|
HC PIPELINE EMBOLIZATION DEVICE
|
Facility
|
IP
|
$19,571.39
|
|
| Hospital Charge Code |
27800081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,329.98 |
| Max. Negotiated Rate |
$17,614.25 |
| Rate for Payer: Aetna Commercial |
$16,635.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,721.40
|
| Rate for Payer: Cash Price |
$15,657.11
|
| Rate for Payer: Cofinity Commercial |
$13,699.97
|
| Rate for Payer: Cofinity Commercial |
$16,831.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,699.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,657.11
|
| Rate for Payer: Healthscope Commercial |
$17,614.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,635.68
|
| Rate for Payer: PHP Commercial |
$16,635.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,721.40
|
| Rate for Payer: Priority Health SBD |
$12,329.98
|
|
|
HC PISTACHIO NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200118
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC PISTACHIO NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200118
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PITOCIN AUGMENTATION
|
Facility
|
OP
|
$475.03
|
|
| Hospital Charge Code |
25800002
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$427.53 |
| Rate for Payer: Aetna Commercial |
$403.78
|
| Rate for Payer: Aetna Medicare |
$237.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.77
|
| Rate for Payer: BCBS Complete |
$190.01
|
| Rate for Payer: Cash Price |
$380.02
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Cofinity Commercial |
$408.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$332.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.02
|
| Rate for Payer: Healthscope Commercial |
$427.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.78
|
| Rate for Payer: PHP Commercial |
$403.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.77
|
| Rate for Payer: Priority Health SBD |
$299.27
|
|
|
HC PITOCIN AUGMENTATION
|
Facility
|
IP
|
$475.03
|
|
| Hospital Charge Code |
25800002
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$299.27 |
| Max. Negotiated Rate |
$427.53 |
| Rate for Payer: Aetna Commercial |
$403.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.77
|
| Rate for Payer: Cash Price |
$380.02
|
| Rate for Payer: Cofinity Commercial |
$332.52
|
| Rate for Payer: Cofinity Commercial |
$408.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$332.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.02
|
| Rate for Payer: Healthscope Commercial |
$427.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.78
|
| Rate for Payer: PHP Commercial |
$403.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.77
|
| Rate for Payer: Priority Health SBD |
$299.27
|
|
|
HC PKU STATE TESTING
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
30100387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| 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 |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| 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 |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.50
|
| Rate for Payer: UHCCP Medicaid |
$3.10
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC PKU STATE TESTING
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
30100387
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health SBD |
$13.75
|
|
|
HC PLACE ACCESS BILE TREE RENDEZVOUS PROCEDURE
|
Facility
|
OP
|
$3,683.04
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
36100498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.32 |
| Max. Negotiated Rate |
$17,130.07 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna Medicare |
$6,328.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.88
|
| Rate for Payer: BCBS Complete |
$3,424.92
|
| Rate for Payer: BCBS MAPPO |
$6,085.50
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.50
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.50
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Mclaren Medicaid |
$3,261.83
|
| Rate for Payer: Mclaren Medicare |
$6,085.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,389.77
|
| Rate for Payer: Meridian Medicaid |
$3,424.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PACE Medicare |
$5,781.23
|
| Rate for Payer: PACE SWMI |
$6,085.50
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,261.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health Medicare |
$6,085.50
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,130.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,085.50
|
| Rate for Payer: UHCCP Medicaid |
$3,426.14
|
| Rate for Payer: VA VA |
$6,085.50
|
|
|
HC PLACE ACCESS BILE TREE RENDEZVOUS PROCEDURE
|
Facility
|
IP
|
$3,683.04
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
36100498
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.32 |
| Max. Negotiated Rate |
$3,314.74 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
|
|
HC PLACE BILIARY DRAIN CATH WITH GUIDE INTERNAL EXTERNAL
|
Facility
|
OP
|
$3,683.04
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
36100491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
HC PLACE BILIARY DRAIN CATH WITH GUIDE INTERNAL EXTERNAL
|
Facility
|
IP
|
$3,683.04
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
36100491
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,320.32 |
| Max. Negotiated Rate |
$3,314.74 |
| Rate for Payer: Aetna Commercial |
