|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
OP
|
$214.20
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.52 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna Medicare |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.23
|
| Rate for Payer: BCBS Complete |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$82.52
|
| Rate for Payer: BCN Commercial |
$82.52
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Advantage |
$149.94
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.65
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: Priority Health SBD |
$134.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.23
|
| Rate for Payer: UHC Core |
$111.60
|
| Rate for Payer: UHC Exchange |
$84.18
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
IP
|
$214.20
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.23
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Advantage |
$149.94
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.65
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: Priority Health SBD |
$134.95
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$293.76
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$175.65
|
| Rate for Payer: BCN Commercial |
$175.65
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Advantage |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$252.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$249.70
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$185.07
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.94
|
| Rate for Payer: UHC Core |
$153.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$115.45
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$293.76
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$185.07 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Advantage |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$252.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: PHP Commercial |
$249.70
|
| Rate for Payer: Priority Health SBD |
$185.07
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$482.62
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$304.05 |
| Max. Negotiated Rate |
$434.36 |
| Rate for Payer: Aetna Commercial |
$410.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.70
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cofinity Advantage |
$337.83
|
| Rate for Payer: Cofinity Commercial |
$415.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.10
|
| Rate for Payer: Healthscope Commercial |
$434.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.96
|
| Rate for Payer: PHP Commercial |
$410.23
|
| Rate for Payer: Priority Health SBD |
$304.05
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$482.62
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$461.90 |
| Rate for Payer: Aetna Commercial |
$410.23
|
| Rate for Payer: Aetna Medicare |
$241.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.70
|
| Rate for Payer: BCBS Complete |
$193.05
|
| Rate for Payer: BCBS Trust/PPO |
$461.90
|
| Rate for Payer: BCN Commercial |
$461.90
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cofinity Advantage |
$337.83
|
| Rate for Payer: Cofinity Commercial |
$415.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.10
|
| Rate for Payer: Healthscope Commercial |
$434.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.23
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.96
|
| Rate for Payer: PHP Commercial |
$410.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$112.48
|
| Rate for Payer: Priority Health SBD |
$304.05
|
| Rate for Payer: Priority Health Tiered Network |
$89.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.70
|
| Rate for Payer: UHC Core |
$251.45
|
| Rate for Payer: UHC Exchange |
$189.67
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$700.75
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.47 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Aetna Commercial |
$595.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.49
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Advantage |
$490.52
|
| Rate for Payer: Cofinity Commercial |
$602.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Healthscope Commercial |
$630.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: PHP Commercial |
$595.64
|
| Rate for Payer: Priority Health SBD |
$441.47
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$700.75
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Aetna Commercial |
$595.64
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$71.93
|
| Rate for Payer: BCCCP Commercial |
$60.92
|
| Rate for Payer: BCN Commercial |
$71.93
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Advantage |
$490.52
|
| Rate for Payer: Cofinity Commercial |
$602.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$630.67
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$595.64
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$441.47
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.49
|
| Rate for Payer: UHC Core |
$365.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$275.39
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$700.75
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.47 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Aetna Commercial |
$595.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.49
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Advantage |
$490.52
|
| Rate for Payer: Cofinity Commercial |
$602.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Healthscope Commercial |
$630.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: PHP Commercial |
$595.64
|
| Rate for Payer: Priority Health SBD |
$441.47
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$700.75
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$630.67 |
| Rate for Payer: Aetna Commercial |
$595.64
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$24.22
|
| Rate for Payer: BCN Commercial |
$24.22
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cash Price |
$560.60
|
| Rate for Payer: Cofinity Advantage |
$490.52
|
| Rate for Payer: Cofinity Commercial |
$602.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$630.67
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.64
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$525.56
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$595.64
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$441.47
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.49
|
| Rate for Payer: UHC Core |
$365.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$275.39
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,236.73
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$1,113.06 |
| Rate for Payer: Aetna Commercial |
$1,051.22
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.13
|
| Rate for Payer: BCN Commercial |
$40.13
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$989.38
|
| Rate for Payer: Cash Price |
$989.38
|
| Rate for Payer: Cofinity Advantage |
$865.71
|
| Rate for Payer: Cofinity Commercial |
$1,063.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,113.06
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.22
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.55
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,051.22
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$779.14
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.87
|
| Rate for Payer: UHC Core |
$644.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$486.03
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,236.73
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$779.14 |
| Max. Negotiated Rate |
$1,113.06 |
| Rate for Payer: Aetna Commercial |
$1,051.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.87
