|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
OP
|
$421.71
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$155.86 |
| Max. Negotiated Rate |
$379.54 |
| Rate for Payer: Aetna Commercial |
$358.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.11
|
| Rate for Payer: BCBS Complete |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$184.23
|
| Rate for Payer: BCCCP Commercial |
$160.76
|
| Rate for Payer: Cash Price |
$337.37
|
| Rate for Payer: Cash Price |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$362.67
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Healthscope Commercial |
$379.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.45
|
| Rate for Payer: PHP Commercial |
$358.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.20
|
| Rate for Payer: Priority Health SBD |
$265.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.45
|
| Rate for Payer: UHC Exchange |
$155.86
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
IP
|
$421.71
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$265.68 |
| Max. Negotiated Rate |
$379.54 |
| Rate for Payer: Aetna Commercial |
$358.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.11
|
| Rate for Payer: Cash Price |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$362.67
|
| Rate for Payer: Cofinity Commercial |
$295.20
|
| Rate for Payer: Healthscope Commercial |
$379.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.45
|
| Rate for Payer: PHP Commercial |
$358.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.20
|
| Rate for Payer: Priority Health SBD |
$265.68
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
IP
|
$416.09
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$262.14 |
| Max. Negotiated Rate |
$374.48 |
| Rate for Payer: Aetna Commercial |
$353.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: Cash Price |
$332.87
|
| Rate for Payer: Cofinity Commercial |
$291.26
|
| Rate for Payer: Cofinity Commercial |
$357.84
|
| Rate for Payer: Healthscope Commercial |
$374.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.68
|
| Rate for Payer: PHP Commercial |
$353.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.26
|
| Rate for Payer: Priority Health SBD |
$262.14
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
OP
|
$416.09
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$374.48 |
| Rate for Payer: Aetna Commercial |
$353.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: BCBS Complete |
$166.44
|
| Rate for Payer: BCBS Trust/PPO |
$152.79
|
| Rate for Payer: BCCCP Commercial |
$130.78
|
| Rate for Payer: Cash Price |
$332.87
|
| Rate for Payer: Cash Price |
$332.87
|
| Rate for Payer: Cofinity Commercial |
$291.26
|
| Rate for Payer: Cofinity Commercial |
$357.84
|
| Rate for Payer: Healthscope Commercial |
$374.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.68
|
| Rate for Payer: PHP Commercial |
$353.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.26
|
| Rate for Payer: Priority Health SBD |
$262.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.31
|
| Rate for Payer: UHC Exchange |
$125.74
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$600.30
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.19 |
| Max. Negotiated Rate |
$540.27 |
| Rate for Payer: Aetna Commercial |
$510.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.20
|
| Rate for Payer: Cash Price |
$480.24
|
| Rate for Payer: Cofinity Commercial |
$420.21
|
| Rate for Payer: Cofinity Commercial |
$516.26
|
| Rate for Payer: Healthscope Commercial |
$540.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.26
|
| Rate for Payer: PHP Commercial |
$510.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.21
|
| Rate for Payer: Priority Health SBD |
$378.19
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$600.30
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$1,945.97 |
| Rate for Payer: Aetna Commercial |
$510.26
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$405.67
|
| Rate for Payer: BCCCP Commercial |
$105.62
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$480.24
|
| Rate for Payer: Cash Price |
$480.24
|
| Rate for Payer: Cofinity Commercial |
$420.21
|
| Rate for Payer: Cofinity Commercial |
$516.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$540.27
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.26
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$510.26
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.97
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,556.78
|
| Rate for Payer: Priority Health SBD |
$378.19
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
OP
|
$388.80
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$330.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.72
|
| Rate for Payer: BCBS Complete |
$155.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.22
|
| Rate for Payer: BCCCP Commercial |
$27.25
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Commercial |
$334.37
|
| Rate for Payer: Cofinity Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$349.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.48
|
| Rate for Payer: PHP Commercial |
$330.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.16
|
| Rate for Payer: Priority Health SBD |
$244.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.33
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$20.30
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$388.80
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.94 |
| Max. Negotiated Rate |
$349.92 |
| Rate for Payer: Aetna Commercial |
$330.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.72
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Commercial |
$334.37
|