$3,130.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,393.98
|
| Rate for Payer: Cash Price |
$2,946.43
|
| Rate for Payer: Cofinity Commercial |
$2,578.13
|
| Rate for Payer: Cofinity Commercial |
$3,167.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,578.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,946.43
|
| Rate for Payer: Healthscope Commercial |
$3,314.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,130.58
|
| Rate for Payer: PHP Commercial |
$3,130.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,393.98
|
| Rate for Payer: Priority Health SBD |
$2,320.32
|
|
|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
OP
|
$3,181.54
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Commercial |
$2,704.31
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,068.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$2,545.23
|
| Rate for Payer: Cash Price |
$2,545.23
|
| Rate for Payer: Cofinity Commercial |
$2,736.12
|
| Rate for Payer: Cofinity Commercial |
$2,227.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,227.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,545.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$2,863.39
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,704.31
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$2,704.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,068.00
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$2,004.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
IP
|
$3,181.54
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,004.37 |
| Max. Negotiated Rate |
$2,863.39 |
| Rate for Payer: Aetna Commercial |
$2,704.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,545.23
|
| Rate for Payer: Cofinity Commercial |
$2,227.08
|
| Rate for Payer: Cofinity Commercial |
$2,736.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,227.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,545.23
|
| Rate for Payer: Healthscope Commercial |
$2,863.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,704.31
|
| Rate for Payer: PHP Commercial |
$2,704.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,068.00
|
| Rate for Payer: Priority Health SBD |
$2,004.37
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
OP
|
$1,165.71
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$1,049.14 |
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna Medicare |
$582.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.71
|
| Rate for Payer: BCBS Complete |
$466.28
|
| Rate for Payer: Cash Price |
$932.57
|
| Rate for Payer: Cofinity Commercial |
$1,002.51
|
| Rate for Payer: Cofinity Commercial |
$816.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.57
|
| Rate for Payer: Healthscope Commercial |
$1,049.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.85
|
| Rate for Payer: PHP Commercial |
$990.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.71
|
| Rate for Payer: Priority Health SBD |
$734.40
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
IP
|
$1,165.71
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,049.14 |
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.71
|
| Rate for Payer: Cash Price |
$932.57
|
| Rate for Payer: Cofinity Commercial |
$1,002.51
|
| Rate for Payer: Cofinity Commercial |
$816.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.57
|
| Rate for Payer: Healthscope Commercial |
$1,049.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.85
|
| Rate for Payer: PHP Commercial |
$990.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.71
|
| Rate for Payer: Priority Health SBD |
$734.40
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
IP
|
$1,755.98
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,106.27 |
| Max. Negotiated Rate |
$1,580.38 |
| Rate for Payer: Aetna Commercial |
$1,492.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.39
|
| Rate for Payer: Cash Price |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.78
|
| Rate for Payer: Healthscope Commercial |
$1,580.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.58
|
| Rate for Payer: PHP Commercial |
$1,492.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.39
|
| Rate for Payer: Priority Health SBD |
$1,106.27
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
OP
|
$1,755.98
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$702.39 |
| Max. Negotiated Rate |
$1,580.38 |
| Rate for Payer: Aetna Commercial |
$1,492.58
|
| Rate for Payer: Aetna Medicare |
$877.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.39
|
| Rate for Payer: BCBS Complete |
$702.39
|
| Rate for Payer: Cash Price |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.78
|
| Rate for Payer: Healthscope Commercial |
$1,580.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.58
|
| Rate for Payer: PHP Commercial |
$1,492.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.39
|
| Rate for Payer: Priority Health SBD |
$1,106.27
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
OP
|
$2,107.08
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$842.83 |
| Max. Negotiated Rate |
$1,896.37 |
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Aetna Medicare |
$1,053.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,369.60
|
| Rate for Payer: BCBS Complete |
$842.83
|
| Rate for Payer: Cash Price |
$1,685.66
|
| Rate for Payer: Cofinity Commercial |
$1,474.96
|
| Rate for Payer: Cofinity Commercial |
