|
HC MACROSCOPIC EXAM PARASITE
|
Facility
|
OP
|
$43.20
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
30600093
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna Commercial |
$38.88
|
| Rate for Payer: Aetna Medicare |
$4.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.39
|
| Rate for Payer: ASR ASR |
$41.90
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.31
|
| Rate for Payer: BCBS Trust/PPO |
$33.49
|
| Rate for Payer: BCN Commercial |
$33.49
|
| Rate for Payer: BCN Medicare Advantage |
$4.31
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.31
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Healthscope Whirlpool |
$41.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.31
|
| Rate for Payer: Mclaren Commercial |
$38.88
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicare |
$4.31
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.72
|
| Rate for Payer: PACE Medicare |
$4.09
|
| Rate for Payer: PACE SWMI |
$4.31
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: PHP Medicaid |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.67
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: Priority Health Narrow Network |
$36.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.02
|
| Rate for Payer: UHC Medicare Advantage |
$4.44
|
| Rate for Payer: VA VA |
$4.31
|
|
|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
IP
|
$942.69
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$659.88 |
| Max. Negotiated Rate |
$942.69 |
| Rate for Payer: Aetna Commercial |
$848.42
|
| Rate for Payer: ASR ASR |
$914.41
|
| Rate for Payer: BCBS Trust/PPO |
$730.87
|
| Rate for Payer: BCN Commercial |
$730.87
|
| Rate for Payer: Cash Price |
$754.15
|
| Rate for Payer: Cofinity Commercial |
$886.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.15
|
| Rate for Payer: Healthscope Commercial |
$942.69
|
| Rate for Payer: Healthscope Whirlpool |
$914.41
|
| Rate for Payer: Mclaren Commercial |
$848.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$801.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.57
|
|
|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
OP
|
$942.69
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$240.54 |
| Max. Negotiated Rate |
$942.69 |
| Rate for Payer: Aetna Commercial |
$848.42
|
| Rate for Payer: ASR ASR |
$914.41
|
| Rate for Payer: BCBS Complete |
$377.08
|
| Rate for Payer: BCBS Trust/PPO |
$730.87
|
| Rate for Payer: BCN Commercial |
$730.87
|
| Rate for Payer: Cash Price |
$754.15
|
| Rate for Payer: Cash Price |
$754.15
|
| Rate for Payer: Cofinity Commercial |
$886.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.15
|
| Rate for Payer: Healthscope Commercial |
$942.69
|
| Rate for Payer: Healthscope Whirlpool |
$914.41
|
| Rate for Payer: Mclaren Commercial |
$848.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$801.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.67
|
| Rate for Payer: Priority Health Narrow Network |
$240.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.57
|
|
|
HC MAGGOT THERAPY
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC MAGGOT THERAPY
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$974.61
|
| Rate for Payer: Priority Health Narrow Network |
$760.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$33.87 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.38
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.70
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.70
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.66
|
| Rate for Payer: Mclaren Medicare |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.70
|
| Rate for Payer: PHP Commercial |
$7.37
|
| Rate for Payer: PHP Medicaid |
$3.66
|
| Rate for Payer: PHP Medicare Advantage |
$6.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Medicare |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.90
|
| Rate for Payer: VA VA |
$6.70
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.10
|
| Rate for Payer: ASR ASR |
$2.47
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: BCN Medicare Advantage |
$12.08
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.08
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Healthscope Whirlpool |
$2.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.08
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Mclaren Medicare |
$12.08
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PACE Medicare |
$11.48
|
| Rate for Payer: PACE SWMI |
$12.08
|
| Rate for Payer: PHP Commercial |
$13.29
|
| Rate for Payer: PHP Medicaid |
$6.61
|
| Rate for Payer: PHP Medicare Advantage |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Medicare |
$12.08
|
| Rate for Payer: Priority Health Narrow Network |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$12.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: VA VA |
$12.08
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Healthscope Whirlpool |
$2.47
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$116.98 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.99
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$3.28
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Medicaid |
$3.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Medicaid |
$3.28
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.98
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health Narrow Network |
$93.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,304.30
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.72 |
