|
HC US AAA SCREENING
|
Facility
|
OP
|
$367.02
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$367.02 |
| Rate for Payer: Aetna Commercial |
$330.32
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$356.01
|
| Rate for Payer: ASR Commercial |
$356.01
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$284.55
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cofinity Commercial |
$345.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$367.02
|
| Rate for Payer: Healthscope Whirlpool |
$356.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$330.32
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.97
|
| Rate for Payer: Nomi Health Commercial |
$300.96
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.58
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$257.28
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US AAA SCREENING
|
Facility
|
IP
|
$367.02
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
40200073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$367.02 |
| Rate for Payer: Aetna Commercial |
$330.32
|
| Rate for Payer: ASR ASR |
$356.01
|
| Rate for Payer: ASR Commercial |
$356.01
|
| Rate for Payer: BCBS Trust/PPO |
$299.08
|
| Rate for Payer: BCN Commercial |
$284.55
|
| Rate for Payer: Cash Price |
$293.62
|
| Rate for Payer: Cofinity Commercial |
$345.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.62
|
| Rate for Payer: Healthscope Commercial |
$367.02
|
| Rate for Payer: Healthscope Whirlpool |
$356.01
|
| Rate for Payer: Mclaren Commercial |
$330.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.97
|
| Rate for Payer: Nomi Health Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.98
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
OP
|
$950.92
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$950.92 |
| Rate for Payer: Aetna Commercial |
$855.83
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$922.39
|
| Rate for Payer: ASR Commercial |
$922.39
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.71
|
| Rate for Payer: BCN Commercial |
$737.25
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cofinity Commercial |
$893.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$950.92
|
| Rate for Payer: Healthscope Whirlpool |
$922.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$855.83
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.28
|
| Rate for Payer: Nomi Health Commercial |
$779.75
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$640.14
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$512.11
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US ABDOMEN COMPLETE
|
Facility
|
IP
|
$950.92
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
40200009
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$618.10 |
| Max. Negotiated Rate |
$950.92 |
| Rate for Payer: Aetna Commercial |
$855.83
|
| Rate for Payer: ASR ASR |
$922.39
|
| Rate for Payer: ASR Commercial |
$922.39
|
| Rate for Payer: BCBS Trust/PPO |
$774.90
|
| Rate for Payer: BCN Commercial |
$737.25
|
| Rate for Payer: Cash Price |
$760.74
|
| Rate for Payer: Cofinity Commercial |
$893.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.74
|
| Rate for Payer: Healthscope Commercial |
$950.92
|
| Rate for Payer: Healthscope Whirlpool |
$922.39
|
| Rate for Payer: Mclaren Commercial |
$855.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.28
|
| Rate for Payer: Nomi Health Commercial |
$779.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.81
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
IP
|
$816.66
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$530.83 |
| Max. Negotiated Rate |
$816.66 |
| Rate for Payer: Aetna Commercial |
$734.99
|
| Rate for Payer: ASR ASR |
$792.16
|
| Rate for Payer: ASR Commercial |
$792.16
|
| Rate for Payer: BCBS Trust/PPO |
$665.50
|
| Rate for Payer: BCN Commercial |
$633.16
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$767.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Healthscope Commercial |
$816.66
|
| Rate for Payer: Healthscope Whirlpool |
$792.16
|
| Rate for Payer: Mclaren Commercial |
$734.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: Nomi Health Commercial |
$669.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.66
|
|
|
HC US ABDOMEN LIMITED
|
Facility
|
OP
|
$816.66
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$816.66 |
| Rate for Payer: Aetna Commercial |
$734.99
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$792.16
|
| Rate for Payer: ASR Commercial |
$792.16
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$668.76
|
| Rate for Payer: BCN Commercial |
$633.16
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cash Price |
$653.33
|
| Rate for Payer: Cofinity Commercial |
$767.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$816.66
|
| Rate for Payer: Healthscope Whirlpool |
$792.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$734.99
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.16
|
| Rate for Payer: Nomi Health Commercial |
$669.66
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.32
