|
HC ENDOFORM 2X2
|
Facility
|
IP
|
$38.25
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health SBD |
$24.10
|
|
|
HC ENDOFORM 2X2
|
Facility
|
OP
|
$38.25
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| Rate for Payer: BCBS Complete |
$15.30
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health SBD |
$24.10
|
|
|
HC ENDOFORM 4X4
|
Facility
|
IP
|
$133.06
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Aetna Commercial |
$113.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.49
|
| Rate for Payer: Cash Price |
$106.45
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$93.14
|
| Rate for Payer: Healthscope Commercial |
$119.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.10
|
| Rate for Payer: PHP Commercial |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health SBD |
$83.83
|
|
|
HC ENDOFORM 4X4
|
Facility
|
OP
|
$133.06
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Aetna Commercial |
$113.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.49
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: Cash Price |
$106.45
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$93.14
|
| Rate for Payer: Healthscope Commercial |
$119.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.10
|
| Rate for Payer: PHP Commercial |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health SBD |
$83.83
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
OP
|
$123.00
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.95
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Cofinity Commercial |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health SBD |
$77.49
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
IP
|
$123.00
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$77.49 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.95
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Cofinity Commercial |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health SBD |
$77.49
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.89 |
| Max. Negotiated Rate |
$1,925.39 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.12
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,925.39
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$454.59
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health SBD |
$409.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.48
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$135.89
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.13 |
| Max. Negotiated Rate |
$584.48 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.12
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$454.59
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health SBD |
$409.13
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.94 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Aetna Commercial |
$4,248.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,248.70
|
| Rate for Payer: BCBS Complete |
$1,999.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.00
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cofinity Commercial |
$3,498.60
|
| Rate for Payer: Cofinity Commercial |
$4,298.28
|
| Rate for Payer: Healthscope Commercial |
$4,498.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,248.30
|
| Rate for Payer: PHP Commercial |
$4,248.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.60
|
| Rate for Payer: Priority Health SBD |
$3,148.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.23
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$132.94
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
IP
|
$4,998.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,148.74 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Aetna Commercial |
$4,248.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,248.70
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cofinity Commercial |
$3,498.60
|
| Rate for Payer: Cofinity Commercial |
$4,298.28
|
| Rate for Payer: Healthscope Commercial |
$4,498.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,248.30
|
| Rate for Payer: PHP Commercial |
$4,248.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.60
|
| Rate for Payer: Priority Health SBD |
$3,148.74
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
OP
|
$13,091.70
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,509.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,010.14
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cofinity Commercial |
$9,164.19
|
| Rate for Payer: Cofinity Commercial |
$11,258.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,164.19
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Priority Health SBD |
$8,247.77
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$228.23
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
IP
|
$13,091.70
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,247.77 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,509.60
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cofinity Commercial |
$11,258.86
|
| Rate for Payer: Cofinity Commercial |
$9,164.19
|
| Rate for Payer: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,164.19
|
| Rate for Payer: Priority Health SBD |
$8,247.77
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
IP
|
$708.90
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.61 |
| Max. Negotiated Rate |
$638.01 |
| Rate for Payer: Aetna Commercial |
$602.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.78
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cofinity Commercial |
$496.23
|
| Rate for Payer: Cofinity Commercial |
$609.65
|
| Rate for Payer: Healthscope Commercial |
$638.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.56
|
| Rate for Payer: PHP Commercial |
$602.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.23
|
| Rate for Payer: Priority Health SBD |
$446.61
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
OP
|
$708.90
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$638.01 |
| Rate for Payer: Aetna Commercial |
$602.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.78
|
| Rate for Payer: BCBS Complete |
$283.56
|
| Rate for Payer: BCBS Trust/PPO |
$95.76
|
| Rate for Payer: BCCCP Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cofinity Commercial |
$496.23
|
| Rate for Payer: Cofinity Commercial |
$609.65
|
| Rate for Payer: Healthscope Commercial |
$638.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.56
|
| Rate for Payer: PHP Commercial |
$602.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.23
|
| Rate for Payer: Priority Health SBD |
$446.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.22
|
| Rate for Payer: UHC Exchange |
$39.29
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$215.22
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$221.64 |
| Rate for Payer: Aetna Commercial |
$182.94
|
| Rate for Payer: Aetna Medicare |
$184.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.64
|
| Rate for Payer: BCBS Complete |
$101.85
|
| Rate for Payer: BCBS MAPPO |
$177.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.70
|
| Rate for Payer: BCCCP Commercial |
$107.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.31
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$185.09
|
| Rate for Payer: Cofinity Commercial |
$150.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.31
|
| Rate for Payer: Healthscope Commercial |
$193.70
|
| Rate for Payer: Mclaren Medicaid |
$96.99
|
| Rate for Payer: Mclaren Medicare |
$177.31
|
| Rate for Payer: Meridian Medicaid |
$101.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.94
|