| Max. Negotiated Rate |
$1,304.30 |
| Rate for Payer: Aetna Commercial |
$1,173.87
|
| Rate for Payer: ASR ASR |
$1,265.17
|
| Rate for Payer: BCBS Complete |
$521.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.22
|
| Rate for Payer: BCN Commercial |
$1,011.22
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,226.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,043.44
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.17
|
| Rate for Payer: Mclaren Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,186.91
|
| Rate for Payer: Priority Health Narrow Network |
$926.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,147.78
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,304.30
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$913.01 |
| Max. Negotiated Rate |
$1,304.30 |
| Rate for Payer: Aetna Commercial |
$1,173.87
|
| Rate for Payer: ASR ASR |
$1,265.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.22
|
| Rate for Payer: BCN Commercial |
$1,011.22
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,226.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,043.44
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.17
|
| Rate for Payer: Mclaren Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,147.78
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
IP
|
$421.71
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$421.71 |
| Rate for Payer: Aetna Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$409.06
|
| Rate for Payer: BCBS Trust/PPO |
$326.95
|
| Rate for Payer: BCN Commercial |
$326.95
|
| Rate for Payer: Cash Price |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$396.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.37
|
| Rate for Payer: Healthscope Commercial |
$421.71
|
| Rate for Payer: Healthscope Whirlpool |
$409.06
|
| Rate for Payer: Mclaren Commercial |
$379.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.10
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
OP
|
$421.71
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$160.76 |
| Max. Negotiated Rate |
$421.71 |
| Rate for Payer: Aetna Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$409.06
|
| Rate for Payer: BCBS Complete |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$326.95
|
| Rate for Payer: BCCCP Commercial |
$160.76
|
| Rate for Payer: BCN Commercial |
$326.95
|
| Rate for Payer: Cash Price |
$337.37
|
| Rate for Payer: Cash Price |
$337.37
|
| Rate for Payer: Cofinity Commercial |
$396.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.37
|
| Rate for Payer: Healthscope Commercial |
$421.71
|
| Rate for Payer: Healthscope Whirlpool |
$409.06
|
| Rate for Payer: Mclaren Commercial |
$379.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.76
|
| Rate for Payer: Priority Health Narrow Network |
$299.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.10
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
IP
|
$416.09
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$291.26 |
| Max. Negotiated Rate |
$416.09 |
| Rate for Payer: Aetna Commercial |
$374.48
|
| Rate for Payer: ASR ASR |
$403.61
|
| Rate for Payer: BCBS Trust/PPO |
$322.59
|
| Rate for Payer: BCN Commercial |
$322.59
|
| Rate for Payer: Cash Price |
$332.87
|
| Rate for Payer: Cofinity Commercial |
$391.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.87
|
| Rate for Payer: Healthscope Commercial |
$416.09
|
| Rate for Payer: Healthscope Whirlpool |
$403.61
|
| Rate for Payer: Mclaren Commercial |
$374.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.16
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
OP
|
$416.09
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$416.09 |
| Rate for Payer: Aetna Commercial |
$374.48
|
| Rate for Payer: ASR ASR |
$403.61
|
| Rate for Payer: BCBS Complete |
$166.44
|
| Rate for Payer: BCBS Trust/PPO |
$322.59
|
| Rate for Payer: BCCCP Commercial |
$130.78
|
| Rate for Payer: BCN Commercial |
$322.59
|
| Rate for Payer: Cash Price |
$332.87
|
| Rate for Payer: Cash Price |
$332.87
|
| Rate for Payer: Cofinity Commercial |
$391.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.87
|
| Rate for Payer: Healthscope Commercial |
$416.09
|
| Rate for Payer: Healthscope Whirlpool |
$403.61
|
| Rate for Payer: Mclaren Commercial |
$374.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.64
|
| Rate for Payer: Priority Health Narrow Network |
$295.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.16
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$600.30
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.62 |
| Max. Negotiated Rate |
$781.74 |
| Rate for Payer: Aetna Commercial |
$540.27
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$582.29
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$465.41
|
| Rate for Payer: BCCCP Commercial |
$105.62
|
| Rate for Payer: BCN Commercial |
$465.41
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$480.24
|
| Rate for Payer: Cash Price |
$480.24
|
| Rate for Payer: Cofinity Commercial |
$564.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$600.30
|
| Rate for Payer: Healthscope Whirlpool |
$582.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$540.27
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.26
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.55
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$518.84
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.26
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$600.30
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.21 |