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$276.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
OP
|
$602.20
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$602.20 |
| Rate for Payer: Aetna Commercial |
$541.98
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$584.13
|
| Rate for Payer: ASR Commercial |
$584.13
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$493.14
|
| Rate for Payer: BCCCP Commercial |
$95.65
|
| Rate for Payer: BCN Commercial |
$466.89
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$602.20
|
| Rate for Payer: Healthscope Whirlpool |
$584.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$541.98
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: Nomi Health Commercial |
$493.80
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.65
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$422.14
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US BREAST BIL COMPLETE
|
Facility
|
IP
|
$602.20
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$391.43 |
| Max. Negotiated Rate |
$602.20 |
| Rate for Payer: Aetna Commercial |
$541.98
|
| Rate for Payer: ASR ASR |
$584.13
|
| Rate for Payer: ASR Commercial |
$584.13
|
| Rate for Payer: BCBS Trust/PPO |
$490.73
|
| Rate for Payer: BCN Commercial |
$466.89
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Healthscope Commercial |
$602.20
|
| Rate for Payer: Healthscope Whirlpool |
$584.13
|
| Rate for Payer: Mclaren Commercial |
$541.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: Nomi Health Commercial |
$493.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.94
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
OP
|
$562.45
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$562.45 |
| Rate for Payer: Aetna Commercial |
$506.20
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$545.58
|
| Rate for Payer: ASR Commercial |
$545.58
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$460.59
|
| Rate for Payer: BCCCP Commercial |
$79.63
|
| Rate for Payer: BCN Commercial |
$436.07
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cofinity Commercial |
$528.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$562.45
|
| Rate for Payer: Healthscope Whirlpool |
$545.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$506.20
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.08
|
| Rate for Payer: Nomi Health Commercial |
$461.21
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.82
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$394.28
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC US BREAST BIL LIMITED
|
Facility
|
IP
|
$562.45
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200071
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$365.59 |
| Max. Negotiated Rate |
$562.45 |
| Rate for Payer: Aetna Commercial |
$506.20
|
| Rate for Payer: ASR ASR |
$545.58
|
| Rate for Payer: ASR Commercial |
$545.58
|
| Rate for Payer: BCBS Trust/PPO |
$458.34
|
| Rate for Payer: BCN Commercial |
$436.07
|
| Rate for Payer: Cash Price |
$449.96
|
| Rate for Payer: Cofinity Commercial |
$528.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.96
|
| Rate for Payer: Healthscope Commercial |
$562.45
|
| Rate for Payer: Healthscope Whirlpool |
$545.58
|
| Rate for Payer: Mclaren Commercial |
$506.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.08
|
| Rate for Payer: Nomi Health Commercial |
$461.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.96
|
|
|
HC US BREAST UNI, COMPLETE
|
Facility
|
IP
|
$561.59
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$365.03 |
| Max. Negotiated Rate |
$561.59 |
| Rate for Payer: Aetna Commercial |
$505.43
|
| Rate for Payer: ASR ASR |
$544.74
|
| Rate for Payer: ASR Commercial |
$544.74
|
| Rate for Payer: BCBS Trust/PPO |
$457.64
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$527.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$561.59
|
| Rate for Payer: Healthscope Whirlpool |
$544.74
|
| Rate for Payer: Mclaren Commercial |
$505.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
|
|
HC US BREAST UNI, COMPLETE
|
Facility
|
OP
|
$561.59
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
40200068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$561.59 |
| Rate for Payer: Aetna Commercial |
$505.43
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$544.74
|
| Rate for Payer: ASR Commercial |
$544.74
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$459.89
|
| Rate for Payer: BCCCP Commercial |
$95.65
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$527.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$561.59
|
| Rate for Payer: Healthscope Whirlpool |
$544.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$505.43
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.07
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$393.67
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US BREAST UNI, LIMITED
|
Facility
|
IP
|
$561.59
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200069
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$365.03 |
| Max. Negotiated Rate |
$561.59 |
| Rate for Payer: Aetna Commercial |
$505.43
|
| Rate for Payer: ASR ASR |
