|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.20 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$1,184.40
|
| Rate for Payer: ASR ASR |
$1,276.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.29
|
| Rate for Payer: BCN Commercial |
$1,020.29
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,237.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Healthscope Commercial |
$1,316.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,276.52
|
| Rate for Payer: Mclaren Commercial |
$1,184.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.08
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$141.94 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.57
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$49.26
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$37.11
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$37.11 |
| Rate for Payer: Aetna Commercial |
$33.40
|
| Rate for Payer: ASR ASR |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$28.77
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cofinity Commercial |
$34.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.69
|
| Rate for Payer: Healthscope Commercial |
$37.11
|
| Rate for Payer: Healthscope Whirlpool |
$36.00
|
| Rate for Payer: Mclaren Commercial |
$33.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.66
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$37.11
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$95.43 |
| Rate for Payer: Aetna Commercial |
$33.40
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.21
|
| Rate for Payer: ASR ASR |
$36.00
|
| Rate for Payer: BCBS Complete |
$27.67
|
| Rate for Payer: BCBS MAPPO |
$48.17
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$28.77
|
| Rate for Payer: BCN Medicare Advantage |
$48.17
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cofinity Commercial |
$34.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.17
|
| Rate for Payer: Healthscope Commercial |
$37.11
|
| Rate for Payer: Healthscope Whirlpool |
$36.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$48.17
|
| Rate for Payer: Mclaren Commercial |
$33.40
|
| Rate for Payer: Mclaren Medicaid |
$26.35
|
| Rate for Payer: Mclaren Medicare |
$48.17
|
| Rate for Payer: Meridian Medicaid |
$27.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.54
|
| Rate for Payer: PACE Medicare |
$45.76
|
| Rate for Payer: PACE SWMI |
$48.17
|
| Rate for Payer: PHP Commercial |
$52.99
|
| Rate for Payer: PHP Medicaid |
$26.35
|
| Rate for Payer: PHP Medicare Advantage |
$48.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.43
|
| Rate for Payer: Priority Health Medicare |
$48.17
|
| Rate for Payer: Priority Health Narrow Network |
$76.34
|
| Rate for Payer: Railroad Medicare Medicare |
$48.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.66
|
| Rate for Payer: UHC Medicare Advantage |
$49.62
|
| Rate for Payer: VA VA |
$48.17
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,475.00
|
| Rate for Payer: ASR ASR |
$2,667.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,132.08
|
| Rate for Payer: BCN Commercial |
$2,132.08
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,585.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.00
|
| Rate for Payer: Healthscope Commercial |
$2,750.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,667.50
|
| Rate for Payer: Mclaren Commercial |
$2,475.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,337.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,420.00
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$2,750.00 |
| Rate for Payer: Aetna Commercial |
$2,475.00
|
| Rate for Payer: ASR ASR |
$2,667.50
|
| Rate for Payer: BCBS Complete |
$1,100.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,132.08
|
| Rate for Payer: BCN Commercial |
$2,132.08
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,585.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.00
|
| Rate for Payer: Healthscope Commercial |
$2,750.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,667.50
|
| Rate for Payer: Mclaren Commercial |
$2,475.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,337.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,502.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,952.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,420.00
|
|
|
HC UA - KETONE
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna Commercial |
$11.02
|
| Rate for Payer: ASR ASR |
$11.87
|
| Rate for Payer: BCBS Trust/PPO |
$9.49
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$11.87
|
| Rate for Payer: Mclaren Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.77
|
|
|
HC UA - KETONE
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna Commercial |
$11.02
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.35
|
| Rate for Payer: ASR ASR |
$11.87
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.49
|
| Rate for Payer: BCN Commercial |
$9.49
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$12.24
|
| Rate for Payer: Healthscope Whirlpool |
$11.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.48
|
| Rate for Payer: Mclaren Commercial |
$11.02
|
| Rate for Payer: Mclaren Medicaid |
$1.90
|
| Rate for Payer: Mclaren Medicare |
$3.48
|
| Rate for Payer: Meridian Medicaid |
$2.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: PHP Medicaid |
$1.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.18
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health Narrow Network |
$5.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.77
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: VA VA |
$3.48
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$64.06
|
| Rate for Payer: BCN Commercial |
$64.06
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.14
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Narrow Network |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: BCBS Trust/PPO |
$64.06
|
| Rate for Payer: BCN Commercial |
$64.06
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.14
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,446.22
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,674.11 |