| Rate for Payer: Cofinity Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$349.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.48
|
| Rate for Payer: PHP Commercial |
$330.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.16
|
| Rate for Payer: Priority Health SBD |
$244.94
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,731.95
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.72 |
| Max. Negotiated Rate |
$4,496.47 |
| Rate for Payer: Aetna Commercial |
$2,322.16
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,775.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$2,185.56
|
| Rate for Payer: Cash Price |
$2,185.56
|
| Rate for Payer: Cofinity Commercial |
$1,912.36
|
| Rate for Payer: Cofinity Commercial |
$2,349.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$2,458.76
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,322.16
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$2,322.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,496.47
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.18
|
| Rate for Payer: Priority Health SBD |
$1,721.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.89
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$311.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,731.95
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,721.13 |
| Max. Negotiated Rate |
$2,458.76 |
| Rate for Payer: Aetna Commercial |
$2,322.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,775.77
|
| Rate for Payer: Cash Price |
$2,185.56
|
| Rate for Payer: Cofinity Commercial |
$1,912.36
|
| Rate for Payer: Cofinity Commercial |
$2,349.48
|
| Rate for Payer: Healthscope Commercial |
$2,458.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,322.16
|
| Rate for Payer: PHP Commercial |
$2,322.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.36
|
| Rate for Payer: Priority Health SBD |
$1,721.13
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,154.20
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.15 |
| Max. Negotiated Rate |
$1,038.78 |
| Rate for Payer: Aetna Commercial |
$981.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.23
|
| Rate for Payer: Cash Price |
$923.36
|
| Rate for Payer: Cofinity Commercial |
$807.94
|
| Rate for Payer: Cofinity Commercial |
$992.61
|
| Rate for Payer: Healthscope Commercial |
$1,038.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$981.07
|
| Rate for Payer: PHP Commercial |
$981.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.94
|
| Rate for Payer: Priority Health SBD |
$727.15
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,154.20
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$1,038.78 |
| Rate for Payer: Aetna Commercial |
$981.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.23
|
| Rate for Payer: BCBS Complete |
$461.68
|
| Rate for Payer: BCBS Trust/PPO |
$330.25
|
| Rate for Payer: BCCCP Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$923.36
|
| Rate for Payer: Cash Price |
$923.36
|
| Rate for Payer: Cofinity Commercial |
$992.61
|
| Rate for Payer: Cofinity Commercial |
$807.94
|
| Rate for Payer: Healthscope Commercial |
$1,038.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$981.07
|
| Rate for Payer: PHP Commercial |
$981.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.94
|
| Rate for Payer: Priority Health SBD |
$727.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.32
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$73.02
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$365.48
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$123.12 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Aetna Commercial |
$310.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.56
|
| Rate for Payer: BCBS Complete |
$146.19
|
| Rate for Payer: BCBS Trust/PPO |
$144.51
|
| Rate for Payer: BCCCP Commercial |
$127.76
|
| Rate for Payer: Cash Price |
$292.38
|
| Rate for Payer: Cash Price |
$292.38
|
| Rate for Payer: Cofinity Commercial |
$255.84
|
| Rate for Payer: Cofinity Commercial |
$314.31
|
| Rate for Payer: Healthscope Commercial |
$328.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.66
|
| Rate for Payer: PHP Commercial |
$310.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.84
|
| Rate for Payer: Priority Health SBD |
$230.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.43
|
| Rate for Payer: UHC Exchange |
$123.12
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$365.48
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$230.25 |
| Max. Negotiated Rate |
$328.93 |
| Rate for Payer: Aetna Commercial |
$310.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.56
|
| Rate for Payer: Cash Price |
$292.38
|
| Rate for Payer: Cofinity Commercial |
$255.84
|
| Rate for Payer: Cofinity Commercial |
$314.31
|
| Rate for Payer: Healthscope Commercial |
$328.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.66
|
| Rate for Payer: PHP Commercial |
$310.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.84
|
| Rate for Payer: Priority Health SBD |
$230.25
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$580.45
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$365.68 |
| Max. Negotiated Rate |
$522.40 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.29
|
| Rate for Payer: Cash Price |
$464.36
|
| Rate for Payer: Cofinity Commercial |
$406.32
|
| Rate for Payer: Cofinity Commercial |
$499.19
|
| Rate for Payer: Healthscope Commercial |
$522.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.38
|
| Rate for Payer: PHP Commercial |
$493.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.32
|
| Rate for Payer: Priority Health SBD |
$365.68
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$580.45
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$716.43 |
| Rate for Payer: Aetna Commercial |
$493.38
