|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$365.48
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$255.84 |
| Max. Negotiated Rate |
$365.48 |
| Rate for Payer: Aetna Commercial |
$328.93
|
| Rate for Payer: ASR ASR |
$354.52
|
| Rate for Payer: BCBS Trust/PPO |
$283.36
|
| Rate for Payer: BCN Commercial |
$283.36
|
| Rate for Payer: Cash Price |
$292.38
|
| Rate for Payer: Cofinity Commercial |
$343.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.38
|
| Rate for Payer: Healthscope Commercial |
$365.48
|
| Rate for Payer: Healthscope Whirlpool |
$354.52
|
| Rate for Payer: Mclaren Commercial |
$328.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.62
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$365.48
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$365.48 |
| Rate for Payer: Aetna Commercial |
$328.93
|
| Rate for Payer: ASR ASR |
$354.52
|
| Rate for Payer: BCBS Complete |
$146.19
|
| Rate for Payer: BCBS Trust/PPO |
$283.36
|
| Rate for Payer: BCCCP Commercial |
$127.76
|
| Rate for Payer: BCN Commercial |
$283.36
|
| Rate for Payer: Cash Price |
$292.38
|
| Rate for Payer: Cash Price |
$292.38
|
| Rate for Payer: Cofinity Commercial |
$343.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.38
|
| Rate for Payer: Healthscope Commercial |
$365.48
|
| Rate for Payer: Healthscope Whirlpool |
$354.52
|
| Rate for Payer: Mclaren Commercial |
$328.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.59
|
| Rate for Payer: Priority Health Narrow Network |
$259.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.62
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
IP
|
$580.45
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$406.32 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$522.40
|
| Rate for Payer: ASR ASR |
$563.04
|
| Rate for Payer: BCBS Trust/PPO |
$450.02
|
| Rate for Payer: BCN Commercial |
$450.02
|
| Rate for Payer: Cash Price |
$464.36
|
| Rate for Payer: Cofinity Commercial |
$545.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.36
|
| Rate for Payer: Healthscope Commercial |
$580.45
|
| Rate for Payer: Healthscope Whirlpool |
$563.04
|
| Rate for Payer: Mclaren Commercial |
$522.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.80
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$580.45
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$522.40
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$563.04
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$450.02
|
| Rate for Payer: BCCCP Commercial |
$70.40
|
| Rate for Payer: BCN Commercial |
$450.02
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$464.36
|
| Rate for Payer: Cash Price |
$464.36
|
| Rate for Payer: Cofinity Commercial |
$545.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$580.45
|
| Rate for Payer: Healthscope Whirlpool |
$563.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$522.40
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.38
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.33
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$386.66
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$510.80
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
OP
|
$700.46
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$700.46 |
| Rate for Payer: Aetna Commercial |
$630.41
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$679.45
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$543.07
|
| Rate for Payer: BCCCP Commercial |
$54.57
|
| Rate for Payer: BCN Commercial |
$543.07
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$658.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$700.46
|
| Rate for Payer: Healthscope Whirlpool |
$679.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$630.41
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.39
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.33
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$386.66
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.40
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MAMMO DUCTOGRAM SINGLE
|
Facility
|
IP
|
$700.46
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
32000250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$490.32 |
| Max. Negotiated Rate |
$700.46 |
| Rate for Payer: Aetna Commercial |
$630.41
|
| Rate for Payer: ASR ASR |
$679.45
|
| Rate for Payer: BCBS Trust/PPO |
$543.07
|
| Rate for Payer: BCN Commercial |
$543.07
|
| Rate for Payer: Cash Price |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$658.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.37
|
| Rate for Payer: Healthscope Commercial |
$700.46
|
| Rate for Payer: Healthscope Whirlpool |
$679.45
|
| Rate for Payer: Mclaren Commercial |
$630.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$616.40
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
OP
|
$82.50
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| Rate for Payer: ASR ASR |
$80.02
|
| Rate for Payer: BCBS Complete |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.96
|
| Rate for Payer: BCN Commercial |
$63.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cofinity Commercial |
$77.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.00
|
| Rate for Payer: Healthscope Commercial |
$82.50
|
| Rate for Payer: Healthscope Whirlpool |
$80.02
|
| Rate for Payer: Mclaren Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.08
|
| Rate for Payer: Priority Health Narrow Network |
$58.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.60
|
|
|
HC MANIFOLD 5-GANG
|
Facility
|
IP
|
$82.50
|
|
| Hospital Charge Code |
27000672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Aetna Commercial |
$74.25
|
| Rate for Payer: ASR ASR |
$80.02
|
| Rate for Payer: BCBS Trust/PPO |
$63.96
|
| Rate for Payer: BCN Commercial |
$63.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cofinity Commercial |
$77.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.00
|
| Rate for Payer: Healthscope Commercial |
$82.50
|
| Rate for Payer: Healthscope Whirlpool |
$80.02
|
| Rate for Payer: Mclaren Commercial |
$74.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.60
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$781.45 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: Aetna Medicare |
