|
HC MAGNESIUM LEVEL
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| 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 |
$25.73
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS MAPPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.70
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.70
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.70
|
| Rate for Payer: Mclaren Medicare |
$6.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.04
|
| Rate for Payer: Meridian Medicaid |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$6.37
|
| Rate for Payer: PACE SWMI |
$6.70
|
| Rate for Payer: PHP Commercial |
$7.37
|
| Rate for Payer: PHP Medicaid |
$3.59
|
| Rate for Payer: PHP Medicare Advantage |
$6.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.95
|
| Rate for Payer: Priority Health Medicare |
$6.70
|
| Rate for Payer: Priority Health Narrow Network |
$31.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.70
|
| Rate for Payer: UHC Exchange |
$10.38
|
| Rate for Payer: UHC Medicaid |
$3.50
|
| Rate for Payer: UHCCP DNSP |
$6.70
|
| Rate for Payer: UHCCP Medicaid |
$3.50
|
| Rate for Payer: VA VA |
$6.70
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.62
|
| Rate for Payer: Priority Health Narrow Network |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$64.42
|
| Rate for Payer: BCN Commercial |
$64.42
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| 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 |
$76.10
|
| Rate for Payer: BCBS Complete |
$3.29
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$64.68
|
| Rate for Payer: BCN Commercial |
$64.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.99
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: Meridian Medicaid |
$3.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$6.59
|
| Rate for Payer: PHP Medicaid |
$3.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.00
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health Narrow Network |
$110.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.99
|
| Rate for Payer: UHC Exchange |
$9.28
|
| Rate for Payer: UHC Medicaid |
$3.13
|
| Rate for Payer: UHCCP DNSP |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$3.13
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC MALLEABLE SS VE
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
27000716
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: ASR ASR |
$180.42
|
| Rate for Payer: BCBS Trust/PPO |
$152.74
|
| Rate for Payer: BCN Commercial |
$152.74
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$186.00
|
| Rate for Payer: Mclaren Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.10
|
| Rate for Payer: Nomi Health Commercial |
$152.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.68
|
|
|
HC MALLEABLE SS VE
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
27000716
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: ASR ASR |
$180.42
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: BCBS Trust/PPO |
$153.36
|
| Rate for Payer: BCN Commercial |
$153.36
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$180.42
|
| Rate for Payer: Healthscope Whirlpool |
$186.00
|
| Rate for Payer: Mclaren Commercial |
$167.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.10
|
| Rate for Payer: Nomi Health Commercial |
$152.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.97
|
| Rate for Payer: Priority Health Narrow Network |
$130.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.68
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.75 |
| Max. Negotiated Rate |
$1,357.00 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: ASR ASR |
$1,316.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.37
|
| Rate for Payer: BCN Commercial |
$1,114.37
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,275.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.60
|
| Rate for Payer: Healthscope Commercial |
$1,316.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.00
|
| Rate for Payer: Mclaren Commercial |
$1,221.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.45
|
| Rate for Payer: Nomi Health Commercial |
$1,112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,194.16
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$502.09 |
| Max. Negotiated Rate |
$1,357.00 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Aetna Medicare |
$502.09
|
| Rate for Payer: ASR ASR |
$1,316.29
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.85
|
| Rate for Payer: BCN Commercial |
$1,118.85
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,275.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.60
|
| Rate for Payer: Healthscope Commercial |
$1,316.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.00
|
| Rate for Payer: Mclaren Commercial |
$1,221.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.45
|
| Rate for Payer: Nomi Health Commercial |
$1,112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,189.00
|
| Rate for Payer: Priority Health Narrow Network |
