|
HC BRACE WHFO RIGID W/O JOINTS
|
Facility
|
OP
|
$339.17
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
27400040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.67 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: Aetna Commercial |
$305.25
|
| Rate for Payer: Aetna Medicare |
$169.59
|
| Rate for Payer: ASR ASR |
$328.99
|
| Rate for Payer: ASR Commercial |
$328.99
|
| Rate for Payer: BCBS Complete |
$135.67
|
| Rate for Payer: BCBS Trust/PPO |
$277.75
|
| Rate for Payer: BCN Commercial |
$262.96
|
| Rate for Payer: Cash Price |
$271.34
|
| Rate for Payer: Cofinity Commercial |
$318.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.34
|
| Rate for Payer: Healthscope Commercial |
$339.17
|
| Rate for Payer: Healthscope Whirlpool |
$328.99
|
| Rate for Payer: Mclaren Commercial |
$305.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.29
|
| Rate for Payer: Nomi Health Commercial |
$278.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.18
|
| Rate for Payer: Priority Health Narrow Network |
$237.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.47
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
OP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$193.10 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$434.48
|
| Rate for Payer: Aetna Medicare |
$241.38
|
| Rate for Payer: ASR ASR |
$468.27
|
| Rate for Payer: ASR Commercial |
$468.27
|
| Rate for Payer: BCBS Complete |
$193.10
|
| Rate for Payer: BCBS Trust/PPO |
$395.32
|
| Rate for Payer: BCN Commercial |
$374.28
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$453.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$482.75
|
| Rate for Payer: Healthscope Whirlpool |
$468.27
|
| Rate for Payer: Mclaren Commercial |
$434.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.99
|
| Rate for Payer: Priority Health Narrow Network |
$338.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.82
|
|
|
HC BRACE WHO W/O JOINTS CF
|
Facility
|
IP
|
$482.75
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
27400041
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.79 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$434.48
|
| Rate for Payer: ASR ASR |
$468.27
|
| Rate for Payer: ASR Commercial |
$468.27
|
| Rate for Payer: BCBS Trust/PPO |
$393.39
|
| Rate for Payer: BCN Commercial |
$374.28
|
| Rate for Payer: Cash Price |
$386.20
|
| Rate for Payer: Cofinity Commercial |
$453.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.20
|
| Rate for Payer: Healthscope Commercial |
$482.75
|
| Rate for Payer: Healthscope Whirlpool |
$468.27
|
| Rate for Payer: Mclaren Commercial |
$434.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.34
|
| Rate for Payer: Nomi Health Commercial |
$395.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$424.82
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$926.16 |
| Max. Negotiated Rate |
$2,315.40 |
| Rate for Payer: Aetna Commercial |
$2,083.86
|
| Rate for Payer: Aetna Medicare |
$1,157.70
|
| Rate for Payer: ASR ASR |
$2,245.94
|
| Rate for Payer: ASR Commercial |
$2,245.94
|
| Rate for Payer: BCBS Complete |
$926.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,896.08
|
| Rate for Payer: BCN Commercial |
$1,795.13
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$2,176.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,315.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,245.94
|
| Rate for Payer: Mclaren Commercial |
$2,083.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,028.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,623.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,037.55
|
|
|
HC BRACE WRIST HAND OROTHISIS W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,315.40
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
27400053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.01 |
| Max. Negotiated Rate |
$2,315.40 |
| Rate for Payer: Aetna Commercial |
$2,083.86
|
| Rate for Payer: ASR ASR |
$2,245.94
|
| Rate for Payer: ASR Commercial |
$2,245.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,886.82
|
| Rate for Payer: BCN Commercial |
$1,795.13
|
| Rate for Payer: Cash Price |
$1,852.32
|
| Rate for Payer: Cofinity Commercial |
$2,176.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,852.32
|
| Rate for Payer: Healthscope Commercial |
$2,315.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,245.94
|
| Rate for Payer: Mclaren Commercial |
$2,083.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,968.09
|
| Rate for Payer: Nomi Health Commercial |
$1,898.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,037.55
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
IP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.48 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$137.74
|
| Rate for Payer: ASR ASR |
$148.45
|
| Rate for Payer: ASR Commercial |
$148.45
|
| Rate for Payer: BCBS Trust/PPO |
$124.71
|
| Rate for Payer: BCN Commercial |
$118.65
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$143.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Healthscope Whirlpool |
$148.45
|
| Rate for Payer: Mclaren Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$125.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.68
|
|
|
HC BRACE WRIST/THUMB SPLINT
|
Facility
|
OP
|
$153.04
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$153.04 |
| Rate for Payer: Aetna Commercial |
$137.74
|
| Rate for Payer: Aetna Medicare |
$76.52
|
| Rate for Payer: ASR ASR |
$148.45
|
| Rate for Payer: ASR Commercial |
$148.45
|
| Rate for Payer: BCBS Complete |
$61.22
|
| Rate for Payer: BCBS Trust/PPO |
