|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
IP
|
$3,966.57
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,776.60 |
| Max. Negotiated Rate |
$3,966.57 |
| Rate for Payer: Aetna Commercial |
$3,569.91
|
| Rate for Payer: ASR ASR |
$3,847.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,075.28
|
| Rate for Payer: BCN Commercial |
$3,075.28
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cofinity Commercial |
$3,728.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.26
|
| Rate for Payer: Healthscope Commercial |
$3,966.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,847.57
|
| Rate for Payer: Mclaren Commercial |
$3,569.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,371.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,776.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,490.58
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
IP
|
$3,036.13
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,125.29 |
| Max. Negotiated Rate |
$3,036.13 |
| Rate for Payer: Aetna Commercial |
$2,732.52
|
| Rate for Payer: ASR ASR |
$2,945.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,353.91
|
| Rate for Payer: BCN Commercial |
$2,353.91
|
| Rate for Payer: Cash Price |
$2,428.90
|
| Rate for Payer: Cofinity Commercial |
$2,853.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,428.90
|
| Rate for Payer: Healthscope Commercial |
$3,036.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,945.05
|
| Rate for Payer: Mclaren Commercial |
$2,732.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,671.79
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
OP
|
$3,036.13
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.98 |
| Max. Negotiated Rate |
$3,036.13 |
| Rate for Payer: Aetna Commercial |
$2,732.52
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$2,945.05
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,353.91
|
| Rate for Payer: BCCCP Commercial |
$791.70
|
| Rate for Payer: BCN Commercial |
$2,353.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$2,428.90
|
| Rate for Payer: Cash Price |
$2,428.90
|
| Rate for Payer: Cofinity Commercial |
$2,853.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,428.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$3,036.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,945.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$2,732.52
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,580.71
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.23
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$600.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,671.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
OP
|
$3,667.20
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.00 |
| Max. Negotiated Rate |
$3,667.20 |
| Rate for Payer: Aetna Commercial |
$3,300.48
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$3,557.18
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,843.18
|
| Rate for Payer: BCCCP Commercial |
$519.00
|
| Rate for Payer: BCN Commercial |
$2,843.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$2,933.76
|
| Rate for Payer: Cash Price |
$2,933.76
|
| Rate for Payer: Cofinity Commercial |
$3,447.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,933.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$3,667.20
|
| Rate for Payer: Healthscope Whirlpool |
$3,557.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$3,300.48
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,117.12
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,567.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.23
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$600.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,227.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
IP
|
$3,667.20
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,567.04 |
| Max. Negotiated Rate |
$3,667.20 |
| Rate for Payer: Aetna Commercial |
$3,300.48
|
| Rate for Payer: ASR ASR |
$3,557.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,843.18
|
| Rate for Payer: BCN Commercial |
$2,843.18
|
| Rate for Payer: Cash Price |
$2,933.76
|
| Rate for Payer: Cofinity Commercial |
$3,447.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,933.76
|
| Rate for Payer: Healthscope Commercial |
$3,667.20
|
| Rate for Payer: Healthscope Whirlpool |
$3,557.18
|
| Rate for Payer: Mclaren Commercial |
$3,300.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,117.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,567.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,227.14
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
OP
|
$4,045.36
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$518.26 |
| Max. Negotiated Rate |
$4,045.36 |
| Rate for Payer: Aetna Commercial |
$3,640.82
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$3,924.00
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.37
|
| Rate for Payer: BCCCP Commercial |
$518.26
|
| Rate for Payer: BCN Commercial |
$3,136.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$3,236.29
|
| Rate for Payer: Cash Price |
$3,236.29
|
| Rate for Payer: Cofinity Commercial |
