|
HC MAGGOT THERAPY
|
Facility
|
OP
|
$1,092.42
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$436.97 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health SBD |
$688.22
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.38
|
| Rate for Payer: BCBS Complete |
$3.77
|
| Rate for Payer: BCBS MAPPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.94
|
| Rate for Payer: BCN Commercial |
$5.94
|
| Rate for Payer: BCN Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.70
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.59
|
| Rate for Payer: Mclaren Medicare |
$6.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.04
|
| Rate for Payer: Meridian Medicaid |
$3.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$10.05
|
| Rate for Payer: PACE Medicare |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.70
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.89
|
| Rate for Payer: Priority Health Medicare |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$5.51
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.70
|
| Rate for Payer: UHC Medicare Advantage |
$6.70
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.70
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$14.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.28
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$13.82
|
| Rate for Payer: BCN Medicare Advantage |
$13.82
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Mclaren Medicaid |
$7.41
|
| Rate for Payer: Mclaren Medicare |
$13.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.51
|
| Rate for Payer: Meridian Medicaid |
$7.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$41.46
|
| Rate for Payer: PACE Medicare |
$13.13
|
| Rate for Payer: PACE SWMI |
$13.82
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$13.82
|
| Rate for Payer: Priority Health Narrow Network |
$33.28
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.82
|
| Rate for Payer: UHC Medicare Advantage |
$13.82
|
| Rate for Payer: UHCCP Medicaid |
$7.78
|
| Rate for Payer: VA VA |
$13.82
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.97
|
| Rate for Payer: BCN Commercial |
$3.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$3.21
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Medicaid |
$3.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$8.98
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.17
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health Narrow Network |
$4.94
|
| Rate for Payer: Priority Health SBD |
$48.45
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health SBD |
$48.45
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,330.39
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$532.16 |
| Max. Negotiated Rate |
$1,197.35 |
| Rate for Payer: Aetna Commercial |
$1,130.83
|
| Rate for Payer: Aetna Medicare |
$665.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.75
|
| Rate for Payer: BCBS Complete |
$532.16
|
| Rate for Payer: Cash Price |
$1,064.31
|
| Rate for Payer: Cofinity Commercial |
$1,144.14
|
| Rate for Payer: Cofinity Commercial |
$931.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$931.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.31
|
| Rate for Payer: Healthscope Commercial |
$1,197.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.83
|
| Rate for Payer: PHP Commercial |
$1,130.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.75
|
| Rate for Payer: Priority Health SBD |
$838.15
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,330.39
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$838.15 |
| Max. Negotiated Rate |
$1,197.35 |
| Rate for Payer: Aetna Commercial |
$1,130.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.75
|
| Rate for Payer: Cash Price |
$1,064.31
|
| Rate for Payer: Cofinity Commercial |
$1,144.14
|
| Rate for Payer: Cofinity Commercial |
$931.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$931.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.31
|
| Rate for Payer: Healthscope Commercial |
$1,197.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.83
|
| Rate for Payer: PHP Commercial |
$1,130.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.75
|
| Rate for Payer: Priority Health SBD |
$838.15
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
OP
|
$430.14
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$387.13 |
| Rate for Payer: Aetna Commercial |
$365.62
|
| Rate for Payer: Aetna Medicare |
$215.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.59
|
| Rate for Payer: BCBS Complete |
$172.06
|
| Rate for Payer: BCBS Trust/PPO |
$211.21
|
| Rate for Payer: BCCCP Commercial |
$148.01
|
| Rate for Payer: BCN Commercial |
$211.21
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cofinity Commercial |
$369.92
|
| Rate for Payer: Cofinity Commercial |
$301.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$387.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.62
|
| Rate for Payer: PHP Commercial |
$365.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.66
|
| Rate for Payer: Priority Health Narrow Network |
$97.33
|
| Rate for Payer: Priority Health SBD |
$270.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.06
|
| Rate for Payer: UHC Exchange |
$318.30
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
IP
|
$430.14
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$270.99 |
| Max. Negotiated Rate |
$387.13 |
| Rate for Payer: Aetna Commercial |
$365.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.59
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cofinity Commercial |
$301.10
|
| Rate for Payer: Cofinity Commercial |
$369.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$387.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.62
|
| Rate for Payer: PHP Commercial |
$365.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.59
|
| Rate for Payer: Priority Health SBD |
$270.99
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
IP
|
$424.41
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$267.38 |
| Max. Negotiated Rate |
$381.97 |
| Rate for Payer: Aetna Commercial |
$360.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.87
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.53
|
| Rate for Payer: Healthscope Commercial |
$381.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.75
|
| Rate for Payer: PHP Commercial |
$360.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.87
|
| Rate for Payer: Priority Health SBD |
$267.38
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
OP
|
$424.41
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$381.97 |
| Rate for Payer: Aetna Commercial |
$360.75
|
| Rate for Payer: Aetna Medicare |
$212.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.87
|
| Rate for Payer: BCBS Complete |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$174.13
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$174.13
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.53
|
| Rate for Payer: Healthscope Commercial |
$381.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.75
|
| Rate for Payer: PHP Commercial |
$360.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.49
|
| Rate for Payer: Priority Health Narrow Network |
$80.39
|
| Rate for Payer: Priority Health SBD |
$267.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.91
|
| Rate for Payer: UHC Exchange |
$314.06
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$720.36
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.75 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$612.31
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCCCP Commercial |
$92.31
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cofinity Commercial |
$504.25
|
| Rate for Payer: Cofinity Commercial |
$619.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$504.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$648.32