$125.32
|
| Rate for Payer: BCN Commercial |
$118.65
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$143.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.43
|
| Rate for Payer: Healthscope Commercial |
$153.04
|
| Rate for Payer: Healthscope Whirlpool |
$148.45
|
| Rate for Payer: Mclaren Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$125.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.09
|
| Rate for Payer: Priority Health Narrow Network |
$107.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.68
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
OP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna Commercial |
$201.79
|
| Rate for Payer: Aetna Medicare |
$34.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.80
|
| Rate for Payer: ASR ASR |
$217.48
|
| Rate for Payer: ASR Commercial |
$217.48
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$34.24
|
| Rate for Payer: BCBS Trust/PPO |
$183.61
|
| Rate for Payer: BCN Commercial |
$173.83
|
| Rate for Payer: BCN Medicare Advantage |
$34.24
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Healthscope Whirlpool |
$217.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$34.24
|
| Rate for Payer: Mclaren Commercial |
$201.79
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$34.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.95
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: PACE Medicare |
$32.53
|
| Rate for Payer: PACE SWMI |
$34.24
|
| Rate for Payer: PHP Commercial |
$37.66
|
| Rate for Payer: PHP Medicaid |
$18.35
|
| Rate for Payer: PHP Medicare Advantage |
$34.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.45
|
| Rate for Payer: Priority Health Medicare |
$34.24
|
| Rate for Payer: Priority Health Narrow Network |
$157.17
|
| Rate for Payer: Railroad Medicare Medicare |
$34.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.24
|
| Rate for Payer: UHC Exchange |
$53.07
|
| Rate for Payer: UHC Medicare Advantage |
$34.24
|
| Rate for Payer: UHCCP DNSP |
$34.24
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$34.24
|
|
|
HC BRACHY SOURCE I-125 NSTRD
|
Facility
|
IP
|
$224.21
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
27800089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna Commercial |
$201.79
|
| Rate for Payer: ASR ASR |
$217.48
|
| Rate for Payer: ASR Commercial |
$217.48
|
| Rate for Payer: BCBS Trust/PPO |
$182.71
|
| Rate for Payer: BCN Commercial |
$173.83
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$210.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Healthscope Whirlpool |
$217.48
|
| Rate for Payer: Mclaren Commercial |
$201.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$183.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.30
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
IP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.45 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,608.16
|
| Rate for Payer: ASR ASR |
$1,733.24
|
| Rate for Payer: ASR Commercial |
$1,733.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.10
|
| Rate for Payer: BCN Commercial |
$1,385.34
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,679.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,733.24
|
| Rate for Payer: Mclaren Commercial |
$1,608.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: Nomi Health Commercial |
$1,465.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,572.43
|
|
|
HC BRAVO PROCEDURE
|
Facility
|
OP
|
$1,786.85
|
|
| Hospital Charge Code |
36000091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.74 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,608.16
|
| Rate for Payer: Aetna Medicare |
$893.42
|
| Rate for Payer: ASR ASR |
$1,733.24
|
| Rate for Payer: ASR Commercial |
$1,733.24
|
| Rate for Payer: BCBS Complete |
$714.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.25
|
| Rate for Payer: BCN Commercial |
$1,385.34
|
| Rate for Payer: Cash Price |
$1,429.48
|
| Rate for Payer: Cofinity Commercial |
$1,679.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,429.48
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,733.24
|
| Rate for Payer: Mclaren Commercial |
$1,608.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.82
|
| Rate for Payer: Nomi Health Commercial |
$1,465.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,565.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,252.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,572.43
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BRAZIL NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
OP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,071.69 |
| Max. Negotiated Rate |
$5,179.22 |
| Rate for Payer: Aetna Commercial |
$4,661.30
|
| Rate for Payer: Aetna Medicare |
$2,589.61
|
| Rate for Payer: ASR ASR |
$5,023.84
|
| Rate for Payer: ASR Commercial |
$5,023.84
|
| Rate for Payer: BCBS Complete |
$2,071.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,241.26
|
| Rate for Payer: BCN Commercial |
$4,015.45
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$4,868.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$5,179.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,023.84
|
| Rate for Payer: Mclaren Commercial |
$4,661.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: Nomi Health Commercial |
$4,246.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,538.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,630.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,557.71
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION MR
|
Facility
|
IP
|
$5,179.22
