|
HC UA DIPSTICK MANUAL
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
OP
|
$12.73
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.35
|
| Rate for Payer: BCBS Complete |
$1.91
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.71
|
| Rate for Payer: BCN Commercial |
$3.71
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Mclaren Medicaid |
$1.82
|
| Rate for Payer: Mclaren Medicare |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: Meridian Medicaid |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.48
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health SBD |
$8.02
|
| Rate for Payer: Priority Health Tiered Network |
$2.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.22
|
| Rate for Payer: UHC Core |
$5.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.48
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicaid |
$1.82
|
| Rate for Payer: UHCCP Medicaid |
$1.82
|
| Rate for Payer: VA VA |
$3.48
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.81
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$1.60
|
| Rate for Payer: Mclaren Medicare |
$3.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Meridian Medicaid |
$3.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$4.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$2.90
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.05
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: Priority Health SBD |
$24.84
|
| Rate for Payer: Priority Health Tiered Network |
$2.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.58
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.05
|
| Rate for Payer: UHC Exchange |
$4.58
|
| Rate for Payer: UHC Medicaid |
$1.60
|
| Rate for Payer: UHCCP Medicaid |
$1.60
|
| Rate for Payer: VA VA |
$3.05
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: Priority Health SBD |
$24.84
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna Medicare |
$42.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.87
|
| Rate for Payer: BCBS Complete |
$34.38
|
| Rate for Payer: BCBS Trust/PPO |
$13.10
|
| Rate for Payer: BCN Commercial |
$13.10
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Advantage |
$60.17
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.07
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.47
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health SBD |
$54.15
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.87
|
| Rate for Payer: UHC Core |
$44.79
|
| Rate for Payer: UHC Exchange |
$33.78
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$77.36 |
| Rate for Payer: Aetna Commercial |
$73.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.87
|
| Rate for Payer: Cash Price |
$68.77
|
| Rate for Payer: Cofinity Advantage |
$60.17
|
| Rate for Payer: Cofinity Commercial |
$73.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.77
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.47
|
| Rate for Payer: PHP Commercial |
$73.07
|
| Rate for Payer: Priority Health SBD |
$54.15
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
IP
|
$9,827.84
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,191.54 |
| Max. Negotiated Rate |
$8,845.06 |
| Rate for Payer: Aetna Commercial |
$8,353.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,388.10
|
| Rate for Payer: Cash Price |
$7,862.27
|
| Rate for Payer: Cofinity Advantage |
$6,879.49
|
| Rate for Payer: Cofinity Commercial |
$8,451.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,862.27
|
| Rate for Payer: Healthscope Commercial |
$8,845.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,353.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,370.88
|
| Rate for Payer: PHP Commercial |
$8,353.66
|
| Rate for Payer: Priority Health SBD |
$6,191.54
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,827.84
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Commercial |
$8,353.66
|
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,388.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,589.59
|
| Rate for Payer: BCN Commercial |
$4,589.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Cash Price |
$7,862.27
|
| Rate for Payer: Cash Price |
$7,862.27
|
| Rate for Payer: Cash Price |
$7,862.27
|
| Rate for Payer: Cofinity Advantage |
$6,879.49
|
| Rate for Payer: Cofinity Commercial |
$8,451.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,862.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Healthscope Commercial |
$8,845.06
|
| Rate for Payer: Mclaren Medicaid |
$3,864.33
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,353.66
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,370.88
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Commercial |
$8,353.66
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health SBD |
$6,191.54
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
OP
|
$249.34
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$224.41 |
| Rate for Payer: Aetna Commercial |
$211.94
|
| Rate for Payer: Aetna Medicare |
$124.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.07
|
| Rate for Payer: BCBS Complete |
$99.74
|
| Rate for Payer: BCBS Trust/PPO |
$159.33
|
| Rate for Payer: BCN Commercial |
$159.33
|
| Rate for Payer: Cash Price |
$199.47
|
| Rate for Payer: Cash Price |
$199.47
|
| Rate for Payer: Cofinity Advantage |
$174.54
|
| Rate for Payer: Cofinity Commercial |
$214.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.47