$544.74
|
| Rate for Payer: ASR Commercial |
$544.74
|
| Rate for Payer: BCBS Trust/PPO |
$457.64
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$527.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$561.59
|
| Rate for Payer: Healthscope Whirlpool |
$544.74
|
| Rate for Payer: Mclaren Commercial |
$505.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
|
|
HC US BREAST UNI, LIMITED
|
Facility
|
OP
|
$561.59
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
40200069
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$561.59 |
| Rate for Payer: Aetna Commercial |
$505.43
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$544.74
|
| Rate for Payer: ASR Commercial |
$544.74
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$459.89
|
| Rate for Payer: BCCCP Commercial |
$79.63
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$527.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$561.59
|
| Rate for Payer: Healthscope Whirlpool |
$544.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$505.43
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.07
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$393.67
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC US CHEST
|
Facility
|
IP
|
$561.59
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
40200007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$365.03 |
| Max. Negotiated Rate |
$561.59 |
| Rate for Payer: Aetna Commercial |
$505.43
|
| Rate for Payer: ASR ASR |
$544.74
|
| Rate for Payer: ASR Commercial |
$544.74
|
| Rate for Payer: BCBS Trust/PPO |
$457.64
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$527.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$561.59
|
| Rate for Payer: Healthscope Whirlpool |
$544.74
|
| Rate for Payer: Mclaren Commercial |
$505.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
|
|
HC US CHEST
|
Facility
|
OP
|
$561.59
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
40200007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$561.59 |
| Rate for Payer: Aetna Commercial |
$505.43
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$544.74
|
| Rate for Payer: ASR Commercial |
$544.74
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$459.89
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$527.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$561.59
|
| Rate for Payer: Healthscope Whirlpool |
$544.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$505.43
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.34
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$267.47
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US CHORIONIC VILLIS SAMPLE
|
Facility
|
OP
|
$573.60
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$573.60 |
| Rate for Payer: Aetna Commercial |
$516.24
|
| Rate for Payer: Aetna Medicare |
$286.80
|
| Rate for Payer: ASR ASR |
$556.39
|
| Rate for Payer: ASR Commercial |
$556.39
|
| Rate for Payer: BCBS Complete |
$229.44
|
| Rate for Payer: BCBS Trust/PPO |
$469.72
|
| Rate for Payer: BCN Commercial |
$444.71
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Commercial |
$539.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$573.60
|
| Rate for Payer: Healthscope Whirlpool |
$556.39
|
| Rate for Payer: Mclaren Commercial |
$516.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: Nomi Health Commercial |
$470.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.59
|
| Rate for Payer: Priority Health Narrow Network |
$402.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.77
|
|
|
HC US CHORIONIC VILLIS SAMPLE
|
Facility
|
IP
|
$573.60
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$372.84 |
| Max. Negotiated Rate |
$573.60 |
| Rate for Payer: Aetna Commercial |
$516.24
|
| Rate for Payer: ASR ASR |
$556.39
|
| Rate for Payer: ASR Commercial |
$556.39
|
| Rate for Payer: BCBS Trust/PPO |
$467.43
|
| Rate for Payer: BCN Commercial |
$444.71
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Commercial |
$539.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$573.60
|
| Rate for Payer: Healthscope Whirlpool |
$556.39
|
| Rate for Payer: Mclaren Commercial |
$516.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: Nomi Health Commercial |
$470.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.77
|
|
|
HC US CRANIAL
|
Facility
|
IP
|
$826.35
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
40200053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$537.13 |
| Max. Negotiated Rate |
$826.35 |
| Rate for Payer: Aetna Commercial |
$743.72
|
| Rate for Payer: ASR ASR |
$801.56
|
| Rate for Payer: ASR Commercial |
$801.56
|
| Rate for Payer: BCBS Trust/PPO |
$673.39
|
| Rate for Payer: BCN Commercial |
$640.67
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$776.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$826.35
|
| Rate for Payer: Healthscope Whirlpool |
$801.56
|
| Rate for Payer: Mclaren Commercial |
$743.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.19
|
|
|
HC US CRANIAL
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
40200053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$826.35 |
