|
HC MR BREAST BIL W CON
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
HCPCS C8906
|
| Hospital Charge Code |
61000058
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,132.92 |
| Rate for Payer: Aetna Commercial |
$1,919.63
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,068.93
|
| Rate for Payer: ASR Commercial |
$2,068.93
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,746.65
|
| Rate for Payer: BCN Commercial |
$1,653.65
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| 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: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,132.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,919.63
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,868.86
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,495.18
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,876.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
IP
|
$2,175.58
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,414.13 |
| Max. Negotiated Rate |
$2,175.58 |
| Rate for Payer: Aetna Commercial |
$1,958.02
|
| Rate for Payer: ASR ASR |
$2,110.31
|
| Rate for Payer: ASR Commercial |
$2,110.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,772.88
|
| Rate for Payer: BCN Commercial |
$1,686.73
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Commercial |
$2,045.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Healthscope Commercial |
$2,175.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,110.31
|
| Rate for Payer: Mclaren Commercial |
$1,958.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: Nomi Health Commercial |
$1,783.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,914.51
|
|
|
HC MR BREAST BIL WO W CON
|
Facility
|
OP
|
$2,175.58
|
|
|
Service Code
|
HCPCS 77049
|
| Hospital Charge Code |
61000059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$268.37 |
| Max. Negotiated Rate |
$2,175.58 |
| Rate for Payer: Aetna Commercial |
$1,958.02
|
| Rate for Payer: Aetna Medicare |
$1,087.79
|
| Rate for Payer: ASR ASR |
$2,110.31
|
| Rate for Payer: ASR Commercial |
$2,110.31
|
| Rate for Payer: BCBS Complete |
$870.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,781.58
|
| Rate for Payer: BCCCP Commercial |
$324.98
|
| Rate for Payer: BCN Commercial |
$1,686.73
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cofinity Commercial |
$2,045.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.46
|
| Rate for Payer: Healthscope Commercial |
$2,175.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,110.31
|
| Rate for Payer: Mclaren Commercial |
$1,958.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,849.24
|
| Rate for Payer: Nomi Health Commercial |
$1,783.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.46
|
| Rate for Payer: Priority Health Narrow Network |
$268.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,914.51
|
|
|
HC MR BREAST CAD
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$20.81
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC MR BREAST CAD
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
HCPCS C8937
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
IP
|
$908.41
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$590.47 |
| Max. Negotiated Rate |
$908.41 |
| Rate for Payer: Aetna Commercial |
$817.57
|
| Rate for Payer: ASR ASR |
$881.16
|
| Rate for Payer: ASR Commercial |
$881.16
|
| Rate for Payer: BCBS Trust/PPO |
$740.26
|
| Rate for Payer: BCN Commercial |
$704.29
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cofinity Commercial |
$853.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.73
|
| Rate for Payer: Healthscope Commercial |
$908.41
|
| Rate for Payer: Healthscope Whirlpool |
$881.16
|
| Rate for Payer: Mclaren Commercial |
$817.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.15
|
| Rate for Payer: Nomi Health Commercial |
$744.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$799.40
|
|
|
HC MR BREAST UNI SCREEN W CON
|
Facility
|
OP
|
$908.41
|
|
|
Service Code
|
HCPCS C8903
|
| Hospital Charge Code |
61000085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$908.41 |
| Rate for Payer: Aetna Commercial |
$817.57
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$881.16
|
| Rate for Payer: ASR Commercial |
$881.16
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$743.90
|
| Rate for Payer: BCN Commercial |
$704.29
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cash Price |
$726.73
|
| Rate for Payer: Cofinity Commercial |
$853.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$908.41
|
| Rate for Payer: Healthscope Whirlpool |
$881.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$817.57
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$772.15
|
| Rate for Payer: Nomi Health Commercial |
$744.90
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$795.95
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$636.80
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$799.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
OP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,234.53 |
| Rate for Payer: Aetna Commercial |
$1,111.08
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,197.49
|
| Rate for Payer: ASR Commercial |
$1,197.49
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.96
|
| Rate for Payer: BCN Commercial |
$957.13
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| 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 |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,234.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,197.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,111.08
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,012.31
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,081.70
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$865.41
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,086.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST UNI SCREEN WO W CON
|
Facility
|
IP
|
$1,234.53
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$802.44 |
| 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: ASR Commercial |
$1,197.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.02
|
| 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 Commercial |
$1,049.35
|
| Rate for Payer: Nomi Health Commercial |
$1,012.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,086.39
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
OP
|
$2,354.05
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,354.05 |
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: ASR Commercial |
$1,522.29
|
| Rate for Payer: ASR Commercial |
$2,283.43
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,927.73
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,375.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,062.62
