|
HC US BREAST BIL LIMITED
|
Facility
|
IP
|
$551.42
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$385.99 |
| Max. Negotiated Rate |
$551.42 |
| Rate for Payer: Aetna Commercial |
$496.28
|
| Rate for Payer: ASR ASR |
$534.88
|
| Rate for Payer: BCBS Trust/PPO |
$427.52
|
| Rate for Payer: BCN Commercial |
$427.52
|
| Rate for Payer: Cash Price |
$441.14
|
| Rate for Payer: Cofinity Commercial |
$518.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.14
|
| Rate for Payer: Healthscope Commercial |
$551.42
|
| Rate for Payer: Healthscope Whirlpool |
$534.88
|
| Rate for Payer: Mclaren Commercial |
$496.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.25
|
|
|
HC US BREAST UNI, COMPLETE
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCCCP Commercial |
$105.89
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.03
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$390.91
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US BREAST UNI, COMPLETE
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$385.41 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
|
|
HC US BREAST UNI, LIMITED
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200069
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$385.41 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
|
|
HC US BREAST UNI, LIMITED
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200069
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCCCP Commercial |
$87.39
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.03
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$390.91
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC US CHEST
|
Facility
|
OP
|
$550.58
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
40200007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.47
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$249.98
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US CHEST
|
Facility
|
IP
|
$550.58
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
40200007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$385.41 |
| Max. Negotiated Rate |
$550.58 |
| Rate for Payer: Aetna Commercial |
$495.52
|
| Rate for Payer: ASR ASR |
$534.06
|
| Rate for Payer: BCBS Trust/PPO |
$426.86
|
| Rate for Payer: BCN Commercial |
$426.86
|
| Rate for Payer: Cash Price |
$440.46
|
| Rate for Payer: Cofinity Commercial |
$517.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.46
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$534.06
|
| Rate for Payer: Mclaren Commercial |
$495.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$467.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$484.51
|
|
|
HC US CHORIONIC VILLIS SAMPLE
|
Facility
|
OP
|
$562.35
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Aetna Commercial |
$506.12
|
| Rate for Payer: ASR ASR |
$545.48
|
| Rate for Payer: BCBS Complete |
$224.94
|
| Rate for Payer: BCBS Trust/PPO |
$435.99
|
| Rate for Payer: BCN Commercial |
$435.99
|
| Rate for Payer: Cash Price |
$449.88
|
| Rate for Payer: Cofinity Commercial |
$528.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.88
|
| Rate for Payer: Healthscope Commercial |
$562.35
|
| Rate for Payer: Healthscope Whirlpool |
$545.48
|
| Rate for Payer: Mclaren Commercial |
$506.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$478.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.74
|
| Rate for Payer: Priority Health Narrow Network |
$399.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.87
|
|
|
HC US CHORIONIC VILLIS SAMPLE
|
Facility
|
IP
|
$562.35
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$393.64 |
| Max. Negotiated Rate |
$562.35 |
| Rate for Payer: Aetna Commercial |
$506.12
|
| Rate for Payer: ASR ASR |
$545.48
|
| Rate for Payer: BCBS Trust/PPO |
$435.99
|
| Rate for Payer: BCN Commercial |
$435.99
|
| Rate for Payer: Cash Price |
$449.88
|
| Rate for Payer: Cofinity Commercial |
$528.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.88
|
| Rate for Payer: Healthscope Commercial |
$562.35
|
| Rate for Payer: Healthscope Whirlpool |
$545.48
|
| Rate for Payer: Mclaren Commercial |
$506.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$478.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.87
|
|
|
HC US CRANIAL
|
Facility
|
IP
|
$810.15
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
40200053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$567.10 |
| Max. Negotiated Rate |
$810.15 |
| Rate for Payer: Aetna Commercial |
$729.14
|
| Rate for Payer: ASR ASR |
$785.85
|
| Rate for Payer: BCBS Trust/PPO |
$628.11
|
| Rate for Payer: BCN Commercial |
$628.11
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cofinity Commercial |
$761.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.12
|
| Rate for Payer: Healthscope Commercial |
$810.15
|
| Rate for Payer: Healthscope Whirlpool |
$785.85
|
| Rate for Payer: Mclaren Commercial |
$729.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.93
|
|
|
HC US CRANIAL
|
Facility
|
OP
|
$810.15
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
40200053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$810.15 |
| Rate for Payer: Aetna Commercial |
$729.14
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$785.85
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$628.11
|
| Rate for Payer: BCN Commercial |
$628.11
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cofinity Commercial |
$761.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$810.15
|
| Rate for Payer: Healthscope Whirlpool |
$785.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$729.14
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.63
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.24
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$575.21
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.93
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US DUPLX DOP ABD PEL SCROT LTD
|
Facility
|
IP
|
$991.60
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$694.12 |
| Max. Negotiated Rate |
$991.60 |
| Rate for Payer: Aetna Commercial |
$892.44
|
| Rate for Payer: ASR ASR |
$961.85
|
| Rate for Payer: BCBS Trust/PPO |
$768.79
|
| Rate for Payer: BCN Commercial |
$768.79
|
| Rate for Payer: Cash Price |
$793.28
|
| Rate for Payer: Cofinity Commercial |
$932.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.28
|
| Rate for Payer: Healthscope Commercial |
$991.60
|
| Rate for Payer: Healthscope Whirlpool |
$961.85
|
| Rate for Payer: Mclaren Commercial |
$892.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.61
|
|
|
HC US DUPLX DOP ABD PEL SCROT LTD
|
Facility
|
OP
|
$991.60
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$991.60 |
| Rate for Payer: Aetna Commercial |
$892.44
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$961.85
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$768.79
|
| Rate for Payer: BCN Commercial |
$768.79
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$793.28