| Max. Negotiated Rate |
$600.30 |
| Rate for Payer: Aetna Commercial |
$540.27
|
| Rate for Payer: ASR ASR |
$582.29
|
| Rate for Payer: BCBS Trust/PPO |
$465.41
|
| Rate for Payer: BCN Commercial |
$465.41
|
| Rate for Payer: Cash Price |
$480.24
|
| Rate for Payer: Cofinity Commercial |
$564.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.24
|
| Rate for Payer: Healthscope Commercial |
$600.30
|
| Rate for Payer: Healthscope Whirlpool |
$582.29
|
| Rate for Payer: Mclaren Commercial |
$540.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.26
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
OP
|
$388.80
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$349.92
|
| Rate for Payer: ASR ASR |
$377.14
|
| Rate for Payer: BCBS Complete |
$155.52
|
| Rate for Payer: BCBS Trust/PPO |
$301.44
|
| Rate for Payer: BCCCP Commercial |
$27.25
|
| Rate for Payer: BCN Commercial |
$301.44
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Commercial |
$365.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.04
|
| Rate for Payer: Healthscope Commercial |
$388.80
|
| Rate for Payer: Healthscope Whirlpool |
$377.14
|
| Rate for Payer: Mclaren Commercial |
$349.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.81
|
| Rate for Payer: Priority Health Narrow Network |
$276.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.14
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$388.80
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$349.92
|
| Rate for Payer: ASR ASR |
$377.14
|
| Rate for Payer: BCBS Trust/PPO |
$301.44
|
| Rate for Payer: BCN Commercial |
$301.44
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Commercial |
$365.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.04
|
| Rate for Payer: Healthscope Commercial |
$388.80
|
| Rate for Payer: Healthscope Whirlpool |
$377.14
|
| Rate for Payer: Mclaren Commercial |
$349.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.14
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,731.95
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.30 |
| Max. Negotiated Rate |
$2,731.95 |
| Rate for Payer: Aetna Commercial |
$2,458.76
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$2,649.99
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,118.08
|
| Rate for Payer: BCN Commercial |
$2,118.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$2,185.56
|
| Rate for Payer: Cash Price |
$2,185.56
|
| Rate for Payer: Cofinity Commercial |
$2,568.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,185.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$2,731.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,649.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$2,458.76
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,322.16
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,486.07
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,939.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,404.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,731.95
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,912.36 |
| Max. Negotiated Rate |
$2,731.95 |
| Rate for Payer: Aetna Commercial |
$2,458.76
|
| Rate for Payer: ASR ASR |
$2,649.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,118.08
|
| Rate for Payer: BCN Commercial |
$2,118.08
|
| Rate for Payer: Cash Price |
$2,185.56
|
| Rate for Payer: Cofinity Commercial |
$2,568.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,185.56
|
| Rate for Payer: Healthscope Commercial |
$2,731.95
|
| Rate for Payer: Healthscope Whirlpool |
$2,649.99
|
| Rate for Payer: Mclaren Commercial |
$2,458.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,322.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,912.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,404.12
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,154.20
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$1,154.20 |
| Rate for Payer: Aetna Commercial |
$1,038.78
|
| Rate for Payer: ASR ASR |
$1,119.57
|
| Rate for Payer: BCBS Complete |
$461.68
|
| Rate for Payer: BCBS Trust/PPO |
$894.85
|
| Rate for Payer: BCCCP Commercial |
$171.06
|
| Rate for Payer: BCN Commercial |
$894.85
|
| Rate for Payer: Cash Price |
$923.36
|
| Rate for Payer: Cash Price |
$923.36
|
| Rate for Payer: Cofinity Commercial |
$1,084.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.36
|
| Rate for Payer: Healthscope Commercial |
$1,154.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,119.57
|
| Rate for Payer: Mclaren Commercial |
$1,038.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$981.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.38
|
| Rate for Payer: Priority Health Narrow Network |
$74.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,015.70
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,154.20
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$807.94 |
| Max. Negotiated Rate |
$1,154.20 |
| Rate for Payer: Aetna Commercial |
$1,038.78
|
| Rate for Payer: ASR ASR |
$1,119.57
|
| Rate for Payer: BCBS Trust/PPO |
$894.85
|
| Rate for Payer: BCN Commercial |
$894.85
|
| Rate for Payer: Cash Price |
$923.36
|
| Rate for Payer: Cofinity Commercial |
$1,084.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.36
|
| Rate for Payer: Healthscope Commercial |
$1,154.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,119.57
|
| Rate for Payer: Mclaren Commercial |
$1,038.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$981.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,015.70
|
|
