|
HC ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$223.91
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna Commercial |
$190.32
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$97.21
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$97.21
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$179.13
|
| Rate for Payer: Cash Price |
$179.13
|
| Rate for Payer: Cash Price |
$179.13
|
| Rate for Payer: Cofinity Advantage |
$156.74
|
| Rate for Payer: Cofinity Commercial |
$192.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$201.52
|
| Rate for Payer: Mclaren Medicaid |
$105.35
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.32
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.93
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$190.32
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$141.06
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.54
|
| Rate for Payer: UHC Core |
$116.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$88.00
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
IP
|
$223.91
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.06 |
| Max. Negotiated Rate |
$201.52 |
| Rate for Payer: Aetna Commercial |
$190.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.54
|
| Rate for Payer: Cash Price |
$179.13
|
| Rate for Payer: Cofinity Advantage |
$156.74
|
| Rate for Payer: Cofinity Commercial |
$192.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.13
|
| Rate for Payer: Healthscope Commercial |
$201.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.93
|
| Rate for Payer: PHP Commercial |
$190.32
|
| Rate for Payer: Priority Health SBD |
$141.06
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,923.12
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$2,484.65
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,900.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,761.75
|
| Rate for Payer: BCN Commercial |
$1,761.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cofinity Advantage |
$2,046.18
|
| Rate for Payer: Cofinity Commercial |
$2,513.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,338.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$2,630.81
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,484.65
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,192.34
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$2,484.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$1,841.57
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$2,923.12
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,841.57 |
| Max. Negotiated Rate |
$2,630.81 |
| Rate for Payer: Aetna Commercial |
$2,484.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,900.03
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cofinity Advantage |
$2,046.18
|
| Rate for Payer: Cofinity Commercial |
$2,513.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,338.50
|
| Rate for Payer: Healthscope Commercial |
$2,630.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,484.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,192.34
|
| Rate for Payer: PHP Commercial |
$2,484.65
|
| Rate for Payer: Priority Health SBD |
$1,841.57
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
IP
|
$81.71
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$73.54 |
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cofinity Advantage |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.28
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: Priority Health SBD |
$51.48
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
OP
|
$81.71
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$73.54 |
| Rate for Payer: Aetna Commercial |
$69.45
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.11
|
| 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 |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cash Price |
$65.37
|
| Rate for Payer: Cofinity Advantage |
$57.20
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$73.54
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.45
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.28
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$69.45
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
OP
|
$163.24
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$146.92 |
| Rate for Payer: Aetna Commercial |
$138.75
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.11
|
| 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 |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$12.89
|
| Rate for Payer: BCN Commercial |
$12.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$130.59
|
| Rate for Payer: Cash Price |
$130.59
|
| Rate for Payer: Cofinity Advantage |
$114.27
|
| Rate for Payer: Cofinity Commercial |
$140.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$146.92
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Mclaren Medicare |
$12.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: Meridian Medicaid |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.75
|
| Rate for Payer: Nomi Health Commercial |
$18.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.43
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$138.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.09
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health SBD |
$102.84
|
| Rate for Payer: Priority Health Tiered Network |
$9.67
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.14
|
| Rate for Payer: UHC Core |
$18.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.09
|
| Rate for Payer: UHC Exchange |
$18.14
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
IP
|
$163.24
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.84 |
| Max. Negotiated Rate |
$146.92 |
| Rate for Payer: Aetna Commercial |
$138.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.11
|
| Rate for Payer: Cash Price |
$130.59
|
| Rate for Payer: Cofinity Advantage |
$114.27
|
| Rate for Payer: Cofinity Commercial |
$140.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.59
|
| Rate for Payer: Healthscope Commercial |
$146.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.43
|
| Rate for Payer: PHP Commercial |
$138.75
|
| Rate for Payer: Priority Health SBD |
$102.84
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,404.70