$3,802.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$4,045.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,924.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$3,640.82
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,438.56
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,831.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.23
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$600.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,559.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
IP
|
$4,045.36
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,831.75 |
| Max. Negotiated Rate |
$4,045.36 |
| Rate for Payer: Aetna Commercial |
$3,640.82
|
| Rate for Payer: ASR ASR |
$3,924.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.37
|
| Rate for Payer: BCN Commercial |
$3,136.37
|
| Rate for Payer: Cash Price |
$3,236.29
|
| Rate for Payer: Cofinity Commercial |
$3,802.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.29
|
| Rate for Payer: Healthscope Commercial |
$4,045.36
|
| Rate for Payer: Healthscope Whirlpool |
$3,924.00
|
| Rate for Payer: Mclaren Commercial |
$3,640.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,438.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,831.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,559.92
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$355.98 |
| Rate for Payer: Aetna Commercial |
$320.38
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$345.30
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$275.99
|
| Rate for Payer: BCN Commercial |
$275.99
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$284.78
|
| Rate for Payer: Cash Price |
$284.78
|
| Rate for Payer: Cofinity Commercial |
$334.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$355.98
|
| Rate for Payer: Healthscope Whirlpool |
$345.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$320.38
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.58
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.94
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$252.75
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.26
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC BREATH HYDROGEN/METHANE TEST
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
CPT 91065
|
| Hospital Charge Code |
75000012
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$355.98 |
| Rate for Payer: Aetna Commercial |
$320.38
|
| Rate for Payer: ASR ASR |
$345.30
|
| Rate for Payer: BCBS Trust/PPO |
$275.99
|
| Rate for Payer: BCN Commercial |
$275.99
|
| Rate for Payer: Cash Price |
$284.78
|
| Rate for Payer: Cofinity Commercial |
$334.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.78
|
| Rate for Payer: Healthscope Commercial |
$355.98
|
| Rate for Payer: Healthscope Whirlpool |
$345.30
|
| Rate for Payer: Mclaren Commercial |
$320.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.26
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
OP
|
$24.13
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$44.56 |
| Rate for Payer: Aetna Commercial |
$21.72
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$23.41
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$18.71
|
| Rate for Payer: BCN Commercial |
$18.71
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$24.13
|
| Rate for Payer: Healthscope Whirlpool |
$23.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$21.72
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.51
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.96
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$17.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
HC BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT
|
Facility
|
IP
|
$24.13
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
91800002
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Aetna Commercial |
$21.72
|
| Rate for Payer: ASR ASR |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$18.71
|
| Rate for Payer: BCN Commercial |
$18.71
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$24.13
|
| Rate for Payer: Healthscope Whirlpool |
$23.41
|
| Rate for Payer: Mclaren Commercial |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
IP
|
$252.97
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$252.97 |
| Rate for Payer: Aetna Commercial |
$227.67
|
| Rate for Payer: ASR ASR |
$245.38
|
| Rate for Payer: BCBS Trust/PPO |
$196.13
|
| Rate for Payer: BCN Commercial |
$196.13
|
| Rate for Payer: Cash Price |
$202.38
|
| Rate for Payer: Cofinity Commercial |
$237.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.38
|
| Rate for Payer: Healthscope Commercial |
$252.97
|
| Rate for Payer: Healthscope Whirlpool |
$245.38
|
| Rate for Payer: Mclaren Commercial |
$227.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.61
|
|
|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
OP
|
$252.97
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.19 |
| Max. Negotiated Rate |
$252.97 |
| Rate for Payer: Aetna Commercial |
$227.67
|
| Rate for Payer: ASR ASR |
$245.38
|
| Rate for Payer: BCBS Complete |
$101.19
|
| Rate for Payer: BCBS Trust/PPO |
$196.13
|
| Rate for Payer: BCN Commercial |
$196.13
|
| Rate for Payer: Cash Price |
$202.38
|
| Rate for Payer: Cofinity Commercial |
