|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
IP
|
$283.77
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$255.39 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.45
|
| Rate for Payer: Cash Price |
$227.02
|
| Rate for Payer: Cofinity Commercial |
$198.64
|
| Rate for Payer: Cofinity Commercial |
$244.04
|
| Rate for Payer: Healthscope Commercial |
$255.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.20
|
| Rate for Payer: PHP Commercial |
$241.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.64
|
| Rate for Payer: Priority Health SBD |
$178.78
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
IP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.50 |
| Max. Negotiated Rate |
$1,089.29 |
| Rate for Payer: Aetna Commercial |
$1,028.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.71
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$1,040.88
|
| Rate for Payer: Cofinity Commercial |
$847.22
|
| Rate for Payer: Healthscope Commercial |
$1,089.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: PHP Commercial |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: Priority Health SBD |
$762.50
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
OP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,089.29 |
| Rate for Payer: Aetna Commercial |
$1,028.77
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$847.22
|
| Rate for Payer: Cofinity Commercial |
$1,040.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,089.29
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,028.77
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$762.50
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.35
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.17
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$777.75
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$1,111.08 |
| Rate for Payer: Aetna Commercial |
$1,049.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.44
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,061.70
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Healthscope Commercial |
$1,111.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.35
|
| Rate for Payer: PHP Commercial |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.17
|
| Rate for Payer: Priority Health SBD |
$777.75
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
OP
|
$2,091.10
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,881.99 |
| Rate for Payer: Aetna Commercial |
$1,777.44
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,463.77
|
| Rate for Payer: Cofinity Commercial |
$1,798.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,881.99
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,777.44
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$1,317.39
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
IP
|
$2,091.10
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,317.39 |
| Max. Negotiated Rate |
$1,881.99 |
| Rate for Payer: Aetna Commercial |
$1,777.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.22
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,463.77
|
| Rate for Payer: Cofinity Commercial |
$1,798.35
|
| Rate for Payer: Healthscope Commercial |
$1,881.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: PHP Commercial |
$1,777.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: Priority Health SBD |
$1,317.39
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$346.11 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.40
|
| Rate for Payer: BCBS Complete |
$853.17
|
| Rate for Payer: BCBS Trust/PPO |
$414.25
|
| Rate for Payer: BCCCP Commercial |
$366.01
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Cofinity Commercial |
$1,493.04
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,812.98
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.04
|
| Rate for Payer: Priority Health SBD |
$1,343.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.72
|
| Rate for Payer: UHC Exchange |
$346.11
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,343.74 |
| Max. Negotiated Rate |
$1,919.63 |
| Rate for Payer: Aetna Commercial |
$1,812.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$1,493.04
|
| Rate for Payer: Cofinity Commercial |
$1,834.31
|
| Rate for Payer: Healthscope Commercial |
$1,919.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,812.98
|
| Rate for Payer: PHP Commercial |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.04
|
| Rate for Payer: Priority Health SBD |
$1,343.74
|
|
|
HC MR BREAST CAD
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC MR BREAST CAD
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
OP
|
$890.60
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$801.54 |
| Rate for Payer: Aetna Commercial |
$757.01
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$712.48
|
| Rate for Payer: Cash Price |
$712.48
|
| Rate for Payer: Cofinity Commercial |
$623.42
|
| Rate for Payer: Cofinity Commercial |
$765.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$801.54
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$757.01
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$757.01
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.42
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$561.08
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$312.45
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
IP
|
$890.60
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$561.08 |
| Max. Negotiated Rate |
$801.54 |
| Rate for Payer: Aetna Commercial |
$757.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.89
|
| Rate for Payer: Cash Price |
$712.48
|
| Rate for Payer: Cofinity Commercial |
$623.42
|
| Rate for Payer: Cofinity Commercial |
$765.92
|
| Rate for Payer: Healthscope Commercial |
$801.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$757.01
|
| Rate for Payer: PHP Commercial |
$757.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.42
|
| Rate for Payer: Priority Health SBD |
$561.08
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
OP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,089.29 |
| Rate for Payer: Aetna Commercial |
$1,028.77
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$847.22
|
| Rate for Payer: Cofinity Commercial |
$1,040.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,089.29
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,028.77
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$762.50
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
IP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.50 |
| Max. Negotiated Rate |
$1,089.29 |
| Rate for Payer: Aetna Commercial |
$1,028.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.71
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$1,040.88
|
| Rate for Payer: Cofinity Commercial |
$847.22
|
| Rate for Payer: Healthscope Commercial |
