|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
OP
|
$975.34
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$231.64 |
| Max. Negotiated Rate |
$877.81 |
| Rate for Payer: Aetna Commercial |
$829.04
|
| Rate for Payer: Aetna Medicare |
$253.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.79
|
| Rate for Payer: BCBS Complete |
$390.14
|
| Rate for Payer: BCBS MAPPO |
$243.84
|
| Rate for Payer: BCBS Trust/PPO |
$801.83
|
| Rate for Payer: BCN Commercial |
$758.33
|
| Rate for Payer: BCN Medicare Advantage |
$243.84
|
| Rate for Payer: Cash Price |
$780.27
|
| Rate for Payer: Cofinity Commercial |
$838.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.84
|
| Rate for Payer: Healthscope Commercial |
$877.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.04
|
| Rate for Payer: Nomi Health Commercial |
$799.78
|
| Rate for Payer: PACE Senior Care Partners |
$231.64
|
| Rate for Payer: PACE SWMI |
$243.84
|
| Rate for Payer: PHP Commercial |
$829.04
|
| Rate for Payer: PHP Medicare Advantage |
$243.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.97
|
| Rate for Payer: Priority Health HMO/PPO |
$848.55
|
| Rate for Payer: Priority Health Medicare |
$246.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.48
|
| Rate for Payer: Railroad Medicare Medicare |
$243.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.30
|
| Rate for Payer: UHC Core |
$814.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.84
|
| Rate for Payer: UHC Exchange |
$243.84
|
| Rate for Payer: UHC Medicare Advantage |
$243.84
|
| Rate for Payer: VA VA |
$243.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.50
|
|
|
HC MAGGOT THERAPY
|
Facility
|
OP
|
$1,092.42
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.45 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$284.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.38
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: BCBS MAPPO |
$273.10
|
| Rate for Payer: BCBS Trust/PPO |
$898.08
|
| Rate for Payer: BCN Commercial |
$849.36
|
| Rate for Payer: BCN Medicare Advantage |
$273.10
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.10
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PACE Senior Care Partners |
$259.45
|
| Rate for Payer: PACE SWMI |
$273.10
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: PHP Medicare Advantage |
$273.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Medicare |
$275.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.92
|
| Rate for Payer: Railroad Medicare Medicare |
$273.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.10
|
| Rate for Payer: UHC Exchange |
$273.10
|
| Rate for Payer: UHC Medicare Advantage |
$273.10
|
| Rate for Payer: VA VA |
$273.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC MAGGOT THERAPY
|
Facility
|
IP
|
$1,092.42
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$710.07 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: BCBS Trust/PPO |
$891.74
|
| Rate for Payer: BCN Commercial |
$844.22
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$4.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$5.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$4.84
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO |
$2.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO |
$2.26
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: BCBS Trust/PPO |
$62.78
|
| Rate for Payer: BCN Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO |
$66.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.68
|
| Rate for Payer: UHC Core |
$64.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.68
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.03
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$19.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.23
|
| Rate for Payer: BCN Commercial |
$59.80
|
| Rate for Payer: BCN Medicare Advantage |
$19.23
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.68
|
| Rate for Payer: Mclaren Medicaid |
$4.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.19
|
| Rate for Payer: Meridian Medicaid |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PACE Senior Care Partners |
$18.27
|
| Rate for Payer: PACE SWMI |
$19.23
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO |
$66.91
|
| Rate for Payer: Priority Health Medicare |
$19.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.68
|
| Rate for Payer: UHC Core |
$64.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.23
|
| Rate for Payer: UHC Exchange |
$19.23
|
| Rate for Payer: UHC Medicare Advantage |
$19.23
|
| Rate for Payer: UHCCP Medicaid |
$4.33
|
| Rate for Payer: VA VA |
$19.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.68
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,330.39
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.97 |
| Max. Negotiated Rate |
$1,197.35 |
| Rate for Payer: Aetna Commercial |
$1,130.83
|
| Rate for Payer: Aetna Medicare |
$345.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$415.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$415.75
