|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
OP
|
$438.74
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$394.87 |
| Rate for Payer: Aetna Commercial |
$372.93
|
| Rate for Payer: Aetna Medicare |
$219.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.18
|
| Rate for Payer: BCBS Complete |
$175.50
|
| Rate for Payer: BCBS Trust/PPO |
$253.64
|
| Rate for Payer: BCCCP Commercial |
$148.01
|
| Rate for Payer: BCN Commercial |
$253.64
|
| Rate for Payer: Cash Price |
$350.99
|
| Rate for Payer: Cash Price |
$350.99
|
| Rate for Payer: Cofinity Advantage |
$307.12
|
| Rate for Payer: Cofinity Commercial |
$377.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.99
|
| Rate for Payer: Healthscope Commercial |
$394.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.06
|
| Rate for Payer: PHP Commercial |
$372.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$121.66
|
| Rate for Payer: Priority Health SBD |
$276.41
|
| Rate for Payer: Priority Health Tiered Network |
$97.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.18
|
| Rate for Payer: UHC Core |
$228.58
|
| Rate for Payer: UHC Exchange |
$172.42
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
IP
|
$432.90
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$272.73 |
| Max. Negotiated Rate |
$389.61 |
| Rate for Payer: Aetna Commercial |
$367.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.38
|
| Rate for Payer: Cash Price |
$346.32
|
| Rate for Payer: Cofinity Advantage |
$303.03
|
| Rate for Payer: Cofinity Commercial |
$372.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.32
|
| Rate for Payer: Healthscope Commercial |
$389.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.68
|
| Rate for Payer: PHP Commercial |
$367.96
|
| Rate for Payer: Priority Health SBD |
$272.73
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
OP
|
$432.90
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$389.61 |
| Rate for Payer: Aetna Commercial |
$367.96
|
| Rate for Payer: Aetna Medicare |
$216.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.38
|
| Rate for Payer: BCBS Complete |
$173.16
|
| Rate for Payer: BCBS Trust/PPO |
$209.73
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$209.73
|
| Rate for Payer: Cash Price |
$346.32
|
| Rate for Payer: Cash Price |
$346.32
|
| Rate for Payer: Cofinity Advantage |
$303.03
|
| Rate for Payer: Cofinity Commercial |
$372.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.32
|
| Rate for Payer: Healthscope Commercial |
$389.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.68
|
| Rate for Payer: PHP Commercial |
$367.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$100.49
|
| Rate for Payer: Priority Health SBD |
$272.73
|
| Rate for Payer: Priority Health Tiered Network |
$80.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.38
|
| Rate for Payer: UHC Core |
$225.54
|
| Rate for Payer: UHC Exchange |
$170.13
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$756.38
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$680.74 |
| Rate for Payer: Aetna Commercial |
$642.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.65
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cofinity Advantage |
$529.47
|
| Rate for Payer: Cofinity Commercial |
$650.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.10
|
| Rate for Payer: Healthscope Commercial |
$680.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.28
|
| Rate for Payer: PHP Commercial |
$642.92
|
| Rate for Payer: Priority Health SBD |
$476.52
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$756.38
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$642.92
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$535.08
|
| Rate for Payer: BCCCP Commercial |
$92.31
|
| Rate for Payer: BCN Commercial |
$535.08
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cofinity Advantage |
$529.47
|
| Rate for Payer: Cofinity Commercial |
$650.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$680.74
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.92
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.28
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$642.92
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$476.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$404.51
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$364.06 |
| Rate for Payer: Aetna Commercial |
$343.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.93
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cofinity Advantage |
$283.16
|
| Rate for Payer: Cofinity Commercial |
$347.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.61
|
| Rate for Payer: Healthscope Commercial |
$364.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: PHP Commercial |
$343.83
|
| Rate for Payer: Priority Health SBD |
$254.84
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
OP
|
$404.51
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$364.06 |
| Rate for Payer: Aetna Commercial |
$343.83
|
| Rate for Payer: Aetna Medicare |
$202.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.93
|
| Rate for Payer: BCBS Complete |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$71.52
|
| Rate for Payer: BCCCP Commercial |
$25.13
|
| Rate for Payer: BCN Commercial |
$71.52
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cofinity Advantage |
$283.16
|
| Rate for Payer: Cofinity Commercial |
$347.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.61
|
| Rate for Payer: Healthscope Commercial |
$364.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: PHP Commercial |
$343.83
|
| Rate for Payer: Priority Health SBD |
$254.84
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,842.32
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,790.66 |
| Max. Negotiated Rate |
$2,558.09 |
| Rate for Payer: Aetna Commercial |
$2,415.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.51
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cofinity Advantage |
$1,989.62
|
| Rate for Payer: Cofinity Commercial |
$2,444.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,273.86
|
| Rate for Payer: Healthscope Commercial |
$2,558.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,415.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,131.74
|
| Rate for Payer: PHP Commercial |
$2,415.97
|
| Rate for Payer: Priority Health SBD |
$1,790.66
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,842.32