$1,428.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: ASR ASR |
$3,880.00
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.20
|
| Rate for Payer: BCN Commercial |
$3,101.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,760.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Healthscope Commercial |
$4,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,880.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,428.61
|
| Rate for Payer: Mclaren Commercial |
$3,600.00
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Commercial |
$1,571.47
|
| Rate for Payer: PHP Medicaid |
$781.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,640.00
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,840.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,520.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
HC MANIPULATION FINGER JOINT UNDER ANES EACH JOINT
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,800.00 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$3,600.00
|
| Rate for Payer: ASR ASR |
$3,880.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.20
|
| Rate for Payer: BCN Commercial |
$3,101.20
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,760.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,200.00
|
| Rate for Payer: Healthscope Commercial |
$4,000.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,880.00
|
| Rate for Payer: Mclaren Commercial |
$3,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,800.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,520.00
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.15 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: ASR ASR |
$469.96
|
| Rate for Payer: BCBS Trust/PPO |
$375.63
|
| Rate for Payer: BCN Commercial |
$375.63
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$455.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$484.50
|
| Rate for Payer: Healthscope Whirlpool |
$469.96
|
| Rate for Payer: Mclaren Commercial |
$436.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
|
|
HC MANIPULAT PALMAR FAC CORD POST INJ
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
76100318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna Medicare |
$209.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: ASR ASR |
$469.96
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$375.63
|
| Rate for Payer: BCN Commercial |
$375.63
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$455.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Healthscope Commercial |
$484.50
|
| Rate for Payer: Healthscope Whirlpool |
$469.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$209.62
|
| Rate for Payer: Mclaren Commercial |
$436.05
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.82
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Commercial |
$230.58
|
| Rate for Payer: PHP Medicaid |
$114.66
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$440.90
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$344.00
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.36
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
OP
|
$1,463.70
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.14 |
| Max. Negotiated Rate |
$1,463.70 |
| Rate for Payer: Aetna Commercial |
$1,317.33
|
| Rate for Payer: Aetna Medicare |
$607.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: ASR ASR |
$1,419.79
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.81
|
| Rate for Payer: BCN Commercial |
$1,134.81
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Cash Price |
$1,170.96
|
| Rate for Payer: Cash Price |
$1,170.96
|
| Rate for Payer: Cofinity Commercial |
$1,375.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Healthscope Commercial |
$1,463.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,419.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$607.20
|
| Rate for Payer: Mclaren Commercial |
$1,317.33
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,244.14
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Commercial |
$667.92
|
| Rate for Payer: PHP Medicaid |
$332.14
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,331.97
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,039.23
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,288.06
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
HC MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH
|
Facility
|
IP
|
$1,463.70
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
36100614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,024.59 |
| Max. Negotiated Rate |
$1,463.70 |
| Rate for Payer: Aetna Commercial |
$1,317.33
|
| Rate for Payer: ASR ASR |
$1,419.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.81
|
| Rate for Payer: BCN Commercial |
$1,134.81
|
| Rate for Payer: Cash Price |
$1,170.96
|
| Rate for Payer: Cofinity Commercial |
$1,375.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.96
|
| Rate for Payer: Healthscope Commercial |
$1,463.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,419.79
|
| Rate for Payer: Mclaren Commercial |
$1,317.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,244.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,024.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,288.06
|
|
|
HC MANTIS CLIP
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$793.80 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna Commercial |
$1,020.60
|
| Rate for Payer: ASR ASR |
$1,099.98
|
| Rate for Payer: BCBS Trust/PPO |
$879.19
|
| Rate for Payer: BCN Commercial |
$879.19
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$1,065.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$907.20
|
| Rate for Payer: Healthscope Commercial |
$1,134.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,099.98
|
| Rate for Payer: Mclaren Commercial |
$1,020.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$997.92
|
|
|
HC MANTIS CLIP
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27200356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.60 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna Commercial |
$1,020.60
|
| Rate for Payer: ASR ASR |
$1,099.98
|
| Rate for Payer: BCBS Complete |
$453.60
|
| Rate for Payer: BCBS Trust/PPO |
$879.19
|
| Rate for Payer: BCN Commercial |