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$79.44
|
| Rate for Payer: BCCCP Commercial |
$70.40
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$464.36
|
| Rate for Payer: Cash Price |
$464.36
|
| Rate for Payer: Cofinity Commercial |
$499.19
|
| Rate for Payer: Cofinity Commercial |
$406.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$522.40
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.38
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$493.38
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$365.68
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$68.11
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
OP
|
$700.46
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$716.43 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$60.12
|
| Rate for Payer: BCCCP Commercial |
$54.57
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$490.32
|
| Rate for Payer: Cofinity Commercial |
$602.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$630.41
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.39
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$595.39
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.43
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health Narrow Network |
$573.14
|
| Rate for Payer: Priority Health SBD |
$441.29
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$53.05
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$700.46
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.29 |
| Max. Negotiated Rate |
$630.41 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.30
|
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$490.32
|
| Rate for Payer: Cofinity Commercial |
$602.40
|
| Rate for Payer: Healthscope Commercial |
$630.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.39
|
| Rate for Payer: PHP Commercial |
$595.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.32
|
| Rate for Payer: Priority Health SBD |
$441.29
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
IP
|
$82.50
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$70.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.62
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Healthscope Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.12
|
| Rate for Payer: PHP Commercial |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: Priority Health SBD |
$51.98
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
OP
|
$82.50
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$70.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.62
|
| Rate for Payer: BCBS Complete |
$33.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Healthscope Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.12
|
| Rate for Payer: PHP Commercial |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: Priority Health SBD |
$51.98
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$3,400.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,600.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$3,440.00
|
| Rate for Payer: Healthscope Commercial |
$3,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PHP Commercial |
$3,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health SBD |
$2,520.00
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.82 |
| Max. Negotiated Rate |
$4,301.45 |
| Rate for Payer: Aetna Commercial |
$3,400.00
|
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,600.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,787.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,787.60
|
| Rate for Payer: BCBS Complete |
$821.44
|
| Rate for Payer: BCBS MAPPO |
$1,430.08
|
| Rate for Payer: BCBS Trust/PPO |
$603.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$3,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Healthscope Commercial |
$3,600.00
|
| Rate for Payer: Mclaren Medicaid |
$782.25
|
| Rate for Payer: Mclaren Medicare |
$1,430.08
|
| Rate for Payer: Meridian Medicaid |
$821.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,501.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Commercial |
$3,400.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,301.45
|
| Rate for Payer: Priority Health Medicare |
$1,430.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,441.16
|
| Rate for Payer: Priority Health SBD |
$2,520.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$361.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$620.74 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$45.78
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$339.15
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.82
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.74
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$496.59
|
| Rate for Payer: Priority Health SBD |
$305.24
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.24 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.92
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$339.15
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.82
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.15
|
| Rate for Payer: Priority Health SBD |
$305.24
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
IP
|
$1,463.70
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$922.13 |
| Max. Negotiated Rate |
$1,317.33 |
| Rate for Payer: Aetna Commercial |
$1,244.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.40
|
| Rate for Payer: Cash Price |
$1,170.96
|
| Rate for Payer: Cofinity Commercial |
$1,024.59
|
| Rate for Payer: Cofinity Commercial |
$1,258.78
|
| Rate for Payer: Healthscope Commercial |
$1,317.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,244.14
|
| Rate for Payer: PHP Commercial |
$1,244.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.59
|
| Rate for Payer: Priority Health SBD |
$922.13
|
|