|
| Rate for Payer: Healthscope Commercial |
$224.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.00
|
| Rate for Payer: PHP Commercial |
$211.94
|
| Rate for Payer: Priority Health SBD |
$157.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.67
|
| Rate for Payer: UHC Core |
$179.67
|
| Rate for Payer: UHC Exchange |
$179.67
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
IP
|
$249.34
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$224.41 |
| Rate for Payer: Aetna Commercial |
$211.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.07
|
| Rate for Payer: Cash Price |
$199.47
|
| Rate for Payer: Cofinity Advantage |
$174.54
|
| Rate for Payer: Cofinity Commercial |
$214.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.47
|
| Rate for Payer: Healthscope Commercial |
$224.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.00
|
| Rate for Payer: PHP Commercial |
$211.94
|
| Rate for Payer: Priority Health SBD |
$157.08
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
IP
|
$217.91
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$196.12 |
| Rate for Payer: Aetna Commercial |
$185.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.64
|
| Rate for Payer: Cash Price |
$174.33
|
| Rate for Payer: Cofinity Advantage |
$152.54
|
| Rate for Payer: Cofinity Commercial |
$187.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.33
|
| Rate for Payer: Healthscope Commercial |
$196.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.43
|
| Rate for Payer: PHP Commercial |
$185.22
|
| Rate for Payer: Priority Health SBD |
$137.28
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
OP
|
$217.91
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.16 |
| Max. Negotiated Rate |
$197.84 |
| Rate for Payer: Aetna Commercial |
$185.22
|
| Rate for Payer: Aetna Medicare |
$108.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.64
|
| Rate for Payer: BCBS Complete |
$87.16
|
| Rate for Payer: BCBS Trust/PPO |
$197.84
|
| Rate for Payer: BCN Commercial |
$197.84
|
| Rate for Payer: Cash Price |
$174.33
|
| Rate for Payer: Cash Price |
$174.33
|
| Rate for Payer: Cofinity Advantage |
$152.54
|
| Rate for Payer: Cofinity Commercial |
$187.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.33
|
| Rate for Payer: Healthscope Commercial |
$196.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.43
|
| Rate for Payer: PHP Commercial |
$185.22
|
| Rate for Payer: Priority Health SBD |
$137.28
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
OP
|
$217.91
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.16 |
| Max. Negotiated Rate |
$229.42 |
| Rate for Payer: Aetna Commercial |
$185.22
|
| Rate for Payer: Aetna Medicare |
$108.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.64
|
| Rate for Payer: BCBS Complete |
$87.16
|
| Rate for Payer: BCBS Trust/PPO |
$229.42
|
| Rate for Payer: BCN Commercial |
$229.42
|
| Rate for Payer: Cash Price |
$174.33
|
| Rate for Payer: Cash Price |
$174.33
|
| Rate for Payer: Cofinity Advantage |
$152.54
|
| Rate for Payer: Cofinity Commercial |
$187.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.33
|
| Rate for Payer: Healthscope Commercial |
$196.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.43
|
| Rate for Payer: PHP Commercial |
$185.22
|
| Rate for Payer: Priority Health SBD |
$137.28
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
IP
|
$217.91
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$196.12 |
| Rate for Payer: Aetna Commercial |
$185.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.64
|
| Rate for Payer: Cash Price |
$174.33
|
| Rate for Payer: Cofinity Advantage |
$152.54
|
| Rate for Payer: Cofinity Commercial |
$187.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.33
|
| Rate for Payer: Healthscope Commercial |
$196.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.43
|
| Rate for Payer: PHP Commercial |
$185.22
|
| Rate for Payer: Priority Health SBD |
$137.28
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$352.12
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$221.84 |
| Max. Negotiated Rate |
$316.91 |
| Rate for Payer: Aetna Commercial |
$299.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.88
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cofinity Advantage |
$246.48
|
| Rate for Payer: Cofinity Commercial |
$302.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.70
|
| Rate for Payer: Healthscope Commercial |
$316.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.09
|
| Rate for Payer: PHP Commercial |
$299.30
|
| Rate for Payer: Priority Health SBD |
$221.84
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$352.12
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$316.91 |
| Rate for Payer: Aetna Commercial |
$299.30
|
| Rate for Payer: Aetna Medicare |
$176.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.88
|
| Rate for Payer: BCBS Complete |
$140.85
|
| Rate for Payer: BCBS Trust/PPO |
$209.73
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$209.73
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cofinity Advantage |
$246.48
|
| Rate for Payer: Cofinity Commercial |
$302.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.70
|
| Rate for Payer: Healthscope Commercial |
$316.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$281.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.09
|