$951.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,194.16
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
OP
|
$438.74
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$148.01 |
| Max. Negotiated Rate |
$438.74 |
| Rate for Payer: Aetna Commercial |
$394.87
|
| Rate for Payer: Aetna Medicare |
$162.33
|
| Rate for Payer: ASR ASR |
$425.58
|
| Rate for Payer: BCBS Complete |
$175.50
|
| Rate for Payer: BCBS Trust/PPO |
$361.74
|
| Rate for Payer: BCCCP Commercial |
$148.01
|
| Rate for Payer: BCN Commercial |
$361.74
|
| Rate for Payer: Cash Price |
$350.99
|
| Rate for Payer: Cash Price |
$350.99
|
| Rate for Payer: Cofinity Commercial |
$412.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.99
|
| Rate for Payer: Healthscope Commercial |
$425.58
|
| Rate for Payer: Healthscope Whirlpool |
$438.74
|
| Rate for Payer: Mclaren Commercial |
$394.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.93
|
| Rate for Payer: Nomi Health Commercial |
$359.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$384.42
|
| Rate for Payer: Priority Health Narrow Network |
$307.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.09
|
|
|
HC MAMM BILAT DIAGNOSTIC W CAD
|
Facility
|
IP
|
$438.74
|
|
|
Service Code
|
HCPCS 77066
|
| Hospital Charge Code |
40100004
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$329.06 |
| Max. Negotiated Rate |
$438.74 |
| Rate for Payer: Aetna Commercial |
$394.87
|
| Rate for Payer: ASR ASR |
$425.58
|
| Rate for Payer: BCBS Trust/PPO |
$360.29
|
| Rate for Payer: BCN Commercial |
$360.29
|
| Rate for Payer: Cash Price |
$350.99
|
| Rate for Payer: Cofinity Commercial |
$412.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.99
|
| Rate for Payer: Healthscope Commercial |
$425.58
|
| Rate for Payer: Healthscope Whirlpool |
$438.74
|
| Rate for Payer: Mclaren Commercial |
$394.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.93
|
| Rate for Payer: Nomi Health Commercial |
$359.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.09
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
OP
|
$432.90
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$389.61
|
| Rate for Payer: Aetna Medicare |
$160.17
|
| Rate for Payer: ASR ASR |
$419.91
|
| Rate for Payer: BCBS Complete |
$173.16
|
| Rate for Payer: BCBS Trust/PPO |
$356.93
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$356.93
|
| Rate for Payer: Cash Price |
$346.32
|
| Rate for Payer: Cash Price |
$346.32
|
| Rate for Payer: Cofinity Commercial |
$406.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.32
|
| Rate for Payer: Healthscope Commercial |
$419.91
|
| Rate for Payer: Healthscope Whirlpool |
$432.90
|
| Rate for Payer: Mclaren Commercial |
$389.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.96
|
| Rate for Payer: Nomi Health Commercial |
$354.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$379.31
|
| Rate for Payer: Priority Health Narrow Network |
$303.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.95
|
|
|
HC MAMM BILAT SCREEN WITH CAD
|
Facility
|
IP
|
$432.90
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300006
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$324.68 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna Commercial |
$389.61
|
| Rate for Payer: ASR ASR |
$419.91
|
| Rate for Payer: BCBS Trust/PPO |
$355.50
|
| Rate for Payer: BCN Commercial |
$355.50
|
| Rate for Payer: Cash Price |
$346.32
|
| Rate for Payer: Cofinity Commercial |
$406.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.32
|
| Rate for Payer: Healthscope Commercial |
$419.91
|
| Rate for Payer: Healthscope Whirlpool |
$432.90
|
| Rate for Payer: Mclaren Commercial |
$389.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.96
|
| Rate for Payer: Nomi Health Commercial |
$354.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.95
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
IP
|
$756.38
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.28 |
| Max. Negotiated Rate |
$756.38 |
| Rate for Payer: Aetna Commercial |
$680.74
|
| Rate for Payer: ASR ASR |
$733.69
|
| Rate for Payer: BCBS Trust/PPO |
$621.14
|
| Rate for Payer: BCN Commercial |
$621.14
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cofinity Commercial |
$711.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.10
|
| Rate for Payer: Healthscope Commercial |
$733.69
|
| Rate for Payer: Healthscope Whirlpool |
$756.38
|
| Rate for Payer: Mclaren Commercial |
$680.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.92
|
| Rate for Payer: Nomi Health Commercial |
$620.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.61
|
|
|
HC MAMMO BREAST ASP CYST
|
Facility
|
OP
|
$756.38
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
36100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$1,093.66 |
| Rate for Payer: Aetna Commercial |
$680.74
|
| Rate for Payer: Aetna Medicare |
$705.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: ASR ASR |
$733.69