$1,812.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,474.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,685.66
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.02
|
| Rate for Payer: PHP Commercial |
$1,791.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.60
|
| Rate for Payer: Priority Health SBD |
$1,327.46
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
IP
|
$2,107.08
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,327.46 |
| Max. Negotiated Rate |
$1,896.37 |
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,685.66
|
| Rate for Payer: Cofinity Commercial |
$1,474.96
|
| Rate for Payer: Cofinity Commercial |
$1,812.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,474.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,685.66
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.02
|
| Rate for Payer: PHP Commercial |
$1,791.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.60
|
| Rate for Payer: Priority Health SBD |
$1,327.46
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
IP
|
$2,918.68
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,838.77 |
| Max. Negotiated Rate |
$2,626.81 |
| Rate for Payer: Aetna Commercial |
$2,480.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.14
|
| Rate for Payer: Cash Price |
$2,334.94
|
| Rate for Payer: Cofinity Commercial |
$2,043.08
|
| Rate for Payer: Cofinity Commercial |
$2,510.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,043.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,334.94
|
| Rate for Payer: Healthscope Commercial |
$2,626.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,480.88
|
| Rate for Payer: PHP Commercial |
$2,480.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.14
|
| Rate for Payer: Priority Health SBD |
$1,838.77
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
OP
|
$2,918.68
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,167.47 |
| Max. Negotiated Rate |
$2,626.81 |
| Rate for Payer: Aetna Commercial |
$2,480.88
|
| Rate for Payer: Aetna Medicare |
$1,459.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.14
|
| Rate for Payer: BCBS Complete |
$1,167.47
|
| Rate for Payer: Cash Price |
$2,334.94
|
| Rate for Payer: Cofinity Commercial |
$2,043.08
|
| Rate for Payer: Cofinity Commercial |
$2,510.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,043.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,334.94
|
| Rate for Payer: Healthscope Commercial |
$2,626.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,480.88
|
| Rate for Payer: PHP Commercial |
$2,480.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.14
|
| Rate for Payer: Priority Health SBD |
$1,838.77
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
IP
|
$1,448.79
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$912.74 |
| Max. Negotiated Rate |
$1,303.91 |
| Rate for Payer: Aetna Commercial |
$1,231.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.71
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cofinity Commercial |
$1,014.15
|
| Rate for Payer: Cofinity Commercial |
$1,245.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.03
|
| Rate for Payer: Healthscope Commercial |
$1,303.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.47
|
| Rate for Payer: PHP Commercial |
$1,231.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.71
|
| Rate for Payer: Priority Health SBD |
$912.74
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
OP
|
$1,448.79
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$1,231.47
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cofinity Commercial |
$1,014.15
|
| Rate for Payer: Cofinity Commercial |
$1,245.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,303.91
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.47
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,231.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.71
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$912.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
IP
|
$1,693.72
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,067.04 |
| Max. Negotiated Rate |
$1,524.35 |
| Rate for Payer: Aetna Commercial |
$1,439.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.92
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cofinity Commercial |
$1,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,456.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,185.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.98
|
| Rate for Payer: Healthscope Commercial |
$1,524.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.66
|
| Rate for Payer: PHP Commercial |
$1,439.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.92
|
| Rate for Payer: Priority Health SBD |
$1,067.04
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
OP
|
$1,693.72
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$1,439.66
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cofinity Commercial |
$1,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,456.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,185.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,524.35
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.66
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$1,439.66
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.92
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$1,067.04
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