| Rate for Payer: PHP Commercial |
$299.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$100.49
|
| Rate for Payer: Priority Health SBD |
$221.84
|
| Rate for Payer: Priority Health Tiered Network |
$80.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.88
|
| Rate for Payer: UHC Core |
$183.45
|
| Rate for Payer: UHC Exchange |
$138.38
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$105.27
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$95.11 |
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Aetna Medicare |
$52.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: BCBS Complete |
$42.11
|
| Rate for Payer: BCBS Trust/PPO |
$59.42
|
| Rate for Payer: BCN Commercial |
$59.42
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Advantage |
$73.69
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$94.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: PHP Commercial |
$89.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.11
|
| Rate for Payer: Priority Health SBD |
$66.32
|
| Rate for Payer: Priority Health Tiered Network |
$76.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Core |
$54.85
|
| Rate for Payer: UHC Exchange |
$41.37
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$105.27
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$94.74 |
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Advantage |
$73.69
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$94.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: PHP Commercial |
$89.48
|
| Rate for Payer: Priority Health SBD |
$66.32
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,848.75
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$20,535.59 |
| Rate for Payer: Aetna Commercial |
$8,371.44
|
| Rate for Payer: Aetna Medicare |
$6,604.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,401.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,942.22
|
| Rate for Payer: BCN Commercial |
$5,942.22
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cofinity Advantage |
$6,894.12
|
| Rate for Payer: Cofinity Commercial |
$8,469.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Healthscope Commercial |
$8,863.88
|
| Rate for Payer: Mclaren Medicaid |
$3,321.09
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$6,667.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,371.44
|
| Rate for Payer: Nomi Health Commercial |
$19,050.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,386.56
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Commercial |
$8,371.44
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,535.59
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health SBD |
$6,204.71
|
| Rate for Payer: Priority Health Tiered Network |
$16,428.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,401.69
|
| Rate for Payer: UHC Core |
$5,131.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Exchange |
$3,870.56
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: VA VA |
$6,350.08
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,848.75
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,204.71 |
| Max. Negotiated Rate |
$8,863.88 |
| Rate for Payer: Aetna Commercial |
$8,371.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,401.69
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cofinity Advantage |
$6,894.12
|
| Rate for Payer: Cofinity Commercial |
$8,469.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.00
|
| Rate for Payer: Healthscope Commercial |
$8,863.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,371.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,386.56
|
| Rate for Payer: PHP Commercial |
$8,371.44
|
| Rate for Payer: Priority Health SBD |
$6,204.71
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,147.85
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$723.15 |
| Max. Negotiated Rate |
$1,033.07 |
| Rate for Payer: Aetna Commercial |
$975.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.10
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cofinity Advantage |
$803.50
|
| Rate for Payer: Cofinity Commercial |
$987.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.28
|
| Rate for Payer: Healthscope Commercial |
$1,033.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.89
|
| Rate for Payer: PHP Commercial |
$975.67
|
| Rate for Payer: Priority Health SBD |
$723.15
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,147.85
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$1,033.07 |
| Rate for Payer: Aetna Commercial |
$975.67
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$746.10
|
| 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 |
$918.28
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cofinity Advantage |
$803.50
|
| Rate for Payer: Cofinity Commercial |
$987.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$1,033.07
|
| 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 |
$975.67
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.89
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$975.67
|
| 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 |
$723.15
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$137.20
|
| Rate for Payer: BCN Commercial |
$137.20
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$137.20
|
| Rate for Payer: BCN Commercial |
$137.20
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$269.86
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