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$623.64
|
| Rate for Payer: BCCCP Commercial |
$92.31
|
| Rate for Payer: BCN Commercial |
$623.64
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cash Price |
$605.10
|
| Rate for Payer: Cofinity Commercial |
$711.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$605.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$733.69
|
| Rate for Payer: Healthscope Whirlpool |
$756.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$705.59
|
| Rate for Payer: Mclaren Commercial |
$680.74
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$387.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.92
|
| Rate for Payer: Nomi Health Commercial |
$620.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.28
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$776.15
|
| Rate for Payer: PHP Medicaid |
$378.20
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$765.08
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Narrow Network |
$612.07
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Exchange |
$1,093.66
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP DNSP |
$705.59
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
IP
|
$404.51
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.38 |
| Max. Negotiated Rate |
$404.51 |
| Rate for Payer: Aetna Commercial |
$364.06
|
| Rate for Payer: ASR ASR |
$392.37
|
| Rate for Payer: BCBS Trust/PPO |
$332.18
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cofinity Commercial |
$380.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.61
|
| Rate for Payer: Healthscope Commercial |
$392.37
|
| Rate for Payer: Healthscope Whirlpool |
$404.51
|
| Rate for Payer: Mclaren Commercial |
$364.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.83
|
| Rate for Payer: Nomi Health Commercial |
$331.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.97
|
|
|
HC MAMMO BREAST ASP CYST ADD LESION
|
Facility
|
OP
|
$404.51
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
36100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$404.51 |
| Rate for Payer: Aetna Commercial |
$364.06
|
| Rate for Payer: Aetna Medicare |
$149.67
|
| Rate for Payer: ASR ASR |
$392.37
|
| Rate for Payer: BCBS Complete |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$333.52
|
| Rate for Payer: BCCCP Commercial |
$25.13
|
| Rate for Payer: BCN Commercial |
$333.52
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cash Price |
$323.61
|
| Rate for Payer: Cofinity Commercial |
$380.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.61
|
| Rate for Payer: Healthscope Commercial |
$392.37
|
| Rate for Payer: Healthscope Whirlpool |
$404.51
|
| Rate for Payer: Mclaren Commercial |
$364.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.83
|
| Rate for Payer: Nomi Health Commercial |
$331.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$283.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.97
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
OP
|
$2,842.32
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$2,842.32 |
| Rate for Payer: Aetna Commercial |
$2,558.09
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$2,757.05
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,343.49
|
| Rate for Payer: BCN Commercial |
$2,343.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cofinity Commercial |
$2,671.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,273.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,757.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,842.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$2,558.09
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,415.97
|
| Rate for Payer: Nomi Health Commercial |
$2,330.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,131.74
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,490.44
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,992.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,501.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$2,550.77
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC MAMMO BREAST GUIDED MASTOTOMY
|
Facility
|
IP
|
$2,842.32
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
36100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,131.74 |
| Max. Negotiated Rate |
$2,842.32 |
| Rate for Payer: Aetna Commercial |
$2,558.09
|
| Rate for Payer: ASR ASR |
$2,757.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.11
|
| Rate for Payer: BCN Commercial |
$2,334.11
|
| Rate for Payer: Cash Price |
$2,273.86
|
| Rate for Payer: Cofinity Commercial |
$2,671.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,273.86
|
| Rate for Payer: Healthscope Commercial |
$2,757.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,842.32
|
| Rate for Payer: Mclaren Commercial |
$2,558.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,415.97
|
| Rate for Payer: Nomi Health Commercial |
$2,330.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,131.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,501.24
