|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
OP
|
$1,821.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$1,821.50 |
| Rate for Payer: Aetna Commercial |
$1,639.35
|
| Rate for Payer: ASR ASR |
$1,766.86
|
| Rate for Payer: BCBS Complete |
$728.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.21
|
| Rate for Payer: BCN Commercial |
$1,412.21
|
| Rate for Payer: Cash Price |
$1,457.20
|
| Rate for Payer: Cofinity Commercial |
$1,712.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,457.20
|
| Rate for Payer: Healthscope Commercial |
$1,821.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,766.86
|
| Rate for Payer: Mclaren Commercial |
$1,639.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,548.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,657.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,293.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,602.92
|
|
|
HC MR BRAIN STEREO W CON REDUCED
|
Facility
|
IP
|
$1,821.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100006
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,275.05 |
| Max. Negotiated Rate |
$1,821.50 |
| Rate for Payer: Aetna Commercial |
$1,639.35
|
| Rate for Payer: ASR ASR |
$1,766.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.21
|
| Rate for Payer: BCN Commercial |
$1,412.21
|
| Rate for Payer: Cash Price |
$1,457.20
|
| Rate for Payer: Cofinity Commercial |
$1,712.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,457.20
|
| Rate for Payer: Healthscope Commercial |
$1,821.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,766.86
|
| Rate for Payer: Mclaren Commercial |
$1,639.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,548.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,602.92
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
IP
|
$1,517.90
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,062.53 |
| Max. Negotiated Rate |
$1,517.90 |
| Rate for Payer: Aetna Commercial |
$1,366.11
|
| Rate for Payer: ASR ASR |
$1,472.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,176.83
|
| Rate for Payer: BCN Commercial |
$1,176.83
|
| Rate for Payer: Cash Price |
$1,214.32
|
| Rate for Payer: Cofinity Commercial |
$1,426.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.32
|
| Rate for Payer: Healthscope Commercial |
$1,517.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,472.36
|
| Rate for Payer: Mclaren Commercial |
$1,366.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,290.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,335.75
|
|
|
HC MR BRAIN STEREO WO CON REDUCED
|
Facility
|
OP
|
$1,517.90
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100005
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$607.16 |
| Max. Negotiated Rate |
$1,517.90 |
| Rate for Payer: Aetna Commercial |
$1,366.11
|
| Rate for Payer: ASR ASR |
$1,472.36
|
| Rate for Payer: BCBS Complete |
$607.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,176.83
|
| Rate for Payer: BCN Commercial |
$1,176.83
|
| Rate for Payer: Cash Price |
$1,214.32
|
| Rate for Payer: Cofinity Commercial |
$1,426.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.32
|
| Rate for Payer: Healthscope Commercial |
$1,517.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,472.36
|
| Rate for Payer: Mclaren Commercial |
$1,366.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,290.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,062.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,381.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,335.75
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
OP
|
$2,319.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$927.80 |
| Max. Negotiated Rate |
$2,319.50 |
| Rate for Payer: Aetna Commercial |
$2,087.55
|
| Rate for Payer: ASR ASR |
$2,249.92
|
| Rate for Payer: BCBS Complete |
$927.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.31
|
| Rate for Payer: BCN Commercial |
$1,798.31
|
| Rate for Payer: Cash Price |
$1,855.60
|
| Rate for Payer: Cofinity Commercial |
$2,180.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,855.60
|
| Rate for Payer: Healthscope Commercial |
$2,319.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,249.92
|
| Rate for Payer: Mclaren Commercial |
$2,087.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,971.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,623.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,110.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,646.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,041.16
|
|
|
HC MR BRAIN STEREO WO W CON REDUCED
|
Facility
|
IP
|
$2,319.50
|
|
|
Service Code
|
CPT 77021
|
| Hospital Charge Code |
61100007
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,623.65 |
| Max. Negotiated Rate |
$2,319.50 |
| Rate for Payer: Aetna Commercial |
$2,087.55
|
| Rate for Payer: ASR ASR |
$2,249.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,798.31
|
| Rate for Payer: BCN Commercial |
$1,798.31
|
| Rate for Payer: Cash Price |
$1,855.60
|
| Rate for Payer: Cofinity Commercial |
$2,180.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,855.60
|
| Rate for Payer: Healthscope Commercial |
$2,319.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,249.92
|
| Rate for Payer: Mclaren Commercial |
$2,087.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,971.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,623.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,041.16
|
|
|
HC MR BRAIN W CON
|
Facility
|
IP
|
$2,438.51
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,706.96 |
| Max. Negotiated Rate |
$2,438.51 |
| Rate for Payer: Aetna Commercial |
$2,194.66
|
| Rate for Payer: ASR ASR |
$2,365.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.58
|
| Rate for Payer: BCN Commercial |
$1,890.58
|
| Rate for Payer: Cash Price |
$1,950.81
|
| Rate for Payer: Cofinity Commercial |
$2,292.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,950.81
|
| Rate for Payer: Healthscope Commercial |
$2,438.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,365.35
|
| Rate for Payer: Mclaren Commercial |
$2,194.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,072.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,145.89
|
|
|
HC MR BRAIN W CON
|
Facility
|
OP
|
$2,438.51
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
61100002
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,438.51 |
| Rate for Payer: Aetna Commercial |
$2,194.66
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,365.35
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.58
|
| Rate for Payer: BCN Commercial |
