|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna American Axle |
$1.72
|
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.62
|
| Rate for Payer: Priority Health SBD |
$1.67
|
| Rate for Payer: Priority Health Tiered Network |
$16.50
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.99
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna American Axle |
$50.99
|
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| 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 |
$3.29
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| 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 |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$8.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.99
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Priority Health Tiered Network |
$4.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.99
|
| Rate for Payer: UHC Core |
$8.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.99
|
| Rate for Payer: UHC Exchange |
$8.99
|
| Rate for Payer: UHC Medicaid |
$3.13
|
| Rate for Payer: UHCCP Medicaid |
$3.13
|
| Rate for Payer: UMR Bronson Commercial |
$29.03
|
| Rate for Payer: VA VA |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna American Axle |
$50.99
|
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: UMR Bronson Commercial |
$34.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC MALLEABLE SS VE
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
27000716
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna American Axle |
$120.90
|
| Rate for Payer: Aetna Commercial |
$158.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.90
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Advantage |
$130.20
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$167.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: PHP Commercial |
$158.10
|
| Rate for Payer: Priority Health SBD |
$117.18
|
| Rate for Payer: UMR Bronson Commercial |
$81.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.50
|
|
|
HC MALLEABLE SS VE
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
27000716
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna American Axle |
$120.90
|
| Rate for Payer: Aetna Commercial |
$158.10
|
| Rate for Payer: Aetna Medicare |
$93.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.90
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Advantage |
$130.20
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$167.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: PHP Commercial |
$158.10
|
| Rate for Payer: Priority Health SBD |
$117.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.90
|
| Rate for Payer: UHC Core |
$96.91
|
| Rate for Payer: UHC Exchange |
$73.10
|
| Rate for Payer: UMR Bronson Commercial |
$68.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.50
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.08 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Aetna American Axle |
$882.05
|
| Rate for Payer: Aetna Commercial |
$1,153.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.05
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Advantage |
$949.90
|
| Rate for Payer: Cofinity Commercial |
$1,167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.60
|
| Rate for Payer: Healthscope Commercial |
$1,221.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$949.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: PHP Commercial |
$1,153.45
|
| Rate for Payer: Priority Health SBD |
$854.91
|
| Rate for Payer: UMR Bronson Commercial |
$597.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.75
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$502.09 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Aetna American Axle |
$882.05
|
| Rate for Payer: Aetna Commercial |
$1,153.45
|
| Rate for Payer: Aetna Medicare |
$678.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.05
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Advantage |
$949.90
|
| Rate for Payer: Cofinity Commercial |
$1,167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.60
|
| Rate for Payer: Healthscope Commercial |
$1,221.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$949.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,017.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: PHP Commercial |
$1,153.45
|
| Rate for Payer: Priority Health SBD |
$854.91
|
| Rate for Payer: UMR Bronson Commercial |
$502.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,017.75
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
IP
|
$438.74
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$394.87 |
| Rate for Payer: Aetna American Axle |
$285.18
|
| Rate for Payer: Aetna Commercial |
$372.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.18
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.06
|
| 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 SBD |
$276.41
|
| Rate for Payer: UMR Bronson Commercial |
$193.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.06
|
|
|
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 American Axle |
$285.18
|
| 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 |
$275.00
|
| Rate for Payer: BCCCP Commercial |
$148.01
|
| Rate for Payer: BCN Commercial |
$275.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.06
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$162.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.06
|
|
|
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 |
$190.48 |
| Max. Negotiated Rate |
$389.61 |
| Rate for Payer: Aetna American Axle |
$281.38
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$303.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.68
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$190.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.68
|
|
|
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 American Axle |
$281.38
|
| 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 |
$227.39
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$227.39
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$303.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.68
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$160.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.68
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$756.38
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.81 |
| Max. Negotiated Rate |
$680.74 |
| Rate for Payer: Aetna American Axle |
$491.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$529.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.28
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$332.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.28
|
|
|
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 American Axle |
$491.65
|
| 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 |
$879.35
|
| Rate for Payer: BCCCP Commercial |
$92.31
|
| Rate for Payer: BCN Commercial |
$879.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$529.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.28
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| 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: UMR Bronson Commercial |
$279.86
|
| Rate for Payer: VA VA |
$705.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.28
|
|
|
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 |
$177.98 |
| Max. Negotiated Rate |
$364.06 |
| Rate for Payer: Aetna American Axle |
$262.93
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$283.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.38
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$177.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.38
|
|
|
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 American Axle |
$262.93
|
| 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 |
$117.53
|
| Rate for Payer: BCCCP Commercial |
$25.13
|
| Rate for Payer: BCN Commercial |
$117.53
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$283.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.38
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$149.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.38
|
|
|
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 American Axle |
$1,847.51
|
| 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 |
$2,820.43
|
| Rate for Payer: BCN Commercial |
$2,820.43
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,989.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,131.74
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| 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: UMR Bronson Commercial |
$1,051.66
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,131.74
|
|
|
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 |
$1,250.62 |
| Max. Negotiated Rate |
$2,558.09 |
| Rate for Payer: Aetna American Axle |
$1,847.51
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,989.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,131.74
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,250.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,131.74
|
|
|
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 American Axle |
$780.54
|
| 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 |
$715.87
|
| Rate for Payer: BCCCP Commercial |
$153.22
|
| Rate for Payer: BCN Commercial |
$715.87
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$840.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.62
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$444.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.62
|
|
|
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 |
$528.37 |
| Max. Negotiated Rate |
$1,080.75 |
| Rate for Payer: Aetna American Axle |
$780.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$840.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.62
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$528.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.62
|
|
|
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 |
$167.31 |
| Max. Negotiated Rate |
$342.23 |
| Rate for Payer: Aetna American Axle |
$247.16
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$266.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.19
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$167.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.19
|
|
|
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 American Axle |
$247.16
|
| 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 |
$215.89
|
| Rate for Payer: BCCCP Commercial |
$117.70
|
| Rate for Payer: BCN Commercial |
$215.89
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$266.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.19
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$140.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.19
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$603.90
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.72 |
| Max. Negotiated Rate |
$543.51 |
| Rate for Payer: Aetna American Axle |
$392.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$422.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.93
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$265.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.93
|
|
|
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 American Axle |
$392.54
|
| 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 |
$119.03
|
| Rate for Payer: BCCCP Commercial |
$64.89
|
| Rate for Payer: BCN Commercial |
$119.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$422.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.93
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| 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: UMR Bronson Commercial |
$223.44
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.93
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$728.76
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.65 |
| Max. Negotiated Rate |
$655.88 |
| Rate for Payer: Aetna American Axle |
$473.69
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$510.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.57
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$320.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.57
|
|
|
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 American Axle |
$473.69
|
| 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 |
$90.30
|
| Rate for Payer: BCCCP Commercial |
$50.35
|
| Rate for Payer: BCN Commercial |
$90.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$510.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.57
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| 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: UMR Bronson Commercial |
$269.64
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.57
|
|