| Max. Negotiated Rate |
$9,446.22 |
| Rate for Payer: Aetna Commercial |
$8,501.60
|
| Rate for Payer: Aetna Medicare |
$6,716.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,396.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,396.05
|
| Rate for Payer: ASR ASR |
$9,162.83
|
| Rate for Payer: BCBS Complete |
$3,858.15
|
| Rate for Payer: BCBS MAPPO |
$6,716.84
|
| Rate for Payer: BCBS Trust/PPO |
$7,323.65
|
| Rate for Payer: BCN Commercial |
$7,323.65
|
| Rate for Payer: BCN Medicare Advantage |
$6,716.84
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cofinity Commercial |
$8,879.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,556.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,716.84
|
| Rate for Payer: Healthscope Commercial |
$9,446.22
|
| Rate for Payer: Healthscope Whirlpool |
$9,162.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,716.84
|
| Rate for Payer: Mclaren Commercial |
$8,501.60
|
| Rate for Payer: Mclaren Medicaid |
$3,674.11
|
| Rate for Payer: Mclaren Medicare |
$6,716.84
|
| Rate for Payer: Meridian Medicaid |
$3,858.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,052.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,724.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,029.29
|
| Rate for Payer: PACE Medicare |
$6,381.00
|
| Rate for Payer: PACE SWMI |
$6,716.84
|
| Rate for Payer: PHP Commercial |
$7,388.52
|
| Rate for Payer: PHP Medicaid |
$3,674.11
|
| Rate for Payer: PHP Medicare Advantage |
$6,716.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,674.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,612.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,596.06
|
| Rate for Payer: Priority Health Medicare |
$6,716.84
|
| Rate for Payer: Priority Health Narrow Network |
$6,706.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,716.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,312.67
|
| Rate for Payer: UHC Medicare Advantage |
$6,918.35
|
| Rate for Payer: VA VA |
$6,716.84
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
IP
|
$9,446.22
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,612.35 |
| Max. Negotiated Rate |
$9,446.22 |
| Rate for Payer: Aetna Commercial |
$8,501.60
|
| Rate for Payer: ASR ASR |
$9,162.83
|
| Rate for Payer: BCBS Trust/PPO |
$7,323.65
|
| Rate for Payer: BCN Commercial |
$7,323.65
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cofinity Commercial |
$8,879.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,556.98
|
| Rate for Payer: Healthscope Commercial |
$9,446.22
|
| Rate for Payer: Healthscope Whirlpool |
$9,162.83
|
| Rate for Payer: Mclaren Commercial |
$8,501.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,029.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,612.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,312.67
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
OP
|
$210.24
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$84.10 |
| Max. Negotiated Rate |
$241.16 |
| Rate for Payer: Aetna Commercial |
$189.22
|
| Rate for Payer: ASR ASR |
$203.93
|
| Rate for Payer: BCBS Complete |
$84.10
|
| Rate for Payer: BCBS Trust/PPO |
$163.00
|
| Rate for Payer: BCN Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$197.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.19
|
| Rate for Payer: Healthscope Commercial |
$210.24
|
| Rate for Payer: Healthscope Whirlpool |
$203.93
|
| Rate for Payer: Mclaren Commercial |
$189.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.16
|
| Rate for Payer: Priority Health Narrow Network |
$192.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.01
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
IP
|
$210.24
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$147.17 |
| Max. Negotiated Rate |
$210.24 |
| Rate for Payer: Aetna Commercial |
$189.22
|
| Rate for Payer: ASR ASR |
$203.93
|
| Rate for Payer: BCBS Trust/PPO |
$163.00
|
| Rate for Payer: BCN Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$197.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.19
|
| Rate for Payer: Healthscope Commercial |
$210.24
|
| Rate for Payer: Healthscope Whirlpool |
$203.93
|
| Rate for Payer: Mclaren Commercial |
$189.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.01
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
IP
|
$209.45
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$209.45 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: ASR ASR |
$203.17
|
| Rate for Payer: BCBS Trust/PPO |
$162.39
|
| Rate for Payer: BCN Commercial |
$162.39
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Healthscope Commercial |
$209.45
|
| Rate for Payer: Healthscope Whirlpool |
$203.17
|
| Rate for Payer: Mclaren Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.32
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
OP
|
$209.45
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$209.45 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: ASR ASR |
$203.17
|
| Rate for Payer: BCBS Complete |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$162.39
|
| Rate for Payer: BCN Commercial |
$162.39
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Healthscope Commercial |
$209.45
|
| Rate for Payer: Healthscope Whirlpool |
$203.17
|
| Rate for Payer: Mclaren Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.60
|
| Rate for Payer: Priority Health Narrow Network |
$148.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.32
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
IP
|
$209.45
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$209.45 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: ASR ASR |
$203.17
|
| Rate for Payer: BCBS Trust/PPO |
$162.39
|
| Rate for Payer: BCN Commercial |
$162.39
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Healthscope Commercial |
$209.45
|
| Rate for Payer: Healthscope Whirlpool |
$203.17
|
| Rate for Payer: Mclaren Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.32
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
OP
|
$209.45
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$209.45 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: ASR ASR |
$203.17
|