$1,890.58
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,950.81
|
| Rate for Payer: Cash Price |
$1,950.81
|
| Rate for Payer: Cofinity Commercial |
$2,292.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,950.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,438.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,365.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,194.66
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,072.73
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,582.37
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,265.90
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,145.89
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BRAIN WO CON
|
Facility
|
IP
|
$2,032.25
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,422.58 |
| Max. Negotiated Rate |
$2,032.25 |
| Rate for Payer: Aetna Commercial |
$1,829.02
|
| Rate for Payer: ASR ASR |
$1,971.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.60
|
| Rate for Payer: BCN Commercial |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,910.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.80
|
| Rate for Payer: Healthscope Commercial |
$2,032.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.28
|
| Rate for Payer: Mclaren Commercial |
$1,829.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,727.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,422.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.38
|
|
|
HC MR BRAIN WO CON
|
Facility
|
OP
|
$2,032.25
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
61100001
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$2,032.25 |
| Rate for Payer: Aetna Commercial |
$1,829.02
|
| 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 |
$1,971.28
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.60
|
| Rate for Payer: BCN Commercial |
$1,575.60
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cash Price |
$1,625.80
|
| Rate for Payer: Cofinity Commercial |
$1,910.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$2,032.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,971.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,829.02
|
| 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 |
$1,727.41
|
| 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 |
$1,422.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,425.87
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.70
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,788.38
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
OP
|
$3,103.66
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$3,103.66 |
| Rate for Payer: Aetna Commercial |
$2,793.29
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$3,010.55
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,406.27
|
| Rate for Payer: BCN Commercial |
$2,406.27
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$2,482.93
|
| Rate for Payer: Cash Price |
$2,482.93
|
| Rate for Payer: Cofinity Commercial |
$2,917.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,482.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$3,103.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,010.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$2,793.29
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,638.11
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,969.24
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.39
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,731.22
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BRAIN WO W CON
|
Facility
|
IP
|
$3,103.66
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
61100003
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,172.56 |
| Max. Negotiated Rate |
$3,103.66 |
| Rate for Payer: Aetna Commercial |
$2,793.29
|
| Rate for Payer: ASR ASR |
$3,010.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,406.27
|
| Rate for Payer: BCN Commercial |
$2,406.27
|
| Rate for Payer: Cash Price |
$2,482.93
|
| Rate for Payer: Cofinity Commercial |
$2,917.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,482.93
|
| Rate for Payer: Healthscope Commercial |
$3,103.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,010.55
|
| Rate for Payer: Mclaren Commercial |
$2,793.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,638.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,731.22
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
IP
|
$283.77
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$198.64 |
| Max. Negotiated Rate |
$283.77 |
| Rate for Payer: Aetna Commercial |
$255.39
|
| Rate for Payer: ASR ASR |
$275.26
|
| Rate for Payer: BCBS Trust/PPO |
$220.01
|
| Rate for Payer: BCN Commercial |
$220.01
|
| Rate for Payer: Cash Price |
$227.02
|
| Rate for Payer: Cofinity Commercial |
$266.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.02
|
| Rate for Payer: Healthscope Commercial |
$283.77
|
| Rate for Payer: Healthscope Whirlpool |
$275.26
|
| Rate for Payer: Mclaren Commercial |
$255.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.72
|
|
|
HC MR BREAST ABBREVIATED WO W CON
|
Facility
|
OP
|
$283.77
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
61000093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$366.01 |
| Rate for Payer: Aetna Commercial |
$255.39
|
| Rate for Payer: ASR ASR |
$275.26
|
| Rate for Payer: BCBS Complete |
$113.51
|
| Rate for Payer: BCBS Trust/PPO |
$220.01
|
| Rate for Payer: BCCCP Commercial |
$366.01
|
| Rate for Payer: BCN Commercial |
$220.01
|
| Rate for Payer: Cash Price |
$227.02
|
| Rate for Payer: Cash Price |
$227.02
|
| Rate for Payer: Cofinity Commercial |
$266.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.02
|
| Rate for Payer: Healthscope Commercial |
$283.77
|
| Rate for Payer: Healthscope Whirlpool |
$275.26
|
| Rate for Payer: Mclaren Commercial |
$255.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.51
|
| Rate for Payer: Priority Health Narrow Network |
$250.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.72
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
IP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$847.22 |
| Max. Negotiated Rate |
$1,210.32 |
| Rate for Payer: Aetna Commercial |
$1,089.29
|
| Rate for Payer: ASR ASR |
$1,174.01
|
| Rate for Payer: BCBS Trust/PPO |
$938.36
|
| Rate for Payer: BCN Commercial |
$938.36
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$1,137.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.26
|
| Rate for Payer: Healthscope Commercial |
$1,210.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.01
|
| Rate for Payer: Mclaren Commercial |