$1,089.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: PHP Commercial |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: Priority Health SBD |
$762.50
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
OP
|
$2,354.05
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,118.64 |
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$988.70
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Exchange |
$653.96
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
IP
|
$1,569.37
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$988.70 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: Priority Health SBD |
$988.70
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
|
|
HC MR BREAST W CON
|
Facility
|
IP
|
$2,354.05
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,483.05 |
| Max. Negotiated Rate |
$2,118.64 |
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: Priority Health SBD |
$988.70
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
|
|
HC MR BREAST W CON
|
Facility
|
OP
|
$1,569.37
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$339.23 |
| Max. Negotiated Rate |
$1,412.43 |
| Rate for Payer: Aetna Commercial |
$1,333.96
|
| Rate for Payer: Aetna Commercial |
$2,000.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.09
|
| Rate for Payer: BCBS Complete |
$627.75
|
| Rate for Payer: BCBS Complete |
$941.62
|
| Rate for Payer: BCBS Trust/PPO |
$417.56
|
| Rate for Payer: BCBS Trust/PPO |
$417.56
|
| Rate for Payer: BCCCP Commercial |
$358.33
|
| Rate for Payer: BCCCP Commercial |
$358.33
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$1,647.84
|
| Rate for Payer: Cofinity Commercial |
$1,349.66
|
| Rate for Payer: Cofinity Commercial |
$1,098.56
|
| Rate for Payer: Cofinity Commercial |
$2,024.48
|
| Rate for Payer: Healthscope Commercial |
$2,118.64
|
| Rate for Payer: Healthscope Commercial |
$1,412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$1,333.96
|
| Rate for Payer: PHP Commercial |
$2,000.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,098.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.84
|
| Rate for Payer: Priority Health SBD |
$988.70
|
| Rate for Payer: Priority Health SBD |
$1,483.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.15
|
| Rate for Payer: UHC Exchange |
$339.23
|
| Rate for Payer: UHC Exchange |
$339.23
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
IP
|
$2,091.10
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,317.39 |
| Max. Negotiated Rate |
$1,881.99 |
| Rate for Payer: Aetna Commercial |
$1,777.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.22
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,463.77
|
| Rate for Payer: Cofinity Commercial |
$1,798.35
|
| Rate for Payer: Healthscope Commercial |
$1,881.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: PHP Commercial |
$1,777.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: Priority Health SBD |
$1,317.39
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
OP
|
$2,091.10
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,881.99 |
| Rate for Payer: Aetna Commercial |
$1,777.44
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.22
|
| 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 |
$254.29
|
| Rate for Payer: BCCCP Commercial |
$233.67
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,798.35
|
| Rate for Payer: Cofinity Commercial |
$1,463.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,881.99
|
| 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 |
$1,777.44
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,777.44
|
| 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 |
$1,463.77
|
| 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 |
$1,317.39
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$221.02
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$968.94 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Aetna Commercial |
$1,307.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.70
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Cofinity Commercial |
$1,076.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.68
|
| Rate for Payer: Healthscope Commercial |
$1,384.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.30
|
| Rate for Payer: PHP Commercial |
$1,307.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.60
|
| Rate for Payer: Priority Health SBD |
$968.94
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,384.20 |
| Rate for Payer: Aetna Commercial |
$1,307.30
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.70
|
| 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 |
$253.18
|
| Rate for Payer: BCCCP Commercial |
$225.34
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Cash Price |
$1,230.40
|
| Rate for Payer: Cofinity Commercial |
$1,076.60
|
| Rate for Payer: Cofinity Commercial |
$1,322.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,384.20
|
| 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 |
$1,307.30
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,307.30
|
| 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 |
$1,076.60
|
| 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 |
$968.94
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$214.80
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
OP
|
$2,111.40
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,900.26 |
| Rate for Payer: Aetna Commercial |
$1,794.69
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,372.41
|
| 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 |
$298.41
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,689.12
|
| Rate for Payer: Cash Price |
$1,689.12
|
| Rate for Payer: Cofinity Commercial |
$1,815.80
|
| Rate for Payer: Cofinity Commercial |
$1,477.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,900.26
|
| 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 |
$1,794.69
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,794.69
|
| 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 |
$1,477.98
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$1,330.18
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$280.95
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
IP
|
$2,111.40
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,330.18 |
| Max. Negotiated Rate |
$1,900.26 |
| Rate for Payer: Aetna Commercial |
$1,794.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,372.41
|
| Rate for Payer: Cash Price |
$1,689.12
|
| Rate for Payer: Cofinity Commercial |
$1,477.98
|
| Rate for Payer: Cofinity Commercial |
$1,815.80
|
| Rate for Payer: Healthscope Commercial |
$1,900.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,794.69
|
| Rate for Payer: PHP Commercial |
$1,794.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,477.98
|
| Rate for Payer: Priority Health SBD |
$1,330.18
|
|