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$2,415.97
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.20
|
| Rate for Payer: BCN Commercial |
$1,716.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cofinity Advantage |
$1,989.62
|
| Rate for Payer: Cofinity Commercial |
$2,444.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,273.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,558.09
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,415.97
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,131.74
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$2,415.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,790.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,200.83
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.22 |
| Max. Negotiated Rate |
$1,080.75 |
| Rate for Payer: Aetna Commercial |
$1,020.71
|
| Rate for Payer: Aetna Medicare |
$600.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.54
|
| Rate for Payer: BCBS Complete |
$480.33
|
| Rate for Payer: BCBS Trust/PPO |
$435.60
|
| Rate for Payer: BCCCP Commercial |
$153.22
|
| Rate for Payer: BCN Commercial |
$435.60
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cofinity Advantage |
$840.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.66
|
| Rate for Payer: Healthscope Commercial |
$1,080.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$960.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.62
|
| Rate for Payer: PHP Commercial |
$1,020.71
|
| Rate for Payer: Priority Health SBD |
$756.52
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,200.83
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$756.52 |
| Max. Negotiated Rate |
$1,080.75 |
| Rate for Payer: Aetna Commercial |
$1,020.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.54
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cofinity Advantage |
$840.58
|
| Rate for Payer: Cofinity Commercial |
$1,032.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.66
|
| Rate for Payer: Healthscope Commercial |
$1,080.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.62
|
| Rate for Payer: PHP Commercial |
$1,020.71
|
| Rate for Payer: Priority Health SBD |
$756.52
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$380.25
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$239.56 |
| Max. Negotiated Rate |
$342.23 |
| Rate for Payer: Aetna Commercial |
$323.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.16
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cofinity Advantage |
$266.18
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.20
|
| Rate for Payer: Healthscope Commercial |
$342.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.19
|
| Rate for Payer: PHP Commercial |
$323.21
|
| Rate for Payer: Priority Health SBD |
$239.56
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$380.25
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$342.23 |
| Rate for Payer: Aetna Commercial |
$323.21
|
| Rate for Payer: Aetna Medicare |
$190.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.16
|
| Rate for Payer: BCBS Complete |
$152.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.12
|
| Rate for Payer: BCCCP Commercial |
$117.70
|
| Rate for Payer: BCN Commercial |
$199.12
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cofinity Advantage |
$266.18
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.20
|
| Rate for Payer: Healthscope Commercial |
$342.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.19
|
| Rate for Payer: PHP Commercial |
$323.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.11
|
| Rate for Payer: Priority Health SBD |
$239.56
|
| Rate for Payer: Priority Health Tiered Network |
$76.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.16
|
| Rate for Payer: UHC Core |
$198.11
|
| Rate for Payer: UHC Exchange |
$149.44
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$603.90
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.46 |
| Max. Negotiated Rate |
$543.51 |
| Rate for Payer: Aetna Commercial |
$513.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.54
|
| Rate for Payer: Cash Price |
$483.12
|
| Rate for Payer: Cofinity Advantage |
$422.73
|
| Rate for Payer: Cofinity Commercial |
$519.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.12
|
| Rate for Payer: Healthscope Commercial |
$543.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$513.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$452.93
|
| Rate for Payer: PHP Commercial |
$513.32
|
| Rate for Payer: Priority Health SBD |
$380.46
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$603.90
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.89 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$513.32
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$109.79
|
| Rate for Payer: BCCCP Commercial |
$64.89
|
| Rate for Payer: BCN Commercial |
$109.79
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$483.12
|
| Rate for Payer: Cash Price |
$483.12
|
| Rate for Payer: Cofinity Advantage |
$422.73
|
| Rate for Payer: Cofinity Commercial |
$519.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$543.51
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$513.32
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$452.93
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$513.32
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$380.46
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.54
|
| Rate for Payer: UHC Core |
$314.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$237.33
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
OP
|
$728.76
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$619.45
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$83.29
|
| Rate for Payer: BCCCP Commercial |
$50.35
|
| Rate for Payer: BCN Commercial |
$83.29
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$583.01
|
| Rate for Payer: Cash Price |
$583.01
|
| Rate for Payer: Cofinity Advantage |
$510.13
|
| Rate for Payer: Cofinity Commercial |
$626.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$655.88
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.45
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.57
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$619.45
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$459.12
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.69
|
| Rate for Payer: UHC Core |