$1,089.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.08
|
|
|
HC MR BREAST BIL SCREEN W CON
|
Facility
|
OP
|
$1,210.32
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$1,210.32 |
| Rate for Payer: Aetna Commercial |
$1,089.29
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$1,174.01
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$938.36
|
| Rate for Payer: BCN Commercial |
$938.36
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cash Price |
$968.26
|
| Rate for Payer: Cofinity Commercial |
$1,137.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$1,210.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,174.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,089.29
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,028.77
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$847.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.39
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$859.33
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,065.08
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$1,234.53 |
| Rate for Payer: Aetna Commercial |
$1,111.08
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$1,197.49
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$957.13
|
| Rate for Payer: BCN Commercial |
$957.13
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,160.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$1,234.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,197.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,111.08
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.35
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,123.42
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$876.52
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,086.39
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BREAST BIL SCREEN WO W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8908
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$864.17 |
| Max. Negotiated Rate |
$1,234.53 |
| Rate for Payer: Aetna Commercial |
$1,111.08
|
| Rate for Payer: ASR ASR |
$1,197.49
|
| Rate for Payer: BCBS Trust/PPO |
$957.13
|
| Rate for Payer: BCN Commercial |
$957.13
|
| Rate for Payer: Cash Price |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,160.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$987.62
|
| Rate for Payer: Healthscope Commercial |
$1,234.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,197.49
|
| Rate for Payer: Mclaren Commercial |
$1,111.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,086.39
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
IP
|
$2,091.10
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,463.77 |
| Max. Negotiated Rate |
$2,091.10 |
| Rate for Payer: Aetna Commercial |
$1,881.99
|
| Rate for Payer: ASR ASR |
$2,028.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.23
|
| Rate for Payer: BCN Commercial |
$1,621.23
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,965.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.88
|
| Rate for Payer: Healthscope Commercial |
$2,091.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,028.37
|
| Rate for Payer: Mclaren Commercial |
$1,881.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.17
|
|
|
HC MR BREAST BIL W CON
|
Facility
|
OP
|
$2,091.10
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$2,091.10 |
| Rate for Payer: Aetna Commercial |
$1,881.99
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$2,028.37
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.23
|
| Rate for Payer: BCN Commercial |
$1,621.23
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cash Price |
$1,672.88
|
| Rate for Payer: Cofinity Commercial |
$1,965.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$2,091.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,028.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,881.99
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,777.44
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,902.90
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,484.68
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.17
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,493.04 |
| Max. Negotiated Rate |
$2,132.92 |
| Rate for Payer: Aetna Commercial |
$1,919.63
|
| Rate for Payer: ASR ASR |
$2,068.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,653.65
|
| Rate for Payer: BCN Commercial |
$1,653.65
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$2,004.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Healthscope Commercial |
$2,132.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.93
|
| Rate for Payer: Mclaren Commercial |
$1,919.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,876.97
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$250.81 |
| Max. Negotiated Rate |
$2,132.92 |
| Rate for Payer: Aetna Commercial |
$1,919.63
|
| Rate for Payer: ASR ASR |
$2,068.93
|
| Rate for Payer: BCBS Complete |
$853.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,653.65
|
| Rate for Payer: BCCCP Commercial |
$366.01
|
| Rate for Payer: BCN Commercial |
$1,653.65
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cash Price |
$1,706.34
|
| Rate for Payer: Cofinity Commercial |
$2,004.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.34
|
| Rate for Payer: Healthscope Commercial |
$2,132.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.93
|
| Rate for Payer: Mclaren Commercial |
$1,919.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,812.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,493.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.51
|
| Rate for Payer: Priority Health Narrow Network |
$250.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,876.97
|
|
|
HC MR BREAST CAD
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC MR BREAST CAD
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.13
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
IP
|
$890.60
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$623.42 |
| Max. Negotiated Rate |
$890.60 |
| Rate for Payer: Aetna Commercial |
$801.54
|
| Rate for Payer: ASR ASR |
$863.88
|
| Rate for Payer: BCBS Trust/PPO |
$690.48
|
| Rate for Payer: BCN Commercial |
$690.48
|
| Rate for Payer: Cash Price |
$712.48
|
| Rate for Payer: Cofinity Commercial |
$837.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.48
|
| Rate for Payer: Healthscope Commercial |
$890.60
|
| Rate for Payer: Healthscope Whirlpool |
$863.88
|
| Rate for Payer: Mclaren Commercial |
$801.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$757.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.73
|
|