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
36100413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,366.49 |
| Max. Negotiated Rate |
$5,179.22 |
| Rate for Payer: Aetna Commercial |
$4,661.30
|
| Rate for Payer: ASR ASR |
$5,023.84
|
| Rate for Payer: ASR Commercial |
$5,023.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,220.55
|
| Rate for Payer: BCN Commercial |
$4,015.45
|
| Rate for Payer: Cash Price |
$4,143.38
|
| Rate for Payer: Cofinity Commercial |
$4,868.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,143.38
|
| Rate for Payer: Healthscope Commercial |
$5,179.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,023.84
|
| Rate for Payer: Mclaren Commercial |
$4,661.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,402.34
|
| Rate for Payer: Nomi Health Commercial |
$4,246.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,366.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,557.71
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
IP
|
$3,670.34
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,385.72 |
| Max. Negotiated Rate |
$3,670.34 |
| Rate for Payer: Aetna Commercial |
$3,303.31
|
| Rate for Payer: ASR ASR |
$3,560.23
|
| Rate for Payer: ASR Commercial |
$3,560.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,990.96
|
| Rate for Payer: BCN Commercial |
$2,845.61
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cofinity Commercial |
$3,450.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,936.27
|
| Rate for Payer: Healthscope Commercial |
$3,670.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,560.23
|
| Rate for Payer: Mclaren Commercial |
$3,303.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,119.79
|
| Rate for Payer: Nomi Health Commercial |
$3,009.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,385.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,229.90
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION STEREO
|
Facility
|
OP
|
$3,670.34
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
36100409
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,468.14 |
| Max. Negotiated Rate |
$3,670.34 |
| Rate for Payer: Aetna Commercial |
$3,303.31
|
| Rate for Payer: Aetna Medicare |
$1,835.17
|
| Rate for Payer: ASR ASR |
$3,560.23
|
| Rate for Payer: ASR Commercial |
$3,560.23
|
| Rate for Payer: BCBS Complete |
$1,468.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,005.64
|
| Rate for Payer: BCN Commercial |
$2,845.61
|
| Rate for Payer: Cash Price |
$2,936.27
|
| Rate for Payer: Cofinity Commercial |
$3,450.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,936.27
|
| Rate for Payer: Healthscope Commercial |
$3,670.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,560.23
|
| Rate for Payer: Mclaren Commercial |
$3,303.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,119.79
|
| Rate for Payer: Nomi Health Commercial |
$3,009.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,385.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,215.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,572.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,229.90
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
IP
|
$4,045.90
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,629.84 |
| Max. Negotiated Rate |
$4,045.90 |
| Rate for Payer: Aetna Commercial |
$3,641.31
|
| Rate for Payer: ASR ASR |
$3,924.52
|
| Rate for Payer: ASR Commercial |
$3,924.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,297.00
|
| Rate for Payer: BCN Commercial |
$3,136.79
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,803.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$4,045.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,924.52
|
| Rate for Payer: Mclaren Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.01
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,560.39
|
|
|
HC BREAST BX W CLIP EACH ADDL LESION US
|
Facility
|
OP
|
$4,045.90
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
36100411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,618.36 |
| Max. Negotiated Rate |
$4,045.90 |
| Rate for Payer: Aetna Commercial |
$3,641.31
|
| Rate for Payer: Aetna Medicare |
$2,022.95
|
| Rate for Payer: ASR ASR |
$3,924.52
|
| Rate for Payer: ASR Commercial |
$3,924.52
|
| Rate for Payer: BCBS Complete |
$1,618.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,313.19
|
| Rate for Payer: BCN Commercial |
$3,136.79
|
| Rate for Payer: Cash Price |
$3,236.72
|
| Rate for Payer: Cofinity Commercial |
$3,803.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,236.72
|
| Rate for Payer: Healthscope Commercial |
$4,045.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,924.52
|
| Rate for Payer: Mclaren Commercial |
$3,641.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,439.01
|
| Rate for Payer: Nomi Health Commercial |
$3,317.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,545.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,836.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,560.39
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
OP
|
$3,096.85
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$3,096.85 |
| Rate for Payer: Aetna Commercial |
$2,787.16
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$3,003.94
|
| Rate for Payer: ASR Commercial |
$3,003.94
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,536.01
|
| Rate for Payer: BCN Commercial |
$2,400.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cofinity Commercial |