|
| Rate for Payer: BCBS Complete |
$532.16
|
| Rate for Payer: BCBS MAPPO |
$332.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.71
|
| Rate for Payer: BCN Commercial |
$1,034.38
|
| Rate for Payer: BCN Medicare Advantage |
$332.60
|
| Rate for Payer: Cash Price |
$1,064.31
|
| Rate for Payer: Cofinity Commercial |
$1,144.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.60
|
| Rate for Payer: Healthscope Commercial |
$1,197.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$382.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.83
|
| Rate for Payer: Nomi Health Commercial |
$1,090.92
|
| Rate for Payer: PACE Senior Care Partners |
$315.97
|
| Rate for Payer: PACE SWMI |
$332.60
|
| Rate for Payer: PHP Commercial |
$1,130.83
|
| Rate for Payer: PHP Medicare Advantage |
$332.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,157.44
|
| Rate for Payer: Priority Health Medicare |
$335.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.36
|
| Rate for Payer: Railroad Medicare Medicare |
$332.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,170.74
|
| Rate for Payer: UHC Core |
$1,110.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.60
|
| Rate for Payer: UHC Exchange |
$332.60
|
| Rate for Payer: UHC Medicare Advantage |
$332.60
|
| Rate for Payer: VA VA |
$332.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.79
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,330.39
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.75 |
| Max. Negotiated Rate |
$1,197.35 |
| Rate for Payer: Aetna Commercial |
$1,130.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.00
|
| Rate for Payer: BCN Commercial |
$1,028.13
|
| Rate for Payer: Cash Price |
$1,064.31
|
| Rate for Payer: Cofinity Commercial |
$1,144.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.31
|
| Rate for Payer: Healthscope Commercial |
$1,197.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.83
|
| Rate for Payer: Nomi Health Commercial |
$1,090.92
|
| Rate for Payer: PHP Commercial |
$1,130.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,157.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,170.74
|
| Rate for Payer: UHC Core |
$1,110.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.79
|
|
|
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 |
$279.59 |
| Max. Negotiated Rate |
$387.13 |
| Rate for Payer: Aetna Commercial |
$365.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.12
|
| Rate for Payer: BCN Commercial |
$332.41
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cofinity Commercial |
$369.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.11
|
| Rate for Payer: Healthscope Commercial |
$387.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.62
|
| Rate for Payer: Nomi Health Commercial |
$352.71
|
| Rate for Payer: PHP Commercial |
$365.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.59
|
| Rate for Payer: Priority Health HMO/PPO |
$374.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.52
|
| Rate for Payer: UHC Core |
$359.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.60
|
|
|
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 |
$102.16 |
| Max. Negotiated Rate |
$387.13 |
| Rate for Payer: Aetna Commercial |
$365.62
|
| Rate for Payer: Aetna Medicare |
$111.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.42
|
| Rate for Payer: BCBS Complete |
$172.06
|
| Rate for Payer: BCBS MAPPO |
$107.54
|
| Rate for Payer: BCBS Trust/PPO |
$353.62
|
| Rate for Payer: BCCCP Commercial |
$148.01
|
| Rate for Payer: BCN Commercial |
$334.43
|
| Rate for Payer: BCN Medicare Advantage |
$107.54
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cash Price |
$344.11
|
| Rate for Payer: Cofinity Commercial |
$369.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.54
|
| Rate for Payer: Healthscope Commercial |
$387.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.62
|
| Rate for Payer: Nomi Health Commercial |
$352.71
|
| Rate for Payer: PACE Senior Care Partners |
$102.16
|
| Rate for Payer: PACE SWMI |
$107.54
|
| Rate for Payer: PHP Commercial |
$365.62
|
| Rate for Payer: PHP Medicare Advantage |
$107.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.59
|
| Rate for Payer: Priority Health HMO/PPO |
$374.22
|
| Rate for Payer: Priority Health Medicare |
$108.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.19
|
| Rate for Payer: Railroad Medicare Medicare |
$107.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.52
|
| Rate for Payer: UHC Core |
$359.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.54
|
| Rate for Payer: UHC Exchange |
$107.54
|
| Rate for Payer: UHC Medicare Advantage |
$107.54
|
| Rate for Payer: VA VA |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.60
|
|
|
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 |
$275.87 |
| Max. Negotiated Rate |
$381.97 |
| Rate for Payer: Aetna Commercial |
$360.75
|
| Rate for Payer: BCBS Trust/PPO |
$346.45
|
| Rate for Payer: BCN Commercial |