$379.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$286.40
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$728.76
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$459.12 |
| Max. Negotiated Rate |
$655.88 |
| Rate for Payer: Aetna Commercial |
$619.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.69
|
| Rate for Payer: Cash Price |
$583.01
|
| Rate for Payer: Cofinity Advantage |
$510.13
|
| Rate for Payer: Cofinity Commercial |
$626.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.01
|
| Rate for Payer: Healthscope Commercial |
$655.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.57
|
| Rate for Payer: PHP Commercial |
$619.45
|
| Rate for Payer: Priority Health SBD |
$459.12
|
|
|
HC MANGANESE BLOOD
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
30100770
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.31
|
| Rate for Payer: BCBS Complete |
$14.64
|
| Rate for Payer: BCBS MAPPO |
$26.65
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$28.42
|
| Rate for Payer: BCN Medicare Advantage |
$26.65
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Advantage |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.65
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Mclaren Medicaid |
$13.94
|
| Rate for Payer: Mclaren Medicare |
$26.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.98
|
| Rate for Payer: Meridian Medicaid |
$27.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.50
|
| Rate for Payer: Nomi Health Commercial |
$39.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE Medicare |
$25.32
|
| Rate for Payer: PACE SWMI |
$26.65
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: PHP Medicare Advantage |
$26.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$26.65
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: Priority Health Tiered Network |
$21.32
|
| Rate for Payer: Railroad Medicare Medicare |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.98
|
| Rate for Payer: UHC Core |
$39.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.65
|
| Rate for Payer: UHC Exchange |
$39.98
|
| Rate for Payer: UHC Medicaid |
$13.94
|
| Rate for Payer: UHCCP Medicaid |
$13.94
|
| Rate for Payer: VA VA |
$26.65
|
|
|
HC MANGANESE BLOOD
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
30100770
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Advantage |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: Priority Health SBD |
$119.70
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
OP
|
$85.83
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.79
|
| Rate for Payer: BCBS Complete |
$34.33
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Advantage |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.37
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health SBD |
$54.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.79
|
| Rate for Payer: UHC Core |
$44.72
|
| Rate for Payer: UHC Exchange |
$33.73
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
IP
|
$85.83
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.07 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.79
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Advantage |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.37
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health SBD |
$54.07
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
IP
|
$4,161.60
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,621.81 |
| Max. Negotiated Rate |
$3,745.44 |
| Rate for Payer: Aetna Commercial |
$3,537.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,705.04
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Advantage |
$2,913.12
|
| Rate for Payer: Cofinity Commercial |
$3,578.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Healthscope Commercial |
$3,745.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PHP Commercial |
$3,537.36
|
| Rate for Payer: Priority Health SBD |
$2,621.81
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
OP
|
$4,161.60
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$796.29 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$3,537.36
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,705.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$796.29
|
| Rate for Payer: BCN Commercial |
$796.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Advantage |
$2,913.12
|
| Rate for Payer: Cofinity Commercial |
$3,578.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$3,745.44
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$3,537.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$2,621.81
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.04
|
| Rate for Payer: UHC Core |
$2,168.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$1,635.51
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
IP
|
$504.07
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.56 |
| Max. Negotiated Rate |
$453.66 |
| Rate for Payer: Aetna Commercial |
$428.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.65
|
| Rate for Payer: Cash Price |
$403.26
|
| Rate for Payer: Cofinity Advantage |
$352.85
|
| Rate for Payer: Cofinity Commercial |
$433.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.26
|
| Rate for Payer: Healthscope Commercial |
$453.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.05
|
| Rate for Payer: PHP Commercial |
$428.46
|
| Rate for Payer: Priority Health SBD |
$317.56
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
OP
|
$504.07
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.39 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$428.46
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$60.39
|
| Rate for Payer: BCN Commercial |
$60.39
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$403.26
|
| Rate for Payer: Cash Price |
$403.26
|
| Rate for Payer: Cash Price |
$403.26
|
| Rate for Payer: Cofinity Advantage |
$352.85
|
| Rate for Payer: Cofinity Commercial |
$433.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$453.66
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.46
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.05
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$428.46
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$317.56
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.65
|
| Rate for Payer: UHC Core |
$262.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$198.10
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