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.31
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$612.31
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$453.83
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.75
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$720.36
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.83 |
| Max. Negotiated Rate |
$648.32 |
| Rate for Payer: Aetna Commercial |
$612.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.23
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cofinity Commercial |
$504.25
|
| Rate for Payer: Cofinity Commercial |
$619.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$504.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.29
|
| Rate for Payer: Healthscope Commercial |
$648.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.31
|
| Rate for Payer: PHP Commercial |
$612.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.23
|
| Rate for Payer: Priority Health SBD |
$453.83
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$396.58
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$356.92 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.78
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Cofinity Commercial |
$341.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Healthscope Commercial |
$356.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: PHP Commercial |
$337.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: Priority Health SBD |
$249.85
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
OP
|
$396.58
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: Aetna Medicare |
$198.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.78
|
| Rate for Payer: BCBS Complete |
$158.63
|
| Rate for Payer: BCBS Trust/PPO |
$55.83
|
| Rate for Payer: BCCCP Commercial |
$25.13
|
| Rate for Payer: BCN Commercial |
$55.83
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Cofinity Commercial |
$341.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Healthscope Commercial |
$356.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: PHP Commercial |
$337.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: Priority Health SBD |
$249.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.16
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,786.59
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$333.43 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$2,368.60
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.86
|
| Rate for Payer: BCN Commercial |
$1,339.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$1,950.61
|
| Rate for Payer: Cofinity Commercial |
$2,396.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,950.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$2,507.93
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$2,368.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,755.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.43
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,786.59
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,755.55 |
| Max. Negotiated Rate |
$2,507.93 |
| Rate for Payer: Aetna Commercial |
$2,368.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.28
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$1,950.61
|
| Rate for Payer: Cofinity Commercial |
$2,396.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,950.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Healthscope Commercial |
$2,507.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: PHP Commercial |
$2,368.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health SBD |
$1,755.55
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,177.28
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.69 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Aetna Commercial |
$1,000.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,012.46
|
| Rate for Payer: Cofinity Commercial |
$824.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$824.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,059.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: PHP Commercial |
$1,000.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health SBD |
$741.69
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,177.28
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Aetna Commercial |
$1,000.69
|
| Rate for Payer: Aetna Medicare |
$588.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.23
|
| Rate for Payer: BCBS Complete |
$470.91
|
| Rate for Payer: BCBS Trust/PPO |
$340.08
|
| Rate for Payer: BCCCP Commercial |
$153.22
|
| Rate for Payer: BCN Commercial |
$340.08
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,012.46
|
| Rate for Payer: Cofinity Commercial |
$824.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$824.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,059.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: PHP Commercial |
$1,000.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health SBD |
$741.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.50
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$372.79
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$335.51 |
| Rate for Payer: Aetna Commercial |
$316.87
|
| Rate for Payer: Aetna Medicare |
$186.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.31
|
| Rate for Payer: BCBS Complete |
$149.12
|
| Rate for Payer: BCBS Trust/PPO |
$164.70
|
| Rate for Payer: BCCCP Commercial |
$117.70
|
| Rate for Payer: BCN Commercial |
$164.70
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$260.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: PHP Commercial |
$316.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health Narrow Network |
$76.09
|
| Rate for Payer: Priority Health SBD |
$234.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.44
|
| Rate for Payer: UHC Exchange |
$275.86
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$372.79
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$234.86 |
| Max. Negotiated Rate |
$335.51 |
| Rate for Payer: Aetna Commercial |
$316.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.31
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$260.95
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: PHP Commercial |
$316.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health SBD |
$234.86
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$592.06
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$373.00 |
| Max. Negotiated Rate |
$532.85 |
| Rate for Payer: Aetna Commercial |
$503.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.84
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cofinity Commercial |
$414.44
|
| Rate for Payer: Cofinity Commercial |
$509.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.65
|
| Rate for Payer: Healthscope Commercial |
$532.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.25
|
| Rate for Payer: PHP Commercial |
$503.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.84
|
| Rate for Payer: Priority Health SBD |
$373.00
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$592.06
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.89 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$503.25
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$91.15
|
| Rate for Payer: BCCCP Commercial |
$64.89
|
| Rate for Payer: BCN Commercial |
$91.15
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cash Price |
$473.65
|
| Rate for Payer: Cofinity Commercial |
$509.17
|
| Rate for Payer: Cofinity Commercial |
$414.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$532.85
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.25
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$503.25
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$373.00
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$438.12
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