$327.98
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.53
|
| Rate for Payer: Healthscope Commercial |
$381.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.75
|
| Rate for Payer: Nomi Health Commercial |
$348.02
|
| Rate for Payer: PHP Commercial |
$360.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.87
|
| Rate for Payer: Priority Health HMO/PPO |
$369.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.48
|
| Rate for Payer: UHC Core |
$354.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.31
|
|
|
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 |
$100.80 |
| Max. Negotiated Rate |
$381.97 |
| Rate for Payer: Aetna Commercial |
$360.75
|
| Rate for Payer: Aetna Medicare |
$110.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.63
|
| Rate for Payer: BCBS Complete |
$169.76
|
| Rate for Payer: BCBS MAPPO |
$106.10
|
| Rate for Payer: BCBS Trust/PPO |
$348.91
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$329.98
|
| Rate for Payer: BCN Medicare Advantage |
$106.10
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cash Price |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$364.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.10
|
| Rate for Payer: Healthscope Commercial |
$381.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.75
|
| Rate for Payer: Nomi Health Commercial |
$348.02
|
| Rate for Payer: PACE Senior Care Partners |
$100.80
|
| Rate for Payer: PACE SWMI |
$106.10
|
| Rate for Payer: PHP Commercial |
$360.75
|
| Rate for Payer: PHP Medicare Advantage |
$106.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.87
|
| Rate for Payer: Priority Health HMO/PPO |
$369.24
|
| Rate for Payer: Priority Health Medicare |
$107.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.35
|
| Rate for Payer: Railroad Medicare Medicare |
$106.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.48
|
| Rate for Payer: UHC Core |
$354.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.10
|
| Rate for Payer: UHC Exchange |
$106.10
|
| Rate for Payer: UHC Medicare Advantage |
$106.10
|
| Rate for Payer: VA VA |
$106.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.31
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$720.36
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$648.32 |
| Rate for Payer: Aetna Commercial |
$612.31
|
| Rate for Payer: Aetna Medicare |
$187.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.11
|
| Rate for Payer: BCBS Complete |
$523.36
|
| Rate for Payer: BCBS MAPPO |
$180.09
|
| Rate for Payer: BCBS Trust/PPO |
$592.21
|
| Rate for Payer: BCCCP Commercial |
$92.31
|
| Rate for Payer: BCN Commercial |
$560.08
|
| Rate for Payer: BCN Medicare Advantage |
$180.09
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cofinity Commercial |
$619.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.09
|
| Rate for Payer: Healthscope Commercial |
$648.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.27
|
| Rate for Payer: Mclaren Medicaid |
$498.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.09
|
| Rate for Payer: Meridian Medicaid |
$523.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.31
|
| Rate for Payer: Nomi Health Commercial |
$590.70
|
| Rate for Payer: PACE Senior Care Partners |
$171.09
|
| Rate for Payer: PACE SWMI |
$180.09
|
| Rate for Payer: PHP Commercial |
$612.31
|
| Rate for Payer: PHP Medicare Advantage |
$180.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.23
|
| Rate for Payer: Priority Health HMO/PPO |
$626.71
|
| Rate for Payer: Priority Health Medicare |
$181.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.64
|
| Rate for Payer: Railroad Medicare Medicare |
$180.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.92
|
| Rate for Payer: UHC Core |
$601.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.09
|
| Rate for Payer: UHC Exchange |
$180.09
|
| Rate for Payer: UHC Medicare Advantage |
$180.09
|
| Rate for Payer: UHCCP Medicaid |
$498.41
|
| Rate for Payer: VA VA |
$180.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.27
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$720.36
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$468.23 |
| Max. Negotiated Rate |
$648.32 |
| Rate for Payer: Aetna Commercial |
$612.31
|
| Rate for Payer: BCBS Trust/PPO |
$588.03
|
| Rate for Payer: BCN Commercial |
$556.69
|
| Rate for Payer: Cash Price |
$576.29
|
| Rate for Payer: Cofinity Commercial |
$619.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.29
|
| Rate for Payer: Healthscope Commercial |
$648.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.31
|
| Rate for Payer: Nomi Health Commercial |
$590.70
|
| Rate for Payer: PHP Commercial |
$612.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.23
|
| Rate for Payer: Priority Health HMO/PPO |
$626.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.92
|
| Rate for Payer: UHC Core |
$601.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.27
|
|
|
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 |
