for Payer: PHP Commercial |
$8,077.66
|
| Rate for Payer: Priority Health SBD |
$5,986.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,177.03
|
| Rate for Payer: UHC Core |
$4,951.13
|
| Rate for Payer: UHC Exchange |
$3,734.73
|
|
|
HC PIONEER RE-ENTRY CATHETER
|
Facility
|
IP
|
$9,503.13
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,986.97 |
| Max. Negotiated Rate |
$8,552.82 |
| Rate for Payer: Aetna Commercial |
$8,077.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,177.03
|
| Rate for Payer: Cash Price |
$7,602.50
|
| Rate for Payer: Cofinity Advantage |
$6,652.19
|
| Rate for Payer: Cofinity Commercial |
$8,172.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,602.50
|
| Rate for Payer: Healthscope Commercial |
$8,552.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,077.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,127.35
|
| Rate for Payer: PHP Commercial |
$8,077.66
|
| Rate for Payer: Priority Health SBD |
$5,986.97
|
|
|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
OP
|
$19,962.82
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,845.39 |
| Max. Negotiated Rate |
$17,966.54 |
| Rate for Payer: Aetna Commercial |
$16,968.40
|
| Rate for Payer: Aetna Medicare |
$9,981.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,975.83
|
| Rate for Payer: BCBS Complete |
$7,985.13
|
| Rate for Payer: Cash Price |
$15,970.26
|
| Rate for Payer: Cofinity Advantage |
$13,973.97
|
| Rate for Payer: Cofinity Commercial |
$17,168.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,970.26
|
| Rate for Payer: Healthscope Commercial |
$17,966.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,970.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,968.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,972.11
|
| Rate for Payer: PHP Commercial |
$16,968.40
|
| Rate for Payer: Priority Health SBD |
$12,576.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,975.83
|
| Rate for Payer: UHC Core |
$10,400.63
|
| Rate for Payer: UHC Exchange |
$7,845.39
|
|
|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
IP
|
$19,962.82
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,576.58 |
| Max. Negotiated Rate |
$17,966.54 |
| Rate for Payer: Aetna Commercial |
$16,968.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,975.83
|
| Rate for Payer: Cash Price |
$15,970.26
|
| Rate for Payer: Cofinity Advantage |
$13,973.97
|
| Rate for Payer: Cofinity Commercial |
$17,168.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,970.26
|
| Rate for Payer: Healthscope Commercial |
$17,966.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,968.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,972.11
|
| Rate for Payer: PHP Commercial |
$16,968.40
|
| Rate for Payer: Priority Health SBD |
$12,576.58
|
|
|
HC PISTACHIO NUT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200118
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PISTACHIO NUT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200118
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC PITOCIN AUGMENTATION
|
Facility
|
OP
|
$484.53
|
|
| Hospital Charge Code |
25800002
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$190.42 |
| Max. Negotiated Rate |
$436.08 |
| Rate for Payer: Aetna Commercial |
$411.85
|
| Rate for Payer: Aetna Medicare |
$242.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.94
|
| Rate for Payer: BCBS Complete |
$193.81
|
| Rate for Payer: Cash Price |
$387.62
|
| Rate for Payer: Cofinity Advantage |
$339.17
|
| Rate for Payer: Cofinity Commercial |
$416.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.62
|
| Rate for Payer: Healthscope Commercial |
$436.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.40
|
| Rate for Payer: PHP Commercial |
$411.85
|
| Rate for Payer: Priority Health SBD |
$305.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.94
|
| Rate for Payer: UHC Core |
$252.44
|
| Rate for Payer: UHC Exchange |
$190.42
|
|
|
HC PITOCIN AUGMENTATION
|
Facility
|
IP
|
$484.53
|
|
| Hospital Charge Code |
25800002
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$436.08 |
| Rate for Payer: Aetna Commercial |
$411.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.94
|
| Rate for Payer: Cash Price |
$387.62
|
| Rate for Payer: Cofinity Advantage |
$339.17
|
| Rate for Payer: Cofinity Commercial |
$416.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.62
|
| Rate for Payer: Healthscope Commercial |
$436.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.40
|
| Rate for Payer: PHP Commercial |
$411.85
|
| Rate for Payer: Priority Health SBD |
$305.25
|
|
|
HC PKU STATE TESTING
|
Facility
|
OP
|
$22.27
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
30100387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$3.02
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$5.87
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Advantage |
$15.59
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Mclaren Medicaid |
$2.88
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$8.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.50
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health SBD |
$14.03
|
| Rate for Payer: Priority Health Tiered Network |
$4.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Core |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.50
|
| Rate for Payer: UHC Exchange |
$8.25
|
| Rate for Payer: UHC Medicaid |
$2.88
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC PKU STATE TESTING
|
Facility
|
IP
|
$22.27
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
30100387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Advantage |
$15.59
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: Priority Health SBD |
$14.03
|
|
|
HC PLACE ACCESS BILE TREE RENDEZVOUS PROCEDURE
|
Facility
|
IP
|
$3,756.70
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
36100498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,366.72 |
| Max. Negotiated Rate |
$3,381.03 |
| Rate for Payer: Aetna Commercial |
$3,193.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.86
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cofinity Advantage |
$2,629.69
|
| Rate for Payer: Cofinity Commercial |
$3,230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,005.36
|
| Rate for Payer: Healthscope Commercial |