|
| Rate for Payer: Cash Price |
$989.38
|
| Rate for Payer: Cofinity Advantage |
$865.71
|
| Rate for Payer: Cofinity Commercial |
$1,063.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.38
|
| Rate for Payer: Healthscope Commercial |
$1,113.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.55
|
| Rate for Payer: PHP Commercial |
$1,051.22
|
| Rate for Payer: Priority Health SBD |
$779.14
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,473.59
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$2,226.23 |
| Rate for Payer: Aetna Commercial |
$2,102.55
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,607.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.13
|
| Rate for Payer: BCN Commercial |
$40.13
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,978.87
|
| Rate for Payer: Cash Price |
$1,978.87
|
| Rate for Payer: Cofinity Advantage |
$1,731.51
|
| Rate for Payer: Cofinity Commercial |
$2,127.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,978.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$2,226.23
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,102.55
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,855.19
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$2,102.55
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$1,558.36
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,607.83
|
| Rate for Payer: UHC Core |
$1,288.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$972.12
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,473.59
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,558.36 |
| Max. Negotiated Rate |
$2,226.23 |
| Rate for Payer: Aetna Commercial |
$2,102.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,607.83
|
| Rate for Payer: Cash Price |
$1,978.87
|
| Rate for Payer: Cofinity Advantage |
$1,731.51
|
| Rate for Payer: Cofinity Commercial |
$2,127.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,978.87
|
| Rate for Payer: Healthscope Commercial |
$2,226.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,102.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,855.19
|
| Rate for Payer: PHP Commercial |
$2,102.55
|
| Rate for Payer: Priority Health SBD |
$1,558.36
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
OP
|
$879.73
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Commercial |
$747.77
|
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$206.16
|
| Rate for Payer: BCN Commercial |
$206.16
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cofinity Advantage |
$615.81
|
| Rate for Payer: Cofinity Commercial |
$756.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$791.76
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.77
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.80
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$747.77
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health SBD |
$554.23
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$879.73
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$554.23 |
| Max. Negotiated Rate |
$791.76 |
| Rate for Payer: Aetna Commercial |
$747.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.82
|
| Rate for Payer: Cash Price |
$703.78
|
| Rate for Payer: Cofinity Advantage |
$615.81
|
| Rate for Payer: Cofinity Commercial |
$756.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.78
|
| Rate for Payer: Healthscope Commercial |
$791.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.80
|
| Rate for Payer: PHP Commercial |
$747.77
|
| Rate for Payer: Priority Health SBD |
$554.23
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$124.18
|
| Rate for Payer: BCN Commercial |
$124.18
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$187.54
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.49
|
| Rate for Payer: UHC Core |
$155.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$116.99
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$187.54 |
| Max. Negotiated Rate |
$267.91 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: Priority Health SBD |
$187.54
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$187.54 |
| Max. Negotiated Rate |
$267.91 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: Priority Health SBD |
$187.54
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$46.94
|
| Rate for Payer: BCN Commercial |
$46.94
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$187.54
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.49
|
| Rate for Payer: UHC Core |
$155.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$116.99
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
IP
|
$421.63
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$265.63 |
| Max. Negotiated Rate |
$379.47 |
| Rate for Payer: Aetna Commercial |
$358.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.06
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cofinity Advantage |
$295.14
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.30
|
| Rate for Payer: Healthscope Commercial |
$379.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.22
|
| Rate for Payer: PHP Commercial |
$358.39
|
| Rate for Payer: Priority Health SBD |
$265.63
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
OP
|
$421.63
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$379.47 |
| Rate for Payer: Aetna Commercial |
$358.39
|
| Rate for Payer: Aetna Medicare |
$210.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.06
|
| Rate for Payer: BCBS Complete |
$168.65
|
| Rate for Payer: BCBS Trust/PPO |
$63.60
|
| Rate for Payer: BCN Commercial |
$63.60
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cofinity Advantage |
$295.14
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.30
|
| Rate for Payer: Healthscope Commercial |
$379.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.22
|
| Rate for Payer: PHP Commercial |
$358.39
|
| Rate for Payer: Priority Health SBD |
$265.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.06
|
| Rate for Payer: UHC Core |
$219.67
|
| Rate for Payer: UHC Exchange |
$165.70
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$656.83
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$591.15 |
| Rate for Payer: Aetna Commercial |
$558.31
|
| Rate for Payer: Aetna Medicare |
$328.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.94
|
| Rate for Payer: BCBS Complete |
$262.73
|
| Rate for Payer: BCBS Trust/PPO |
$65.88
|
| Rate for Payer: BCCCP Commercial |
$55.83
|
| Rate for Payer: BCN Commercial |
$65.88
|
| Rate for Payer: Cash Price |
$525.46
|
| Rate for Payer: Cash Price |
$525.46
|
| Rate for Payer: Cofinity Advantage |
$459.78
|
| Rate for Payer: Cofinity Commercial |
$564.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.46
|
| Rate for Payer: Healthscope Commercial |
$591.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.62
|
| Rate for Payer: PHP Commercial |
$558.31
|
| Rate for Payer: Priority Health SBD |
$413.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.94
|
| Rate for Payer: UHC Core |
$342.21
|
| Rate for Payer: UHC Exchange |
$258.13
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$656.83
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$413.80 |
| Max. Negotiated Rate |
$591.15 |
| Rate for Payer: Aetna Commercial |
$558.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.94
|
| Rate for Payer: Cash Price |
$525.46
|
| Rate for Payer: Cofinity Advantage |
$459.78
|
| Rate for Payer: Cofinity Commercial |
$564.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.46
|
| Rate for Payer: Healthscope Commercial |
$591.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.62
|
| Rate for Payer: PHP Commercial |
$558.31
|
| Rate for Payer: Priority Health SBD |
$413.80
|
|
