|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
IP
|
$1,477.77
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$931.00 |
| Max. Negotiated Rate |
$1,329.99 |
| Rate for Payer: Aetna Commercial |
$1,256.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.55
|
| 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: Healthscope Commercial |
$1,329.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.33
|
| Rate for Payer: PHP Commercial |
$1,256.10
|
| Rate for Payer: Priority Health SBD |
$931.00
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
OP
|
$1,727.59
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$1,468.45
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,122.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$370.15
|
| Rate for Payer: BCCCP Commercial |
$566.80
|
| Rate for Payer: BCN Commercial |
$370.15
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cofinity Advantage |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,485.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,382.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$1,554.83
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,468.45
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,295.69
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$1,468.45
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,088.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
IP
|
$1,727.59
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,088.38 |
| Max. Negotiated Rate |
$1,554.83 |
| Rate for Payer: Aetna Commercial |
$1,468.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,122.93
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cofinity Advantage |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,485.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,382.07
|
| Rate for Payer: Healthscope Commercial |
$1,554.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,468.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,295.69
|
| Rate for Payer: PHP Commercial |
$1,468.45
|
| Rate for Payer: Priority Health SBD |
$1,088.38
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
IP
|
$2,438.02
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,535.95 |
| Max. Negotiated Rate |
$2,194.22 |
| Rate for Payer: Aetna Commercial |
$2,072.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.71
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cofinity Advantage |
$1,706.61
|
| Rate for Payer: Cofinity Commercial |
$2,096.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,950.42
|
| Rate for Payer: Healthscope Commercial |
$2,194.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,072.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,828.52
|
| Rate for Payer: PHP Commercial |
$2,072.32
|
| Rate for Payer: Priority Health SBD |
$1,535.95
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
OP
|
$2,438.02
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$2,072.32
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$370.15
|
| Rate for Payer: BCCCP Commercial |
$240.24
|
| Rate for Payer: BCN Commercial |
$370.15
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cofinity Advantage |
$1,706.61
|
| Rate for Payer: Cofinity Commercial |
$2,096.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,950.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$2,194.22
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,072.32
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,828.52
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$2,072.32
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,535.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
OP
|
$2,002.24
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,301.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$708.27
|
| Rate for Payer: BCCCP Commercial |
$330.02
|
| Rate for Payer: BCN Commercial |
$708.27
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cofinity Advantage |
$1,401.57
|
| Rate for Payer: Cofinity Commercial |
$1,721.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$1,802.02
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.90
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.68
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$1,701.90
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,261.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
IP
|
$2,002.24
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,261.41 |
| Max. Negotiated Rate |
$1,802.02 |
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,301.46
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cofinity Advantage |
$1,401.57
|
| Rate for Payer: Cofinity Commercial |
$1,721.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.79
|
| Rate for Payer: Healthscope Commercial |
$1,802.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.68
|
| Rate for Payer: PHP Commercial |
$1,701.90
|
| Rate for Payer: Priority Health SBD |
$1,261.41
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
OP
|
$1,092.42
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$436.97 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
IP
|
$1,092.42
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
|
|
HC PLACEMENT OF BAKRI BALLOON
|
Facility
|
IP
|
$510.33