| Rate for Payer: PACE Medicare |
$168.44
|
| Rate for Payer: PACE SWMI |
$177.31
|
| Rate for Payer: PHP Commercial |
$182.94
|
| Rate for Payer: PHP Medicare Advantage |
$177.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.65
|
| Rate for Payer: Priority Health Medicare |
$177.31
|
| Rate for Payer: Priority Health SBD |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$177.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.31
|
| Rate for Payer: UHC Exchange |
$61.89
|
| Rate for Payer: UHC Medicare Advantage |
$182.63
|
| Rate for Payer: VA VA |
$177.31
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
IP
|
$215.22
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.59 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Aetna Commercial |
$182.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.89
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$150.65
|
| Rate for Payer: Cofinity Commercial |
$185.09
|
| Rate for Payer: Healthscope Commercial |
$193.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.94
|
| Rate for Payer: PHP Commercial |
$182.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.65
|
| Rate for Payer: Priority Health SBD |
$135.59
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,809.61
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$626.07 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,388.17
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,954.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,247.69
|
| Rate for Payer: Cash Price |
$2,247.69
|
| Rate for Payer: Cofinity Commercial |
$1,966.73
|
| Rate for Payer: Cofinity Commercial |
$2,416.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$2,528.65
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,388.17
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,388.17
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,966.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$1,770.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.68
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$626.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$2,809.61
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,770.05 |
| Max. Negotiated Rate |
$2,528.65 |
| Rate for Payer: Aetna Commercial |
$2,388.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.25
|
| Rate for Payer: Cash Price |
$2,247.69
|
| Rate for Payer: Cofinity Commercial |
$1,966.73
|
| Rate for Payer: Cofinity Commercial |
$2,416.26
|
| Rate for Payer: Healthscope Commercial |
$2,528.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,388.17
|
| Rate for Payer: PHP Commercial |
$2,388.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,966.73
|
| Rate for Payer: Priority Health SBD |
$1,770.05
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
OP
|
$78.54
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$70.69 |
| Rate for Payer: Aetna Commercial |
$66.76
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$54.98
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$70.69
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.76
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$66.76
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.98
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$49.48
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
IP
|
$78.54
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$70.69 |
| Rate for Payer: Aetna Commercial |
$66.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.05
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$54.98
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Healthscope Commercial |
$70.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.76
|
| Rate for Payer: PHP Commercial |
$66.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.98
|
| Rate for Payer: Priority Health SBD |
$49.48
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
IP
|
$156.90
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$141.21 |
| Rate for Payer: Aetna Commercial |
$133.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.98
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cofinity Commercial |
$109.83
|
| Rate for Payer: Cofinity Commercial |
$134.93
|
| Rate for Payer: Healthscope Commercial |
$141.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.36
|
| Rate for Payer: PHP Commercial |
$133.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.83
|
| Rate for Payer: Priority Health SBD |
$98.85
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
OP
|
$156.90
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$141.21 |
| Rate for Payer: Aetna Commercial |
$133.36
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.11
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cofinity Commercial |
$134.93
|
| Rate for Payer: Cofinity Commercial |
$109.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$141.21
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Mclaren Medicare |
$12.09
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.36
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$133.36
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.83
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health SBD |
$98.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.51
|
| Rate for Payer: UHC Core |
$14.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Exchange |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,194.83
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,077.93 |
| Max. Negotiated Rate |
$4,675.35 |
| Rate for Payer: Aetna Commercial |
$4,415.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,376.64
|
| Rate for Payer: BCBS Complete |
$2,077.93
|
| Rate for Payer: Cash Price |
$4,155.86
|
| Rate for Payer: Cofinity Commercial |
$3,636.38
|
| Rate for Payer: Cofinity Commercial |
$4,467.55
|
| Rate for Payer: Healthscope Commercial |
$4,675.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,415.61
|
| Rate for Payer: PHP Commercial |
$4,415.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,636.38
|
| Rate for Payer: Priority Health SBD |
$3,272.74
|
|
|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,194.83
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,272.74 |
| Max. Negotiated Rate |
$4,675.35 |
| Rate for Payer: Aetna Commercial |
$4,415.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,376.64
|
| Rate for Payer: Cash Price |
$4,155.86
|
| Rate for Payer: Cofinity Commercial |
$3,636.38
|
| Rate for Payer: Cofinity Commercial |
$4,467.55
|
| Rate for Payer: Healthscope Commercial |
$4,675.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,415.61
|
| Rate for Payer: PHP Commercial |
$4,415.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,636.38
|
| Rate for Payer: Priority Health SBD |
$3,272.74
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,288.24
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$8,359.42 |
| Rate for Payer: Aetna Commercial |
$7,895.00
|
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,037.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,740.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cofinity Commercial |
$7,987.89
|
| Rate for Payer: Cofinity Commercial |
$6,501.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Healthscope Commercial |
$8,359.42
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,895.00
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Commercial |
$7,895.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,501.77
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health SBD |
$5,851.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