$237.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.38
|
| Rate for Payer: Healthscope Commercial |
$252.97
|
| Rate for Payer: Healthscope Whirlpool |
$245.38
|
| Rate for Payer: Mclaren Commercial |
$227.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.20
|
| Rate for Payer: Priority Health Narrow Network |
$179.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.61
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
OP
|
$3,042.82
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,217.13 |
| Max. Negotiated Rate |
$3,042.82 |
| Rate for Payer: Aetna Commercial |
$2,738.54
|
| Rate for Payer: ASR ASR |
$2,951.54
|
| Rate for Payer: BCBS Complete |
$1,217.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,359.10
|
| Rate for Payer: BCN Commercial |
$2,359.10
|
| Rate for Payer: Cash Price |
$2,434.26
|
| Rate for Payer: Cofinity Commercial |
$2,860.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,434.26
|
| Rate for Payer: Healthscope Commercial |
$3,042.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,951.54
|
| Rate for Payer: Mclaren Commercial |
$2,738.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,586.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,768.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,160.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,677.68
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
IP
|
$3,042.82
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,129.97 |
| Max. Negotiated Rate |
$3,042.82 |
| Rate for Payer: Aetna Commercial |
$2,738.54
|
| Rate for Payer: ASR ASR |
$2,951.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,359.10
|
| Rate for Payer: BCN Commercial |
$2,359.10
|
| Rate for Payer: Cash Price |
$2,434.26
|
| Rate for Payer: Cofinity Commercial |
$2,860.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,434.26
|
| Rate for Payer: Healthscope Commercial |
$3,042.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,951.54
|
| Rate for Payer: Mclaren Commercial |
$2,738.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,586.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,677.68
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
IP
|
$268.39
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$268.39 |
| Rate for Payer: Aetna Commercial |
$241.55
|
| Rate for Payer: ASR ASR |
$260.34
|
| Rate for Payer: BCBS Trust/PPO |
$208.08
|
| Rate for Payer: BCN Commercial |
$208.08
|
| Rate for Payer: Cash Price |
$214.71
|
| Rate for Payer: Cofinity Commercial |
$252.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.71
|
| Rate for Payer: Healthscope Commercial |
$268.39
|
| Rate for Payer: Healthscope Whirlpool |
$260.34
|
| Rate for Payer: Mclaren Commercial |
$241.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.18
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
OP
|
$268.39
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$268.39 |
| Rate for Payer: Aetna Commercial |
$241.55
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$260.34
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$208.08
|
| Rate for Payer: BCN Commercial |
$208.08
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$214.71
|
| Rate for Payer: Cash Price |
$214.71
|
| Rate for Payer: Cofinity Commercial |
$252.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$268.39
|
| Rate for Payer: Healthscope Whirlpool |
$260.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$241.55
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.13
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.73
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$54.18
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.18
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
IP
|
$257.96
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$180.57 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$232.16
|
| Rate for Payer: ASR ASR |
$250.22
|
| Rate for Payer: BCBS Trust/PPO |
$200.00
|
| Rate for Payer: BCN Commercial |
$200.00
|
| Rate for Payer: Cash Price |
$206.37
|
| Rate for Payer: Cofinity Commercial |
$242.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.37
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Healthscope Whirlpool |
$250.22
|
| Rate for Payer: Mclaren Commercial |
$232.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.00
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
OP
|
$257.96
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$232.16
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$250.22
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$200.00
|
| Rate for Payer: BCN Commercial |
$200.00
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$206.37
|
| Rate for Payer: Cash Price |
$206.37
|
| Rate for Payer: Cofinity Commercial |
$242.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Healthscope Whirlpool |
$250.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$232.16
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.27
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$46.80
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.00
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC BRONCHOSCOPY
|
Facility
|
OP
|
$2,514.51
|
|
| Hospital Charge Code |