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$321.51 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health SBD |
$321.51
|
|
|
HC PLACEMENT OF BAKRI BALLOON
|
Facility
|
OP
|
$510.33
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$104.50
|
| Rate for Payer: BCN Commercial |
$104.50
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Mclaren Medicaid |
$105.35
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.71
|
| Rate for Payer: UHC Core |
$265.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$200.56
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC PLACEMENT OF JADA SYSTEM
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$104.50
|
| Rate for Payer: BCN Commercial |
$104.50
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Mclaren Medicaid |
$105.35
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,267.89
|
| Rate for Payer: UHC Core |
$4,222.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$3,185.04
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC PLACEMENT OF JADA SYSTEM
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$5,105.80 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
OP
|
$7,411.20
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,957.29 |
| Max. Negotiated Rate |
$6,670.08 |
| Rate for Payer: Aetna Commercial |
$6,299.52
|
| Rate for Payer: Aetna Medicare |
$3,705.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,817.28
|
| Rate for Payer: BCBS Complete |
$2,964.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,957.29
|
| Rate for Payer: BCN Commercial |
$2,957.29
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cofinity Advantage |
$5,187.84
|
| Rate for Payer: Cofinity Commercial |
$6,373.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,928.96
|
| Rate for Payer: Healthscope Commercial |
$6,670.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,928.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,299.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,558.40
|
| Rate for Payer: PHP Commercial |
$6,299.52
|
| Rate for Payer: Priority Health SBD |
$4,669.06
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
IP
|
$7,411.20
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,669.06 |
| Max. Negotiated Rate |
$6,670.08 |
| Rate for Payer: Aetna Commercial |
$6,299.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,817.28
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cofinity Advantage |
$5,187.84
|
| Rate for Payer: Cofinity Commercial |
$6,373.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,928.96
|
| Rate for Payer: Healthscope Commercial |
$6,670.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,299.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,558.40
|
| Rate for Payer: PHP Commercial |
$6,299.52
|
| Rate for Payer: Priority Health SBD |
$4,669.06
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
IP
|
$1,040.40
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.45 |
| Max. Negotiated Rate |
$936.36 |
| Rate for Payer: Aetna Commercial |
$884.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.26
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cofinity Advantage |
$728.28
|
| Rate for Payer: Cofinity Commercial |
$894.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.32
|
| Rate for Payer: Healthscope Commercial |
$936.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.30
|
| Rate for Payer: PHP Commercial |
$884.34
|
| Rate for Payer: Priority Health SBD |
$655.45
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
OP
|
$1,040.40
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.16 |
| Max. Negotiated Rate |
$3,057.58 |
| Rate for Payer: Aetna Commercial |
$884.34
|
| Rate for Payer: Aetna Medicare |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.26
|
| Rate for Payer: BCBS Complete |
$416.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,057.58
|
| Rate for Payer: BCN Commercial |
$3,057.58
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cofinity Advantage |
$728.28
|
| Rate for Payer: Cofinity Commercial |
$894.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.32
|
| Rate for Payer: Healthscope Commercial |
$936.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$832.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.30
|
| Rate for Payer: PHP Commercial |
$884.34
|
| Rate for Payer: Priority Health SBD |
$655.45
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
IP
|
$862.45
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.34 |
| Max. Negotiated Rate |
$776.21 |
| Rate for Payer: Aetna Commercial |
$733.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.59
|
| Rate for Payer: Cash Price |
$689.96
|
| Rate for Payer: Cofinity Advantage |
$603.72
|
| Rate for Payer: Cofinity Commercial |
$741.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.96
|
| Rate for Payer: Healthscope Commercial |
$776.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$646.84
|
| Rate for Payer: PHP Commercial |
$733.08
|
| Rate for Payer: Priority Health SBD |
$543.34
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
OP
|
$862.45
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.98 |
| Max. Negotiated Rate |
$5,004.34 |
| Rate for Payer: Aetna Commercial |
$733.08
|
| Rate for Payer: Aetna Medicare |
$431.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.59
|