|
| Rate for Payer: Cash Price |
$793.28
|
| Rate for Payer: Cofinity Commercial |
$932.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$991.60
|
| Rate for Payer: Healthscope Whirlpool |
$961.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$892.44
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.86
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.01
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$251.21
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.61
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
IP
|
$1,708.29
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,195.80 |
| Max. Negotiated Rate |
$1,708.29 |
| Rate for Payer: Aetna Commercial |
$1,537.46
|
| Rate for Payer: ASR ASR |
$1,657.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.44
|
| Rate for Payer: BCN Commercial |
$1,324.44
|
| Rate for Payer: Cash Price |
$1,366.63
|
| Rate for Payer: Cofinity Commercial |
$1,605.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,366.63
|
| Rate for Payer: Healthscope Commercial |
$1,708.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,657.04
|
| Rate for Payer: Mclaren Commercial |
$1,537.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,452.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,503.30
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
OP
|
$1,708.29
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,708.29 |
| Rate for Payer: Aetna Commercial |
$1,537.46
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$1,657.04
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.44
|
| Rate for Payer: BCN Commercial |
$1,324.44
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$1,366.63
|
| Rate for Payer: Cash Price |
$1,366.63
|
| Rate for Payer: Cofinity Commercial |
$1,605.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,366.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$1,708.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,657.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$1,537.46
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,452.05
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.73
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$367.78
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,503.30
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$333.53 |
| Max. Negotiated Rate |
$476.47 |
| Rate for Payer: Aetna Commercial |
$428.82
|
| Rate for Payer: ASR ASR |
$462.18
|
| Rate for Payer: BCBS Trust/PPO |
$369.41
|
| Rate for Payer: BCN Commercial |
$369.41
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$447.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Healthscope Commercial |
$476.47
|
| Rate for Payer: Healthscope Whirlpool |
$462.18
|
| Rate for Payer: Mclaren Commercial |
$428.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.29
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$476.47 |
| Rate for Payer: Aetna Commercial |
$428.82
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$462.18
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$369.41
|
| Rate for Payer: BCN Commercial |
$369.41
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$447.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$476.47
|
| Rate for Payer: Healthscope Whirlpool |
$462.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$428.82
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.77
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$275.02
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.29
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
OP
|
$423.30
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.32 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: Aetna Commercial |
$380.97
|
| Rate for Payer: ASR ASR |
$410.60
|
| Rate for Payer: BCBS Complete |
$169.32
|
| Rate for Payer: BCBS Trust/PPO |
$328.18
|
| Rate for Payer: BCN Commercial |
$328.18
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cofinity Commercial |
$397.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.64
|
| Rate for Payer: Healthscope Commercial |
$423.30
|
| Rate for Payer: Healthscope Whirlpool |
$410.60
|
| Rate for Payer: Mclaren Commercial |
$380.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.02
|
| Rate for Payer: Priority Health Narrow Network |
$267.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.50
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
IP
|
$423.30
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$296.31 |
| Max. Negotiated Rate |
$423.30 |
| Rate for Payer: Aetna Commercial |
$380.97
|
| Rate for Payer: ASR ASR |
$410.60
|
| Rate for Payer: BCBS Trust/PPO |
$328.18
|
| Rate for Payer: BCN Commercial |
$328.18
|
| Rate for Payer: Cash Price |
$338.64
|
| Rate for Payer: Cofinity Commercial |
$397.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.64
|
| Rate for Payer: Healthscope Commercial |
$423.30
|
| Rate for Payer: Healthscope Whirlpool |
$410.60
|
| Rate for Payer: Mclaren Commercial |
$380.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.50
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
IP
|
$348.47
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.93 |
| Max. Negotiated Rate |
$348.47 |
| Rate for Payer: Aetna Commercial |
$313.62
|
| Rate for Payer: ASR ASR |
$338.02
|
| Rate for Payer: BCBS Trust/PPO |
$270.17
|
| Rate for Payer: BCN Commercial |
$270.17
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Commercial |
$327.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.78
|
| Rate for Payer: Healthscope Commercial |
$348.47
|
| Rate for Payer: Healthscope Whirlpool |
$338.02
|
| Rate for Payer: Mclaren Commercial |
$313.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.65
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
OP
|
$348.47
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.39 |
| Max. Negotiated Rate |
$348.47 |
| Rate for Payer: Aetna Commercial |
$313.62
|
| Rate for Payer: ASR ASR |
$338.02
|
| Rate for Payer: BCBS Complete |
$139.39
|
| Rate for Payer: BCBS Trust/PPO |
$270.17
|
| Rate for Payer: BCN Commercial |
$270.17
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Commercial |
$327.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.78
|
| Rate for Payer: Healthscope Commercial |
$348.47
|
| Rate for Payer: Healthscope Whirlpool |
$338.02
|
| Rate for Payer: Mclaren Commercial |
$313.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.02
|
| Rate for Payer: Priority Health Narrow Network |
$267.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.65
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCCCP Commercial |
$95.77
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.39
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$96.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$36.64 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.64
|
| Rate for Payer: Priority Health Narrow Network |
$29.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