36000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,005.80 |
| Max. Negotiated Rate |
$2,514.51 |
| Rate for Payer: Aetna Commercial |
$2,263.06
|
| Rate for Payer: ASR ASR |
$2,439.07
|
| Rate for Payer: BCBS Complete |
$1,005.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.50
|
| Rate for Payer: BCN Commercial |
$1,949.50
|
| Rate for Payer: Cash Price |
$2,011.61
|
| Rate for Payer: Cofinity Commercial |
$2,363.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,011.61
|
| Rate for Payer: Healthscope Commercial |
$2,514.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,439.07
|
| Rate for Payer: Mclaren Commercial |
$2,263.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,137.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,760.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,288.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,785.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,212.77
|
|
|
HC BRONCHOSCOPY
|
Facility
|
IP
|
$2,514.51
|
|
| Hospital Charge Code |
36000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,760.16 |
| Max. Negotiated Rate |
$2,514.51 |
| Rate for Payer: Aetna Commercial |
$2,263.06
|
| Rate for Payer: ASR ASR |
$2,439.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.50
|
| Rate for Payer: BCN Commercial |
$1,949.50
|
| Rate for Payer: Cash Price |
$2,011.61
|
| Rate for Payer: Cofinity Commercial |
$2,363.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,011.61
|
| Rate for Payer: Healthscope Commercial |
$2,514.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,439.07
|
| Rate for Payer: Mclaren Commercial |
$2,263.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,137.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,760.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,212.77
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
IP
|
$3,115.71
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,181.00 |
| Max. Negotiated Rate |
$3,115.71 |
| Rate for Payer: Aetna Commercial |
$2,804.14
|
| Rate for Payer: ASR ASR |
$3,022.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,415.61
|
| Rate for Payer: BCN Commercial |
$2,415.61
|
| Rate for Payer: Cash Price |
$2,492.57
|
| Rate for Payer: Cofinity Commercial |
$2,928.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,492.57
|
| Rate for Payer: Healthscope Commercial |
$3,115.71
|
| Rate for Payer: Healthscope Whirlpool |
$3,022.24
|
| Rate for Payer: Mclaren Commercial |
$2,804.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,648.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,741.82
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
OP
|
$3,115.71
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,246.28 |
| Max. Negotiated Rate |
$3,115.71 |
| Rate for Payer: Aetna Commercial |
$2,804.14
|
| Rate for Payer: ASR ASR |
$3,022.24
|
| Rate for Payer: BCBS Complete |
$1,246.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,415.61
|
| Rate for Payer: BCN Commercial |
$2,415.61
|
| Rate for Payer: Cash Price |
$2,492.57
|
| Rate for Payer: Cofinity Commercial |
$2,928.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,492.57
|
| Rate for Payer: Healthscope Commercial |
$3,115.71
|
| Rate for Payer: Healthscope Whirlpool |
$3,022.24
|
| Rate for Payer: Mclaren Commercial |
$2,804.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,648.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,835.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,212.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,741.82
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
IP
|
$694.78
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$486.35 |
| Max. Negotiated Rate |
$694.78 |
| Rate for Payer: Aetna Commercial |
$625.30
|
| Rate for Payer: ASR ASR |
$673.94
|
| Rate for Payer: BCBS Trust/PPO |
$538.66
|
| Rate for Payer: BCN Commercial |
$538.66
|
| Rate for Payer: Cash Price |
$555.82
|
| Rate for Payer: Cofinity Commercial |
$653.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.82
|
| Rate for Payer: Healthscope Commercial |
$694.78
|
| Rate for Payer: Healthscope Whirlpool |
$673.94
|
| Rate for Payer: Mclaren Commercial |
$625.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$590.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$611.41
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
OP
|
$694.78
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$694.78 |
| Rate for Payer: Aetna Commercial |
$625.30
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$673.94
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$538.66
|
| Rate for Payer: BCN Commercial |
$538.66
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$555.82
|
| Rate for Payer: Cash Price |
$555.82
|
| Rate for Payer: Cofinity Commercial |
$653.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$694.78
|
| Rate for Payer: Healthscope Whirlpool |
$673.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$625.30
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$590.56
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.25
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$493.29
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$611.41
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
