|
HC GI LONG TUBE PLACEMENT
|
Facility
|
OP
|
$1,251.48
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$1,063.76
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$720.44
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$1,001.18
|
| Rate for Payer: Cash Price |
$1,001.18
|
| Rate for Payer: Cofinity Commercial |
$876.04
|
| Rate for Payer: Cofinity Commercial |
$1,076.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$1,126.33
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,063.76
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$1,063.76
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$788.43
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.17
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$18.34
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
IP
|
$1,251.48
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.43 |
| Max. Negotiated Rate |
$1,126.33 |
| Rate for Payer: Aetna Commercial |
$1,063.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.46
|
| Rate for Payer: Cash Price |
$1,001.18
|
| Rate for Payer: Cofinity Commercial |
$876.04
|
| Rate for Payer: Cofinity Commercial |
$1,076.27
|
| Rate for Payer: Healthscope Commercial |
$1,126.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,063.76
|
| Rate for Payer: PHP Commercial |
$1,063.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.04
|
| Rate for Payer: Priority Health SBD |
$788.43
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$328.25
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.67
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$48.79
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$548.07 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$704.62
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$443.91 |
| Max. Negotiated Rate |
$634.16 |
| Rate for Payer: Aetna Commercial |
$598.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.00
|
| Rate for Payer: Cash Price |
$563.70
|
| Rate for Payer: Cofinity Commercial |
$605.97
|
| Rate for Payer: Cofinity Commercial |
$493.23
|
| Rate for Payer: Healthscope Commercial |
$634.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$598.93
|
| Rate for Payer: PHP Commercial |
$598.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.23
|
| Rate for Payer: Priority Health SBD |
$443.91
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$704.62
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$227.98 |
| Max. Negotiated Rate |
$680.62 |
| Rate for Payer: Aetna Commercial |
$598.93
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: BCBS Complete |
$239.40
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$326.38
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$563.70
|
| Rate for Payer: Cash Price |
$563.70
|
| Rate for Payer: Cofinity Commercial |
$605.97
|
| Rate for Payer: Cofinity Commercial |
$493.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$634.16
|
| Rate for Payer: Mclaren Medicaid |
$227.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Medicaid |
$239.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$598.93
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$598.93
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.23
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health SBD |
$443.91
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.14
|
| Rate for Payer: UHC Core |
$680.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$416.78
|
| Rate for Payer: UHC Medicare Advantage |
$429.28
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$672.08
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.93
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$84.48
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$548.07 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$516.03
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.99
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$129.99
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$548.07 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$869.96
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$548.07 |
| Max. Negotiated Rate |
$782.96 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health SBD |
$548.07
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$869.96
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$739.47
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$564.87
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cash Price |
$695.97
|
| Rate for Payer: Cofinity Commercial |
$608.97
|
| Rate for Payer: Cofinity Commercial |
$748.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$782.96
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$739.47
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$739.47
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$548.07
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.79
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$62.54
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
OP
|
$1,202.46
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$961.97
|
| Rate for Payer: Cash Price |
$961.97
|
| Rate for Payer: Cofinity Commercial |
$1,034.12
|
| Rate for Payer: Cofinity Commercial |
$841.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$1,082.21
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,022.09
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$1,022.09
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$757.55
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.62
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$1,580.56
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,202.46
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$757.55 |
| Max. Negotiated Rate |
$1,082.21 |
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.60
|
| Rate for Payer: Cash Price |
$961.97
|
| Rate for Payer: Cofinity Commercial |
$1,034.12
|
| Rate for Payer: Cofinity Commercial |
$841.72
|
| Rate for Payer: Healthscope Commercial |
$1,082.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,022.09
|
| Rate for Payer: PHP Commercial |
$1,022.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.72
|
| Rate for Payer: Priority Health SBD |
$757.55
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$17.55
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| 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 |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Cofinity Commercial |
$34.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| 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 |
$41.65
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$41.65
|
| 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 |
$34.30
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$30.87
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$13.84
|
| 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 GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna Commercial |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.85
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$34.30
|
| Rate for Payer: Cofinity Commercial |
$42.14
|
| Rate for Payer: Healthscope Commercial |
$44.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: PHP Commercial |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health SBD |
$30.87
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
IP
|
$303.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$272.86 |
| Rate for Payer: Aetna Commercial |
$257.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.07
|
| Rate for Payer: Cash Price |
$242.54
|
| Rate for Payer: Cofinity Commercial |
$212.23
|
| Rate for Payer: Cofinity Commercial |
$260.73
|
| Rate for Payer: Healthscope Commercial |
$272.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.70
|
| Rate for Payer: PHP Commercial |
$257.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.23
|
| Rate for Payer: Priority Health SBD |
$191.00
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
OP
|
$303.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$272.86 |
| Rate for Payer: Aetna Commercial |
$257.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.07
|
| Rate for Payer: BCBS Complete |
$121.27
|
| Rate for Payer: Cash Price |
$242.54
|
| Rate for Payer: Cofinity Commercial |
$212.23
|
| Rate for Payer: Cofinity Commercial |
$260.73
|
| Rate for Payer: Healthscope Commercial |
$272.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.70
|
| Rate for Payer: PHP Commercial |
$257.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.23
|
| Rate for Payer: Priority Health SBD |
$191.00
|
|
|
HC GLUC 6 PHOS DEHYDROGENASE
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
30100228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Medicare |
$10.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.12
|
| Rate for Payer: BCBS Complete |
$5.57
|
| Rate for Payer: BCBS MAPPO |
$9.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$9.70
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$37.10
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.70
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Mclaren Medicaid |
$5.31
|
| Rate for Payer: Mclaren Medicare |
$9.70
|
| Rate for Payer: Meridian Medicaid |
$5.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.05
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.70
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: PHP Medicare Advantage |
$9.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health Medicare |
$9.70
|
| Rate for Payer: Priority Health SBD |
$33.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.64
|
| Rate for Payer: UHC Core |
$16.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.70
|
| Rate for Payer: UHC Exchange |
$9.70
|
| Rate for Payer: UHC Medicare Advantage |
$9.99
|
| Rate for Payer: VA VA |
$9.70
|
|
|
HC GLUC 6 PHOS DEHYDROGENASE
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
30100228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.45
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$37.10
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.05
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health SBD |
$33.39
|
|
|
HC GLUCAGON LEVEL
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
30100221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health SBD |
$51.03
|
|