$2,911.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,477.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$3,096.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,003.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$2,787.16
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,632.32
|
| Rate for Payer: Nomi Health Commercial |
$2,539.42
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,713.46
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,170.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,725.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC BREAST BX W CLIP FIRST LESION MR
|
Facility
|
IP
|
$3,096.85
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
36100412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,012.95 |
| Max. Negotiated Rate |
$3,096.85 |
| Rate for Payer: Aetna Commercial |
$2,787.16
|
| Rate for Payer: ASR ASR |
$3,003.94
|
| Rate for Payer: ASR Commercial |
$3,003.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,523.62
|
| Rate for Payer: BCN Commercial |
$2,400.99
|
| Rate for Payer: Cash Price |
$2,477.48
|
| Rate for Payer: Cofinity Commercial |
$2,911.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,477.48
|
| Rate for Payer: Healthscope Commercial |
$3,096.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,003.94
|
| Rate for Payer: Mclaren Commercial |
$2,787.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,632.32
|
| Rate for Payer: Nomi Health Commercial |
$2,539.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,012.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,725.23
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
IP
|
$3,740.54
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,431.35 |
| Max. Negotiated Rate |
$3,740.54 |
| Rate for Payer: Aetna Commercial |
$3,366.49
|
| Rate for Payer: ASR ASR |
$3,628.32
|
| Rate for Payer: ASR Commercial |
$3,628.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,048.17
|
| Rate for Payer: BCN Commercial |
$2,900.04
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cofinity Commercial |
$3,516.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,992.43
|
| Rate for Payer: Healthscope Commercial |
$3,740.54
|
| Rate for Payer: Healthscope Whirlpool |
$3,628.32
|
| Rate for Payer: Mclaren Commercial |
$3,366.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,179.46
|
| Rate for Payer: Nomi Health Commercial |
$3,067.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,291.68
|
|
|
HC BREAST BX W CLIP FIRST LESION STEREO
|
Facility
|
OP
|
$3,740.54
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
36100408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$3,740.54 |
| Rate for Payer: Aetna Commercial |
$3,366.49
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$3,628.32
|
| Rate for Payer: ASR Commercial |
$3,628.32
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,063.13
|
| Rate for Payer: BCN Commercial |
$2,900.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cash Price |
$2,992.43
|
| Rate for Payer: Cofinity Commercial |
$3,516.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,992.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$3,740.54
|
| Rate for Payer: Healthscope Whirlpool |
$3,628.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$3,366.49
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,179.46
|
| Rate for Payer: Nomi Health Commercial |
$3,067.24
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,431.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,277.46
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,622.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,291.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
OP
|
$4,126.27
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,126.27 |
| Rate for Payer: Aetna Commercial |
$3,713.64
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$4,002.48
|
| Rate for Payer: ASR Commercial |
$4,002.48
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,379.00
|
| Rate for Payer: BCN Commercial |
$3,199.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cofinity Commercial |
$3,878.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$4,126.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,002.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$3,713.64
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.33
|
| Rate for Payer: Nomi Health Commercial |
$3,383.54
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,682.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,615.44
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,892.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,631.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC BREAST BX W CLIP FIRST LESION US
|
Facility
|
IP
|
$4,126.27
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
36100410
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.08 |
| Max. Negotiated Rate |
$4,126.27 |
| Rate for Payer: Aetna Commercial |
$3,713.64
|
| Rate for Payer: ASR ASR |
$4,002.48
|
| Rate for Payer: ASR Commercial |
$4,002.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,362.50
|
| Rate for Payer: BCN Commercial |
$3,199.10
|
| Rate for Payer: Cash Price |
$3,301.02
|
| Rate for Payer: Cofinity Commercial |
$3,878.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.02
|
| Rate for Payer: Healthscope Commercial |
$4,126.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,002.48
|
| Rate for Payer: Mclaren Commercial |
$3,713.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.33
|
| Rate for Payer: Nomi Health Commercial |
$3,383.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,682.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,631.12
|
|