$3,381.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,193.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,817.53
|
| Rate for Payer: PHP Commercial |
$3,193.20
|
| Rate for Payer: Priority Health SBD |
$2,366.72
|
|
|
HC PLACE ACCESS BILE TREE RENDEZVOUS PROCEDURE
|
Facility
|
OP
|
$3,756.70
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
36100498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,664.76 |
| Max. Negotiated Rate |
$20,860.47 |
| Rate for Payer: Aetna Commercial |
$3,193.20
|
| Rate for Payer: Aetna Medicare |
$6,708.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.76
|
| Rate for Payer: BCN Commercial |
$1,664.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cofinity Advantage |
$2,629.69
|
| Rate for Payer: Cofinity Commercial |
$3,230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,005.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Healthscope Commercial |
$3,381.03
|
| Rate for Payer: Mclaren Medicaid |
$3,373.63
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$6,773.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,193.20
|
| Rate for Payer: Nomi Health Commercial |
$19,351.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,817.53
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Commercial |
$3,193.20
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,860.47
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health SBD |
$2,366.72
|
| Rate for Payer: Priority Health Tiered Network |
$16,688.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: VA VA |
$6,450.54
|
|
|
HC PLACE BILIARY DRAIN CATH WITH GUIDE INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,756.70
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
36100491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,366.72 |
| Max. Negotiated Rate |
$3,381.03 |
| Rate for Payer: Aetna Commercial |
$3,193.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.86
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cofinity Advantage |
$2,629.69
|
| Rate for Payer: Cofinity Commercial |
$3,230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,005.36
|
| Rate for Payer: Healthscope Commercial |
$3,381.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,193.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,817.53
|
| Rate for Payer: PHP Commercial |
$3,193.20
|
| Rate for Payer: Priority Health SBD |
$2,366.72
|
|
|
HC PLACE BILIARY DRAIN CATH WITH GUIDE INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,756.70
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
36100491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,664.76 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Commercial |
$3,193.20
|
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.76
|
| Rate for Payer: BCN Commercial |
$1,664.76
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cash Price |
$3,005.36
|
| Rate for Payer: Cofinity Advantage |
$2,629.69
|
| Rate for Payer: Cofinity Commercial |
$3,230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,005.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Healthscope Commercial |
$3,381.03
|
| Rate for Payer: Mclaren Medicaid |
$1,865.82
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,193.20
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,817.53
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Commercial |
$3,193.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health SBD |
$2,366.72
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
IP
|
$3,340.62
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,104.59 |
| Max. Negotiated Rate |
$3,006.56 |
| Rate for Payer: Aetna Commercial |
$2,839.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,171.40
|
| Rate for Payer: Cash Price |
$2,672.50
|
| Rate for Payer: Cofinity Advantage |
$2,338.43
|
| Rate for Payer: Cofinity Commercial |
$2,872.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,672.50
|
| Rate for Payer: Healthscope Commercial |
$3,006.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,839.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,505.47
|
| Rate for Payer: PHP Commercial |
$2,839.53
|
| Rate for Payer: Priority Health SBD |
$2,104.59
|
|
|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
OP
|
$3,340.62
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,664.76 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Commercial |
$2,839.53
|
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,171.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.76
|
| Rate for Payer: BCN Commercial |
$1,664.76
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Cash Price |
$2,672.50
|
| Rate for Payer: Cash Price |
$2,672.50
|
| Rate for Payer: Cash Price |
$2,672.50
|
| Rate for Payer: Cofinity Advantage |
$2,338.43
|
| Rate for Payer: Cofinity Commercial |
$2,872.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,672.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Healthscope Commercial |
$3,006.56
|
| Rate for Payer: Mclaren Medicaid |
$1,865.82
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,839.53
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,505.47
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Commercial |
$2,839.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health SBD |
$2,104.59
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.92 |
| Max. Negotiated Rate |
$1,101.60 |
| Rate for Payer: Aetna Commercial |
$1,040.40
|
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$795.60
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: BCBS Trust/PPO |
$604.69
|
| Rate for Payer: BCCCP Commercial |
$156.92
|
| Rate for Payer: BCN Commercial |
$604.69
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Advantage |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,052.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.20
|
| Rate for Payer: Healthscope Commercial |
$1,101.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$979.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,040.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$918.00
|
| Rate for Payer: PHP Commercial |
$1,040.40
|
| Rate for Payer: Priority Health SBD |
$771.12
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$771.12 |
| Max. Negotiated Rate |
$1,101.60 |