| Rate for Payer: BCBS Complete |
$344.98
|
| Rate for Payer: BCBS Trust/PPO |
$5,004.34
|
| Rate for Payer: BCN Commercial |
$5,004.34
|
| Rate for Payer: Cash Price |
$689.96
|
| Rate for Payer: Cash Price |
$689.96
|
| Rate for Payer: Cofinity Advantage |
$603.72
|
| Rate for Payer: Cofinity Commercial |
$741.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.96
|
| Rate for Payer: Healthscope Commercial |
$776.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$646.84
|
| Rate for Payer: PHP Commercial |
$733.08
|
| Rate for Payer: Priority Health SBD |
$543.34
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,145.32
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.55 |
| Max. Negotiated Rate |
$1,030.79 |
| Rate for Payer: Aetna Commercial |
$973.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.46
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cofinity Advantage |
$801.72
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.26
|
| Rate for Payer: Healthscope Commercial |
$1,030.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.99
|
| Rate for Payer: PHP Commercial |
$973.52
|
| Rate for Payer: Priority Health SBD |
$721.55
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,145.32
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$458.13 |
| Max. Negotiated Rate |
$1,030.79 |
| Rate for Payer: Aetna Commercial |
$973.52
|
| Rate for Payer: Aetna Medicare |
$572.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.46
|
| Rate for Payer: BCBS Complete |
$458.13
|
| Rate for Payer: BCBS Trust/PPO |
$489.46
|
| Rate for Payer: BCN Commercial |
$489.46
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cofinity Advantage |
$801.72
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.26
|
| Rate for Payer: Healthscope Commercial |
$1,030.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$916.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.99
|
| Rate for Payer: PHP Commercial |
$973.52
|
| Rate for Payer: Priority Health SBD |
$721.55
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
IP
|
$10,655.77
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,713.14 |
| Max. Negotiated Rate |
$9,590.19 |
| Rate for Payer: Aetna Commercial |
$9,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,926.25
|
| Rate for Payer: Cash Price |
$8,524.62
|
| Rate for Payer: Cofinity Advantage |
$7,459.04
|
| Rate for Payer: Cofinity Commercial |
$9,163.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,524.62
|
| Rate for Payer: Healthscope Commercial |
$9,590.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,057.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,991.83
|
| Rate for Payer: PHP Commercial |
$9,057.40
|
| Rate for Payer: Priority Health SBD |
$6,713.14
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
OP
|
$10,655.77
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,383.29 |
| Max. Negotiated Rate |
$9,590.19 |
| Rate for Payer: Aetna Commercial |
$9,057.40
|
| Rate for Payer: Aetna Medicare |
$5,327.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,926.25
|
| Rate for Payer: BCBS Complete |
$4,262.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,383.29
|
| Rate for Payer: BCN Commercial |
$3,383.29
|
| Rate for Payer: Cash Price |
$8,524.62
|
| Rate for Payer: Cash Price |
$8,524.62
|
| Rate for Payer: Cofinity Advantage |
$7,459.04
|
| Rate for Payer: Cofinity Commercial |
$9,163.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,524.62
|
| Rate for Payer: Healthscope Commercial |
$9,590.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,524.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,057.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,991.83
|
| Rate for Payer: PHP Commercial |
$9,057.40
|
| Rate for Payer: Priority Health SBD |
$6,713.14
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,071.82
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$402.17 |
| Max. Negotiated Rate |
$964.64 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Medicare |
$535.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.68
|
| Rate for Payer: BCBS Complete |
$428.73
|
| Rate for Payer: BCBS Trust/PPO |
$402.17
|
| Rate for Payer: BCN Commercial |
$402.17
|
| Rate for Payer: Cash Price |
$857.46
|
| Rate for Payer: Cash Price |
$857.46
|
| Rate for Payer: Cofinity Advantage |
$750.27
|
| Rate for Payer: Cofinity Commercial |
$921.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.46
|
| Rate for Payer: Healthscope Commercial |
$964.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$857.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.87
|
| Rate for Payer: PHP Commercial |
$911.05
|
| Rate for Payer: Priority Health SBD |
$675.25
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,071.82
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.25 |
| Max. Negotiated Rate |
$964.64 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.68
|
| Rate for Payer: Cash Price |
$857.46
|
| Rate for Payer: Cofinity Advantage |
$750.27
|
| Rate for Payer: Cofinity Commercial |
$921.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.46
|
| Rate for Payer: Healthscope Commercial |
$964.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.87
|
| Rate for Payer: PHP Commercial |
$911.05
|
| Rate for Payer: Priority Health SBD |
$675.25
|
|