| Rate for Payer: BCBS Complete |
$83.78
|
| Rate for Payer: BCBS Trust/PPO |
$162.39
|
| Rate for Payer: BCN Commercial |
$162.39
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Healthscope Commercial |
$209.45
|
| Rate for Payer: Healthscope Whirlpool |
$203.17
|
| Rate for Payer: Mclaren Commercial |
$188.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.60
|
| Rate for Payer: Priority Health Narrow Network |
$148.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.32
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$323.87
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$129.55 |
| Max. Negotiated Rate |
$323.87 |
| Rate for Payer: Aetna Commercial |
$291.48
|
| Rate for Payer: ASR ASR |
$314.15
|
| Rate for Payer: BCBS Complete |
$129.55
|
| Rate for Payer: BCBS Trust/PPO |
$251.10
|
| Rate for Payer: BCCCP Commercial |
$130.78
|
| Rate for Payer: BCN Commercial |
$251.10
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cofinity Commercial |
$304.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.10
|
| Rate for Payer: Healthscope Commercial |
$323.87
|
| Rate for Payer: Healthscope Whirlpool |
$314.15
|
| Rate for Payer: Mclaren Commercial |
$291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.72
|
| Rate for Payer: Priority Health Narrow Network |
$229.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.01
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$323.87
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$226.71 |
| Max. Negotiated Rate |
$323.87 |
| Rate for Payer: Aetna Commercial |
$291.48
|
| Rate for Payer: ASR ASR |
$314.15
|
| Rate for Payer: BCBS Trust/PPO |
$251.10
|
| Rate for Payer: BCN Commercial |
$251.10
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cofinity Commercial |
$304.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.10
|
| Rate for Payer: Healthscope Commercial |
$323.87
|
| Rate for Payer: Healthscope Whirlpool |
$314.15
|
| Rate for Payer: Mclaren Commercial |
$291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.01
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$101.19
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$101.19 |
| Rate for Payer: Aetna Commercial |
$91.07
|
| Rate for Payer: ASR ASR |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$78.45
|
| Rate for Payer: BCN Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.95
|
| Rate for Payer: Healthscope Commercial |
$101.19
|
| Rate for Payer: Healthscope Whirlpool |
$98.15
|
| Rate for Payer: Mclaren Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.05
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$101.19
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$101.19 |
| Rate for Payer: Aetna Commercial |
$91.07
|
| Rate for Payer: ASR ASR |
$98.15
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$78.45
|
| Rate for Payer: BCN Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.95
|
| Rate for Payer: Healthscope Commercial |
$101.19
|
| Rate for Payer: Healthscope Whirlpool |
$98.15
|
| Rate for Payer: Mclaren Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.08
|
| Rate for Payer: Priority Health Narrow Network |
$71.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.05
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,466.31
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,626.42 |
| Max. Negotiated Rate |
$9,466.31 |
| Rate for Payer: Aetna Commercial |
$8,519.68
|
| Rate for Payer: ASR ASR |
$9,182.32
|
| Rate for Payer: BCBS Trust/PPO |
$7,339.23
|
| Rate for Payer: BCN Commercial |
$7,339.23
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cofinity Commercial |
$8,898.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,573.05
|
| Rate for Payer: Healthscope Commercial |
$9,466.31
|
| Rate for Payer: Healthscope Whirlpool |
$9,182.32
|
| Rate for Payer: Mclaren Commercial |
$8,519.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,046.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,626.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,330.35
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,466.31
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,325.31 |
| Max. Negotiated Rate |
$9,466.31 |
| Rate for Payer: Aetna Commercial |
$8,519.68
|
| Rate for Payer: Aetna Medicare |
$6,079.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,598.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,598.96
|
| Rate for Payer: ASR ASR |
$9,182.32
|
| Rate for Payer: BCBS Complete |
$3,491.88
|
| Rate for Payer: BCBS MAPPO |
$6,079.17
|
| Rate for Payer: BCBS Trust/PPO |
$7,339.23
|
| Rate for Payer: BCN Commercial |
$7,339.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,079.17
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cofinity Commercial |
$8,898.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,573.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,079.17
|
| Rate for Payer: Healthscope Commercial |
$9,466.31
|
| Rate for Payer: Healthscope Whirlpool |
$9,182.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,079.17
|
| Rate for Payer: Mclaren Commercial |
$8,519.68
|
| Rate for Payer: Mclaren Medicaid |
$3,325.31
|
| Rate for Payer: Mclaren Medicare |
$6,079.17
|
| Rate for Payer: Meridian Medicaid |
$3,491.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,383.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,991.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,046.36
|
| Rate for Payer: PACE Medicare |
$5,775.21
|
| Rate for Payer: PACE SWMI |
$6,079.17
|
| Rate for Payer: PHP Commercial |
$6,687.09
|
| Rate for Payer: PHP Medicaid |
$3,325.31
|
| Rate for Payer: PHP Medicare Advantage |
$6,079.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,325.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,626.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,614.34
|
| Rate for Payer: Priority Health Medicare |
$6,079.17
|
| Rate for Payer: Priority Health Narrow Network |
$6,721.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6,079.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,330.35
|
| Rate for Payer: UHC Medicare Advantage |
$6,261.55
|
| Rate for Payer: VA VA |
$6,079.17
|
|