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,650.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,100.13
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR BREAST UNI WO W CON
|
Facility
|
IP
|
$1,569.37
|
|
|
Service Code
|
HCPCS C8905
|
| Hospital Charge Code |
61000057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,020.09 |
| Max. Negotiated Rate |
$1,569.37 |
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: ASR Commercial |
$2,283.43
|
| Rate for Payer: ASR Commercial |
$1,522.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,918.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.88
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
|
|
HC MR BREAST W CON
|
Facility
|
IP
|
$2,354.05
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,530.13 |
| Max. Negotiated Rate |
$2,354.05 |
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: ASR Commercial |
$1,522.29
|
| Rate for Payer: ASR Commercial |
$2,283.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,918.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.88
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
|
|
HC MR BREAST W CON
|
Facility
|
OP
|
$1,569.37
|
|
|
Service Code
|
HCPCS 77048
|
| Hospital Charge Code |
61000055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$269.68 |
| Max. Negotiated Rate |
$1,569.37 |
| Rate for Payer: Aetna Commercial |
$1,412.43
|
| Rate for Payer: Aetna Commercial |
$2,118.64
|
| Rate for Payer: Aetna Medicare |
$1,177.02
|
| Rate for Payer: Aetna Medicare |
$784.68
|
| Rate for Payer: ASR ASR |
$1,522.29
|
| Rate for Payer: ASR ASR |
$2,283.43
|
| Rate for Payer: ASR Commercial |
$1,522.29
|
| Rate for Payer: ASR Commercial |
$2,283.43
|
| Rate for Payer: BCBS Complete |
$627.75
|
| Rate for Payer: BCBS Complete |
$941.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,927.73
|
| Rate for Payer: BCCCP Commercial |
$318.72
|
| Rate for Payer: BCCCP Commercial |
$318.72
|
| Rate for Payer: BCN Commercial |
$1,216.73
|
| Rate for Payer: BCN Commercial |
$1,825.09
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,883.24
|
| Rate for Payer: Cash Price |
$1,255.50
|
| Rate for Payer: Cofinity Commercial |
$2,212.81
|
| Rate for Payer: Cofinity Commercial |
$1,475.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.50
|
| Rate for Payer: Healthscope Commercial |
$2,354.05
|
| Rate for Payer: Healthscope Commercial |
$1,569.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,522.29
|
| Rate for Payer: Mclaren Commercial |
$1,412.43
|
| Rate for Payer: Mclaren Commercial |
$2,118.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.96
|
| Rate for Payer: Nomi Health Commercial |
$1,286.88
|
| Rate for Payer: Nomi Health Commercial |
$1,930.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,530.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.10
|
| Rate for Payer: Priority Health Narrow Network |
$269.68
|
| Rate for Payer: Priority Health Narrow Network |
$269.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,071.56
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
OP
|
$2,132.92
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,132.92 |
| Rate for Payer: Aetna Commercial |
$1,919.63
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$2,068.93
|
| Rate for Payer: ASR Commercial |
$2,068.93
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,746.65
|
| Rate for Payer: BCCCP Commercial |
$207.57
|
| Rate for Payer: BCN Commercial |
$1,653.65
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| 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: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,132.92
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,919.63
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.97
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$211.18
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,876.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR BREAST WO CON BIL
|
Facility
|
IP
|
$2,132.92
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
61000091
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,386.40 |
| 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: ASR Commercial |
$2,068.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.12
|
| 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 Commercial |
$1,812.98
|
| Rate for Payer: Nomi Health Commercial |
$1,748.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,386.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,876.97
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
IP
|
$1,568.76
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,019.69 |
| Max. Negotiated Rate |
$1,568.76 |
| Rate for Payer: Aetna Commercial |
$1,411.88
|
| Rate for Payer: ASR ASR |
$1,521.70
|
| Rate for Payer: ASR Commercial |
$1,521.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.38
|
| Rate for Payer: BCN Commercial |
$1,216.26
|
| Rate for Payer: Cash Price |
$1,255.01
|
| Rate for Payer: Cofinity Commercial |
$1,474.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.01
|
| Rate for Payer: Healthscope Commercial |
$1,568.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.70
|
| Rate for Payer: Mclaren Commercial |
$1,411.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.45
|
| Rate for Payer: Nomi Health Commercial |
$1,286.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.51
|
|
|
HC MR BREAST WO CON UNI
|
Facility
|
OP
|
$1,568.76
|
|
|
Service Code
|
CPT 77046
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,568.76 |
| Rate for Payer: Aetna Commercial |
$1,411.88
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,521.70
|
| Rate for Payer: ASR Commercial |
$1,521.70
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.66
|
| Rate for Payer: BCCCP Commercial |
$201.08
|
| Rate for Payer: BCN Commercial |
$1,216.26
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,255.01
|
| Rate for Payer: Cash Price |
$1,255.01
|
| Rate for Payer: Cofinity Commercial |
$1,474.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,568.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,411.88
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.45
|
| Rate for Payer: Nomi Health Commercial |
$1,286.38
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.97
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$211.18
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
IP
|
$2,153.63
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,399.86 |
| Max. Negotiated Rate |
$2,153.63 |
| Rate for Payer: Aetna Commercial |
$1,938.27
|
| Rate for Payer: ASR ASR |
$2,089.02
|
| Rate for Payer: ASR Commercial |
$2,089.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,754.99
|
| Rate for Payer: BCN Commercial |
$1,669.71
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$2,024.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Healthscope Commercial |