$257.78 |
| Max. Negotiated Rate |
$356.92 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: BCBS Trust/PPO |
$323.73
|
| Rate for Payer: BCN Commercial |
$306.48
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$341.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Healthscope Commercial |
$356.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: Nomi Health Commercial |
$325.20
|
| Rate for Payer: PHP Commercial |
$337.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: Priority Health HMO/PPO |
$345.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.99
|
| Rate for Payer: UHC Core |
$331.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.44
|
|
|
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 |
$25.13 |
| Max. Negotiated Rate |
$356.92 |
| Rate for Payer: Aetna Commercial |
$337.09
|
| Rate for Payer: Aetna Medicare |
$103.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.93
|
| Rate for Payer: BCBS Complete |
$158.63
|
| Rate for Payer: BCBS MAPPO |
$99.14
|
| Rate for Payer: BCBS Trust/PPO |
$326.03
|
| Rate for Payer: BCCCP Commercial |
$25.13
|
| Rate for Payer: BCN Commercial |
$308.34
|
| Rate for Payer: BCN Medicare Advantage |
$99.14
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cash Price |
$317.26
|
| Rate for Payer: Cofinity Commercial |
$341.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.14
|
| Rate for Payer: Healthscope Commercial |
$356.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.09
|
| Rate for Payer: Nomi Health Commercial |
$325.20
|
| Rate for Payer: PACE Senior Care Partners |
$94.19
|
| Rate for Payer: PACE SWMI |
$99.14
|
| Rate for Payer: PHP Commercial |
$337.09
|
| Rate for Payer: PHP Medicare Advantage |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.78
|
| Rate for Payer: Priority Health HMO/PPO |
$345.02
|
| Rate for Payer: Priority Health Medicare |
$100.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.71
|
| Rate for Payer: Railroad Medicare Medicare |
$99.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.99
|
| Rate for Payer: UHC Core |
$331.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.14
|
| Rate for Payer: UHC Exchange |
$99.14
|
| Rate for Payer: UHC Medicare Advantage |
$99.14
|
| Rate for Payer: VA VA |
$99.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.44
|
|
|
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 |
$661.82 |
| Max. Negotiated Rate |
$2,507.93 |
| Rate for Payer: Aetna Commercial |
$2,368.60
|
| Rate for Payer: Aetna Medicare |
$724.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$870.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$870.81
|
| Rate for Payer: BCBS Complete |
$1,205.21
|
| Rate for Payer: BCBS MAPPO |
$696.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,290.86
|
| Rate for Payer: BCN Commercial |
$2,166.57
|
| Rate for Payer: BCN Medicare Advantage |
$696.65
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$2,396.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.65
|
| Rate for Payer: Healthscope Commercial |
$2,507.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,089.94
|
| Rate for Payer: Mclaren Medicaid |
$1,147.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.48
|
| Rate for Payer: Meridian Medicaid |
$1,205.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$801.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: Nomi Health Commercial |
$2,285.00
|
| Rate for Payer: PACE Senior Care Partners |
$661.82
|
| Rate for Payer: PACE SWMI |
$696.65
|
| Rate for Payer: PHP Commercial |
$2,368.60
|
| Rate for Payer: PHP Medicare Advantage |
$696.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health HMO/PPO |
$2,424.33
|
| Rate for Payer: Priority Health Medicare |
$703.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,867.02
|
| Rate for Payer: Railroad Medicare Medicare |
$696.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,452.20
|
| Rate for Payer: UHC Core |
$2,326.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.65
|
| Rate for Payer: UHC Exchange |
$696.65
|
| Rate for Payer: UHC Medicare Advantage |
$696.65
|
| Rate for Payer: UHCCP Medicaid |
$1,147.75
|
| Rate for Payer: VA VA |
$696.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,089.94
|
|
|
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 |
$1,811.28 |
| Max. Negotiated Rate |
$2,507.93 |
| Rate for Payer: Aetna Commercial |
$2,368.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,274.69
|
| Rate for Payer: BCN Commercial |
$2,153.48
|
| Rate for Payer: Cash Price |
$2,229.27
|
| Rate for Payer: Cofinity Commercial |
$2,396.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,229.27
|
| Rate for Payer: Healthscope Commercial |
$2,507.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,089.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.60
|
| Rate for Payer: Nomi Health Commercial |
$2,285.00
|
| Rate for Payer: PHP Commercial |
$2,368.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.28
|