| Rate for Payer: Aetna Commercial |
$743.72
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$801.56
|
| Rate for Payer: ASR Commercial |
$801.56
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$676.70
|
| Rate for Payer: BCN Commercial |
$640.67
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$776.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$826.35
|
| Rate for Payer: Healthscope Whirlpool |
$801.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$743.72
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$724.05
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$579.27
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US DUPLX DOP ABD PEL SCROT LTD
|
Facility
|
IP
|
$1,011.43
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$657.43 |
| Max. Negotiated Rate |
$1,011.43 |
| Rate for Payer: Aetna Commercial |
$910.29
|
| Rate for Payer: ASR ASR |
$981.09
|
| Rate for Payer: ASR Commercial |
$981.09
|
| Rate for Payer: BCBS Trust/PPO |
$824.21
|
| Rate for Payer: BCN Commercial |
$784.16
|
| Rate for Payer: Cash Price |
$809.14
|
| Rate for Payer: Cofinity Commercial |
$950.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.14
|
| Rate for Payer: Healthscope Commercial |
$1,011.43
|
| Rate for Payer: Healthscope Whirlpool |
$981.09
|
| Rate for Payer: Mclaren Commercial |
$910.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.72
|
| Rate for Payer: Nomi Health Commercial |
$829.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$890.06
|
|
|
HC US DUPLX DOP ABD PEL SCROT LTD
|
Facility
|
OP
|
$1,011.43
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,011.43 |
| Rate for Payer: Aetna Commercial |
$910.29
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$981.09
|
| Rate for Payer: ASR Commercial |
$981.09
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$828.26
|
| Rate for Payer: BCN Commercial |
$784.16
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$809.14
|
| Rate for Payer: Cash Price |
$809.14
|
| Rate for Payer: Cofinity Commercial |
$950.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,011.43
|
| Rate for Payer: Healthscope Whirlpool |
$981.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$910.29
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.72
|
| Rate for Payer: Nomi Health Commercial |
$829.37
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.99
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$268.79
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$890.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
IP
|
$1,742.46
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,132.60 |
| Max. Negotiated Rate |
$1,742.46 |
| Rate for Payer: Aetna Commercial |
$1,568.21
|
| Rate for Payer: ASR ASR |
$1,690.19
|
| Rate for Payer: ASR Commercial |
$1,690.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,419.93
|
| Rate for Payer: BCN Commercial |
$1,350.93
|
| Rate for Payer: Cash Price |
$1,393.97
|
| Rate for Payer: Cofinity Commercial |
$1,637.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.97
|
| Rate for Payer: Healthscope Commercial |
$1,742.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.19
|
| Rate for Payer: Mclaren Commercial |
$1,568.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,481.09
|
| Rate for Payer: Nomi Health Commercial |
$1,428.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,533.36
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
OP
|
$1,742.46
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,742.46 |
| Rate for Payer: Aetna Commercial |
$1,568.21
|
| 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 |
$1,690.19
|
| Rate for Payer: ASR Commercial |
$1,690.19
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.90
|
| Rate for Payer: BCN Commercial |
$1,350.93
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,393.97
|
| Rate for Payer: Cash Price |
$1,393.97
|
| Rate for Payer: Cofinity Commercial |
$1,637.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,742.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,568.21
|
| 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 |
$1,481.09
|
| Rate for Payer: Nomi Health Commercial |
$1,428.82
|
| 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 |
$1,132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$491.91
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$393.53
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,533.36
|
| 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 US EACH ADDL FETUS BPP
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$471.42
|
| Rate for Payer: ASR Commercial |
$471.42
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$397.99
|
| Rate for Payer: BCN Commercial |
$376.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$456.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$486.00
|
| Rate for Payer: Healthscope Whirlpool |
$471.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$437.40
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.83
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$294.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