$2,153.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,089.02
|
| Rate for Payer: Mclaren Commercial |
$1,938.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: Nomi Health Commercial |
$1,765.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,895.19
|
|
|
HC MR CARDIAC FOR MORPHOLOGY WO CON
|
Facility
|
OP
|
$2,153.63
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$2,153.63 |
| Rate for Payer: Aetna Commercial |
$1,938.27
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$2,089.02
|
| Rate for Payer: ASR Commercial |
$2,089.02
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,763.61
|
| Rate for Payer: BCN Commercial |
$1,669.71
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cash Price |
$1,722.90
|
| Rate for Payer: Cofinity Commercial |
$2,024.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,722.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$2,153.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,089.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,938.27
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,830.59
|
| Rate for Payer: Nomi Health Commercial |
$1,765.98
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,887.01
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,509.69
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,895.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC MR CARDIAC MORP AND FUNC WO W CON
|
Facility
|
IP
|
$990.98
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$644.14 |
| Max. Negotiated Rate |
$990.98 |
| Rate for Payer: Aetna Commercial |
$891.88
|
| Rate for Payer: ASR ASR |
$961.25
|
| Rate for Payer: ASR Commercial |
$961.25
|
| Rate for Payer: BCBS Trust/PPO |
$807.55
|
| Rate for Payer: BCN Commercial |
$768.31
|
| Rate for Payer: Cash Price |
$792.78
|
| Rate for Payer: Cofinity Commercial |
$931.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.78
|
| Rate for Payer: Healthscope Commercial |
$990.98
|
| Rate for Payer: Healthscope Whirlpool |
$961.25
|
| Rate for Payer: Mclaren Commercial |
$891.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.33
|
| Rate for Payer: Nomi Health Commercial |
$812.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.06
|
|
|
HC MR CARDIAC MORP AND FUNC WO W CON
|
Facility
|
OP
|
$990.98
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$990.98 |
| Rate for Payer: Aetna Commercial |
$891.88
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$961.25
|
| Rate for Payer: ASR Commercial |
$961.25
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$811.51
|
| Rate for Payer: BCN Commercial |
$768.31
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$792.78
|
| Rate for Payer: Cash Price |
$792.78
|
| Rate for Payer: Cofinity Commercial |
$931.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$990.98
|
| Rate for Payer: Healthscope Whirlpool |
$961.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$891.88
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.33
|
| Rate for Payer: Nomi Health Commercial |
$812.60
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$868.30
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$694.68
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC MR CARDIAC VELOCITY MAPPING
|
Facility
|
IP
|
$1,239.30
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$805.54 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,115.37
|
| Rate for Payer: ASR ASR |
$1,202.12
|
| Rate for Payer: ASR Commercial |
$1,202.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.91
|
| Rate for Payer: BCN Commercial |
$960.83
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,164.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.12
|
| Rate for Payer: Mclaren Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,090.58
|
|
|
HC MR CARDIAC VELOCITY MAPPING
|
Facility
|
OP
|
$1,239.30
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
61000048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$495.72 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,115.37
|
| Rate for Payer: Aetna Medicare |
$619.65
|
| Rate for Payer: ASR ASR |
$1,202.12
|
| Rate for Payer: ASR Commercial |
$1,202.12
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.86
|
| Rate for Payer: BCN Commercial |
$960.83
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,164.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.12
|
| Rate for Payer: Mclaren Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.87
|
| Rate for Payer: Priority Health Narrow Network |
$868.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,090.58
|
|
|
HC MR CHEST W CON
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,516.45 |
| Max. Negotiated Rate |
$2,333.00 |
| Rate for Payer: Aetna Commercial |
$2,099.70
|
| Rate for Payer: ASR ASR |
$2,263.01
|
| Rate for Payer: ASR Commercial |
$2,263.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.16
|
| Rate for Payer: BCN Commercial |
$1,808.77
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$2,193.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.40
|
| Rate for Payer: Healthscope Commercial |
$2,333.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,263.01
|
| Rate for Payer: Mclaren Commercial |
$2,099.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.05
|
| Rate for Payer: Nomi Health Commercial |
$1,913.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,053.04
|
|
|
HC MR CHEST W CON
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
61000011
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$414.91 |
| Max. Negotiated Rate |
$2,333.00 |
| Rate for Payer: Aetna Commercial |
$2,099.70
|
| Rate for Payer: Aetna Medicare |
$774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: ASR ASR |
$2,263.01
|
| Rate for Payer: ASR Commercial |
$2,263.01
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,910.49
|
| Rate for Payer: BCN Commercial |
$1,808.77
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$2,193.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$2,333.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,263.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$774.08
|
| Rate for Payer: Mclaren Commercial |
$2,099.70
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.05
|
| Rate for Payer: Nomi Health Commercial |
$1,913.06
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$851.49
|
| Rate for Payer: PHP Medicaid |
$414.91
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,817.76
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,454.21
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,053.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,199.82
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP DNSP |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$414.91
|
| Rate for Payer: VA VA |
$774.08
|
|