| Rate for Payer: Priority Health HMO/PPO |
$2,424.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,867.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,452.20
|
| Rate for Payer: UHC Core |
$2,326.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,089.94
|
|
|
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 |
$765.23 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Aetna Commercial |
$1,000.69
|
| Rate for Payer: BCBS Trust/PPO |
$961.01
|
| Rate for Payer: BCN Commercial |
$909.80
|
| Rate for Payer: Cash Price |
$941.82
|
| Rate for Payer: Cofinity Commercial |
$1,012.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Healthscope Commercial |
$1,059.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: Nomi Health Commercial |
$965.37
|
| Rate for Payer: PHP Commercial |
$1,000.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,024.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$788.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.01
|
| Rate for Payer: UHC Core |
$983.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.96
|
|
|
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 |
$153.22 |
| Max. Negotiated Rate |
$1,059.55 |
| Rate for Payer: Aetna Commercial |
$1,000.69
|
| Rate for Payer: Aetna Medicare |
$306.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$367.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$367.90
|
| Rate for Payer: BCBS Complete |
$470.91
|
| Rate for Payer: BCBS MAPPO |
$294.32
|
| Rate for Payer: BCBS Trust/PPO |
$967.84
|
| Rate for Payer: BCCCP Commercial |
$153.22
|
| Rate for Payer: BCN Commercial |
$915.34
|
| Rate for Payer: BCN Medicare Advantage |
$294.32
|
| 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: Encore Health Key Benefits Commercial |
$941.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.32
|
| Rate for Payer: Healthscope Commercial |
$1,059.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$882.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.69
|
| Rate for Payer: Nomi Health Commercial |
$965.37
|
| Rate for Payer: PACE Senior Care Partners |
$279.60
|
| Rate for Payer: PACE SWMI |
$294.32
|
| Rate for Payer: PHP Commercial |
$1,000.69
|
| Rate for Payer: PHP Medicare Advantage |
$294.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,024.23
|
| Rate for Payer: Priority Health Medicare |
$297.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$788.78
|
| Rate for Payer: Railroad Medicare Medicare |
$294.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.01
|
| Rate for Payer: UHC Core |
$983.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.32
|
| Rate for Payer: UHC Exchange |
$294.32
|
| Rate for Payer: UHC Medicare Advantage |
$294.32
|
| Rate for Payer: VA VA |
$294.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$882.96
|
|
|
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 |
$242.31 |
| Max. Negotiated Rate |
$335.51 |
| Rate for Payer: Aetna Commercial |
$316.87
|
| Rate for Payer: BCBS Trust/PPO |
$304.31
|
| Rate for Payer: BCN Commercial |
$288.09
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$335.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: Nomi Health Commercial |
$305.69
|
| Rate for Payer: PHP Commercial |
$316.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health HMO/PPO |
$324.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.06
|
| Rate for Payer: UHC Core |
$311.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.59
|
|
|
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 |
$88.54 |
| Max. Negotiated Rate |
$335.51 |
| Rate for Payer: Aetna Commercial |
$316.87
|
| Rate for Payer: Aetna Medicare |
$96.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.50
|
| Rate for Payer: BCBS Complete |
$149.12
|
| Rate for Payer: BCBS MAPPO |
$93.20
|
| Rate for Payer: BCBS Trust/PPO |
$306.47
|
| Rate for Payer: BCCCP Commercial |
$117.70
|
| Rate for Payer: BCN Commercial |
$289.84
|
| Rate for Payer: BCN Medicare Advantage |
$93.20
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cash Price |
$298.23
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$335.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.87
|
| Rate for Payer: Nomi Health Commercial |
$305.69
|
| Rate for Payer: PACE Senior Care Partners |
$88.54
|
| Rate for Payer: PACE SWMI |
$93.20
|
| Rate for Payer: PHP Commercial |
$316.87
|
| Rate for Payer: PHP Medicare Advantage |
$93.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.31
|
| Rate for Payer: Priority Health HMO/PPO |
$324.33
|
| Rate for Payer: Priority Health Medicare |
$94.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.77
|
| Rate for Payer: Railroad Medicare Medicare |
$93.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.06
|
| Rate for Payer: UHC Core |
$311.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.20
|
| Rate for Payer: UHC Exchange |
$93.20
|
| Rate for Payer: UHC Medicare Advantage |
$93.20
|
| Rate for Payer: VA VA |
$93.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.59
|
|