$879.19
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$1,065.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$907.20
|
| Rate for Payer: Healthscope Commercial |
$1,134.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,099.98
|
| Rate for Payer: Mclaren Commercial |
$1,020.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$963.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,031.94
|
| Rate for Payer: Priority Health Narrow Network |
$805.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$997.92
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: ASR ASR |
$44.04
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.04
|
| Rate for Payer: Mclaren Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.95
|
|
|
HC MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
30500002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna Commercial |
$40.86
|
| Rate for Payer: Aetna Medicare |
$3.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: ASR ASR |
$44.04
|
| Rate for Payer: BCBS Complete |
$2.18
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$35.20
|
| Rate for Payer: BCN Commercial |
$35.20
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$42.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.80
|
| Rate for Payer: Mclaren Commercial |
$40.86
|
| Rate for Payer: Mclaren Medicaid |
$2.08
|
| Rate for Payer: Mclaren Medicare |
$3.80
|
| Rate for Payer: Meridian Medicaid |
$2.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Medicare |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Medicaid |
$2.08
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.26
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Narrow Network |
$8.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.95
|
| Rate for Payer: UHC Medicare Advantage |
$3.91
|
| Rate for Payer: VA VA |
$3.80
|
|
|
HC MAPLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC MAPLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| 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 |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
OP
|
$6,048.60
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,419.44 |
| Max. Negotiated Rate |
$6,048.60 |
| Rate for Payer: Aetna Commercial |
$5,443.74
|
| Rate for Payer: ASR ASR |
$5,867.14
|
| Rate for Payer: BCBS Complete |
$2,419.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,689.48
|
| Rate for Payer: BCN Commercial |
$4,689.48
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,685.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$6,048.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.14
|
| Rate for Payer: Mclaren Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,141.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,234.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,504.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,294.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,322.77
|
|
|
HC MAPPING W/INTRACARDIAC 3D
|
Facility
|
IP
|
$6,048.60
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
48100035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,234.02 |
| Max. Negotiated Rate |
$6,048.60 |
| Rate for Payer: Aetna Commercial |
$5,443.74
|
| Rate for Payer: ASR ASR |
$5,867.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,689.48
|
| Rate for Payer: BCN Commercial |
$4,689.48
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,685.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$6,048.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,867.14
|
| Rate for Payer: Mclaren Commercial |
$5,443.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,141.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,234.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,322.77
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
OP
|
$4,311.84
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,724.74 |
| Max. Negotiated Rate |
$4,311.84 |
| Rate for Payer: Aetna Commercial |
$3,880.66
|
| Rate for Payer: ASR ASR |
$4,182.48
|
| Rate for Payer: BCBS Complete |
$1,724.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,342.97
|
| Rate for Payer: BCN Commercial |
$3,342.97
|
| Rate for Payer: Cash Price |
$3,449.47
|
| Rate for Payer: Cofinity Commercial |
$4,053.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,449.47
|
| Rate for Payer: Healthscope Commercial |
$4,311.84
|
| Rate for Payer: Healthscope Whirlpool |
$4,182.48
|
| Rate for Payer: Mclaren Commercial |
$3,880.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,665.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,923.77
|
| Rate for Payer: Priority Health Narrow Network |
$3,061.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,794.42
|
|
|
HC MAPPING W/OUT INTRACARDIAC 3D
|
Facility
|
IP
|
$4,311.84
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
48100032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,018.29 |
| Max. Negotiated Rate |
$4,311.84 |
| Rate for Payer: Aetna Commercial |
$3,880.66
|
| Rate for Payer: ASR ASR |
$4,182.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,342.97
|
| Rate for Payer: BCN Commercial |
$3,342.97
|
| Rate for Payer: Cash Price |
$3,449.47
|
| Rate for Payer: Cofinity Commercial |
$4,053.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,449.47
|
| Rate for Payer: Healthscope Commercial |
$4,311.84
|
| Rate for Payer: Healthscope Whirlpool |
$4,182.48
|
| Rate for Payer: Mclaren Commercial |
$3,880.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,665.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,794.42
|
|
|
HC MARS BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
76100331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,452.82 |
| Max. Negotiated Rate |
$7,789.74 |
| Rate for Payer: Aetna Commercial |
$7,010.77
|
| Rate for Payer: ASR ASR |
$7,556.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,039.39
|
| Rate for Payer: BCN Commercial |
$6,039.39
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$7,322.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Healthscope Commercial |
$7,789.74
|
| Rate for Payer: Healthscope Whirlpool |
$7,556.05
|
| Rate for Payer: Mclaren Commercial |
$7,010.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,854.97
|
|