| Rate for Payer: Aetna Commercial |
$1,040.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$795.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Advantage |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,052.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.20
|
| Rate for Payer: Healthscope Commercial |
$1,101.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,040.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$918.00
|
| Rate for Payer: PHP Commercial |
$1,040.40
|
| Rate for Payer: Priority Health SBD |
$771.12
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
IP
|
$1,791.10
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,128.39 |
| Max. Negotiated Rate |
$1,611.99 |
| Rate for Payer: Aetna Commercial |
$1,522.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.21
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cofinity Advantage |
$1,253.77
|
| Rate for Payer: Cofinity Commercial |
$1,540.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.88
|
| Rate for Payer: Healthscope Commercial |
$1,611.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,522.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.33
|
| Rate for Payer: PHP Commercial |
$1,522.43
|
| Rate for Payer: Priority Health SBD |
$1,128.39
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
OP
|
$1,791.10
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.83 |
| Max. Negotiated Rate |
$1,834.36 |
| Rate for Payer: Aetna Commercial |
$1,522.43
|
| Rate for Payer: Aetna Medicare |
$895.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.21
|
| Rate for Payer: BCBS Complete |
$716.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.36
|
| Rate for Payer: BCCCP Commercial |
$432.83
|
| Rate for Payer: BCN Commercial |
$1,834.36
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cofinity Advantage |
$1,253.77
|
| Rate for Payer: Cofinity Commercial |
$1,540.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.88
|
| Rate for Payer: Healthscope Commercial |
$1,611.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,432.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,522.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.33
|
| Rate for Payer: PHP Commercial |
$1,522.43
|
| Rate for Payer: Priority Health SBD |
$1,128.39
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
IP
|
$2,149.22
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,354.01 |
| Max. Negotiated Rate |
$1,934.30 |
| Rate for Payer: Aetna Commercial |
$1,826.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.99
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cofinity Advantage |
$1,504.45
|
| Rate for Payer: Cofinity Commercial |
$1,848.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.38
|
| Rate for Payer: Healthscope Commercial |
$1,934.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.91
|
| Rate for Payer: PHP Commercial |
$1,826.84
|
| Rate for Payer: Priority Health SBD |
$1,354.01
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
OP
|
$2,149.22
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.66 |
| Max. Negotiated Rate |
$1,934.30 |
| Rate for Payer: Aetna Commercial |
$1,826.84
|
| Rate for Payer: Aetna Medicare |
$1,074.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.99
|
| Rate for Payer: BCBS Complete |
$859.69
|
| Rate for Payer: BCBS Trust/PPO |
$537.77
|
| Rate for Payer: BCCCP Commercial |
$171.66
|
| Rate for Payer: BCN Commercial |
$537.77
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cofinity Advantage |
$1,504.45
|
| Rate for Payer: Cofinity Commercial |
$1,848.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.38
|
| Rate for Payer: Healthscope Commercial |
$1,934.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,719.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.91
|
| Rate for Payer: PHP Commercial |
$1,826.84
|
| Rate for Payer: Priority Health SBD |
$1,354.01
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
OP
|
$2,977.05
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$2,679.34 |
| Rate for Payer: Aetna Commercial |
$2,530.49
|
| Rate for Payer: Aetna Medicare |
$1,488.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.08
|
| Rate for Payer: BCBS Complete |
$1,190.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.24
|
| Rate for Payer: BCCCP Commercial |
$266.26
|
| Rate for Payer: BCN Commercial |
$1,075.24
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cofinity Advantage |
$2,083.93
|
| Rate for Payer: Cofinity Commercial |
$2,560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.64
|
| Rate for Payer: Healthscope Commercial |
$2,679.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,381.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.79
|
| Rate for Payer: PHP Commercial |
$2,530.49
|
| Rate for Payer: Priority Health SBD |
$1,875.54
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
IP
|
$2,977.05
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,875.54 |
| Max. Negotiated Rate |
$2,679.34 |
| Rate for Payer: Aetna Commercial |
$2,530.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.08
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cofinity Advantage |
$2,083.93
|
| Rate for Payer: Cofinity Commercial |
$2,560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.64
|
| Rate for Payer: Healthscope Commercial |
$2,679.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.79
|
| Rate for Payer: PHP Commercial |
$2,530.49
|
| Rate for Payer: Priority Health SBD |
$1,875.54
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
OP
|
$1,477.77
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.33 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$1,256.10
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$528.64
|
| Rate for Payer: BCCCP Commercial |
$225.33
|
| Rate for Payer: BCN Commercial |
$528.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cofinity Advantage |
$1,034.44
|
| Rate for Payer: Cofinity Commercial |
$1,270.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,329.99
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.10
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.33
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,256.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$931.00
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