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
IP
|
$1,200.83
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$900.62 |
| Max. Negotiated Rate |
$1,200.83 |
| Rate for Payer: Aetna Commercial |
$1,080.75
|
| Rate for Payer: ASR ASR |
$1,164.81
|
| Rate for Payer: BCBS Trust/PPO |
$986.12
|
| Rate for Payer: BCN Commercial |
$986.12
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cofinity Commercial |
$1,128.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.66
|
| Rate for Payer: Healthscope Commercial |
$1,164.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.83
|
| Rate for Payer: Mclaren Commercial |
$1,080.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.71
|
| Rate for Payer: Nomi Health Commercial |
$984.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,056.73
|
|
|
HC MAMMO BREAST INJECTION DUCTOGRAM
|
Facility
|
OP
|
$1,200.83
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
36100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$1,200.83 |
| Rate for Payer: Aetna Commercial |
$1,080.75
|
| Rate for Payer: Aetna Medicare |
$444.31
|
| Rate for Payer: ASR ASR |
$1,164.81
|
| Rate for Payer: BCBS Complete |
$480.33
|
| Rate for Payer: BCBS Trust/PPO |
$990.08
|
| Rate for Payer: BCCCP Commercial |
$153.22
|
| Rate for Payer: BCN Commercial |
$990.08
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cash Price |
$960.66
|
| Rate for Payer: Cofinity Commercial |
$1,128.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.66
|
| Rate for Payer: Healthscope Commercial |
$1,164.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.83
|
| Rate for Payer: Mclaren Commercial |
$1,080.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$960.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,020.71
|
| Rate for Payer: Nomi Health Commercial |
$984.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$110.17
|
| Rate for Payer: Priority Health Narrow Network |
$88.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,056.73
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
IP
|
$380.25
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$285.19 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$342.23
|
| Rate for Payer: ASR ASR |
$368.84
|
| Rate for Payer: BCBS Trust/PPO |
$312.26
|
| Rate for Payer: BCN Commercial |
$312.26
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cofinity Commercial |
$357.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.20
|
| Rate for Payer: Healthscope Commercial |
$368.84
|
| Rate for Payer: Healthscope Whirlpool |
$380.25
|
| Rate for Payer: Mclaren Commercial |
$342.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.21
|
| Rate for Payer: Nomi Health Commercial |
$311.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.62
|
|
|
HC MAMMO DIAGNOSTIC UNI WITH CAD
|
Facility
|
OP
|
$380.25
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
40100005
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$117.70 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$342.23
|
| Rate for Payer: Aetna Medicare |
$140.69
|
| Rate for Payer: ASR ASR |
$368.84
|
| Rate for Payer: BCBS Complete |
$152.10
|
| Rate for Payer: BCBS Trust/PPO |
$313.52
|
| Rate for Payer: BCCCP Commercial |
$117.70
|
| Rate for Payer: BCN Commercial |
$313.52
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cofinity Commercial |
$357.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.20
|
| Rate for Payer: Healthscope Commercial |
$368.84
|
| Rate for Payer: Healthscope Whirlpool |
$380.25
|
| Rate for Payer: Mclaren Commercial |
$342.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.21
|
| Rate for Payer: Nomi Health Commercial |
$311.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$333.18
|
| Rate for Payer: Priority Health Narrow Network |
$266.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.62
|
|
|
HC MAMMO DUCTOGRAM MULTIPLE
|
Facility
|
OP
|
$603.90
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
32000251
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.89 |
| Max. Negotiated Rate |
$603.90 |
| Rate for Payer: Aetna Commercial |
$543.51
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$585.78
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$497.92
|
| Rate for Payer: BCCCP Commercial |
$64.89
|
| Rate for Payer: BCN Commercial |
$497.92
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$483.12
|
| Rate for Payer: Cash Price |
$483.12
|
| Rate for Payer: Cofinity Commercial |
$567.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$585.78
|
| Rate for Payer: Healthscope Whirlpool |
$603.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$543.51
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$513.32
|
| Rate for Payer: Nomi Health Commercial |
$495.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$452.93
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$570.17
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$456.14
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