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,124.05 |
| Max. Negotiated Rate |
$4,864.23 |
| Rate for Payer: Aetna Commercial |
$4,593.99
|
| Rate for Payer: Aetna Medicare |
$2,702.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,513.05
|
| Rate for Payer: BCBS Complete |
$2,161.88
|
| Rate for Payer: Cash Price |
$4,323.76
|
| Rate for Payer: Cofinity Advantage |
$3,783.29
|
| Rate for Payer: Cofinity Commercial |
$4,648.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,323.76
|
| Rate for Payer: Healthscope Commercial |
$4,864.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,323.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,593.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,053.53
|
| Rate for Payer: PHP Commercial |
$4,593.99
|
| Rate for Payer: Priority Health SBD |
$3,404.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,513.05
|
| Rate for Payer: UHC Core |
$2,815.85
|
| Rate for Payer: UHC Exchange |
$2,124.05
|
|
|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,404.70
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,404.96 |
| Max. Negotiated Rate |
$4,864.23 |
| Rate for Payer: Aetna Commercial |
$4,593.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,513.05
|
| Rate for Payer: Cash Price |
$4,323.76
|
| Rate for Payer: Cofinity Advantage |
$3,783.29
|
| Rate for Payer: Cofinity Commercial |
$4,648.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,323.76
|
| Rate for Payer: Healthscope Commercial |
$4,864.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,593.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,053.53
|
| Rate for Payer: PHP Commercial |
$4,593.99
|
| Rate for Payer: Priority Health SBD |
$3,404.96
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,663.48
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Commercial |
$8,213.96
|
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,281.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,295.43
|
| Rate for Payer: BCN Commercial |
$2,295.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Cash Price |
$7,730.78
|
| Rate for Payer: Cash Price |
$7,730.78
|
| Rate for Payer: Cash Price |
$7,730.78
|
| Rate for Payer: Cofinity Advantage |
$6,764.44
|
| Rate for Payer: Cofinity Commercial |
$8,310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,730.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Healthscope Commercial |
$8,697.13
|
| Rate for Payer: Mclaren Medicaid |
$1,836.94
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,213.96
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,247.61
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Commercial |
$8,213.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health SBD |
$6,087.99
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,281.26
|
| Rate for Payer: UHC Core |
$5,034.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Exchange |
$3,797.75
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,663.48
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,087.99 |
| Max. Negotiated Rate |
$8,697.13 |
| Rate for Payer: Aetna Commercial |
$8,213.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,281.26
|
| Rate for Payer: Cash Price |
$7,730.78
|
| Rate for Payer: Cofinity Advantage |
$6,764.44
|
| Rate for Payer: Cofinity Commercial |
$8,310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,730.78
|
| Rate for Payer: Healthscope Commercial |
$8,697.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,213.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,247.61
|
| Rate for Payer: PHP Commercial |
$8,213.96
|
| Rate for Payer: Priority Health SBD |
$6,087.99
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$504.90
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.09 |
| Max. Negotiated Rate |
$454.41 |
| Rate for Payer: Aetna Commercial |
$429.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.19
|
| Rate for Payer: Cash Price |
$403.92
|
| Rate for Payer: Cofinity Advantage |
$353.43
|
| Rate for Payer: Cofinity Commercial |
$434.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.92
|
| Rate for Payer: Healthscope Commercial |
$454.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.68
|
| Rate for Payer: PHP Commercial |
$429.17
|
| Rate for Payer: Priority Health SBD |
$318.09
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$504.90
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$454.41 |
| Rate for Payer: Aetna Commercial |
$429.17
|
| Rate for Payer: Aetna Medicare |
$252.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.19
|
| Rate for Payer: BCBS Complete |
$201.96
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$403.92
|
| Rate for Payer: Cash Price |
$403.92
|
| Rate for Payer: Cofinity Advantage |
$353.43
|
| Rate for Payer: Cofinity Commercial |
$434.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.92
|
| Rate for Payer: Healthscope Commercial |
$454.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.68
|
| Rate for Payer: PHP Commercial |
$429.17
|
| Rate for Payer: Priority Health SBD |
$318.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.19
|
| Rate for Payer: UHC Core |
$263.05
|
| Rate for Payer: UHC Exchange |
$198.43
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
OP
|
$303.82
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$273.44 |
| Rate for Payer: Aetna Commercial |
$258.25
|
| Rate for Payer: Aetna Medicare |
$151.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.48
|
| Rate for Payer: BCBS Complete |
$121.53
|
| Rate for Payer: BCBS Trust/PPO |
$180.96
|
| Rate for Payer: BCN Commercial |
$180.96
|
| Rate for Payer: Cash Price |
$243.06
|
| Rate for Payer: Cash Price |
$243.06
|
| Rate for Payer: Cofinity Advantage |
$212.67
|
| Rate for Payer: Cofinity Commercial |
$261.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.06
|
| Rate for Payer: Healthscope Commercial |
$273.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.87
|
| Rate for Payer: PHP Commercial |
$258.25
|
| Rate for Payer: Priority Health SBD |
$191.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.48
|
| Rate for Payer: UHC Core |
$158.29
|
| Rate for Payer: UHC Exchange |
$119.40
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
IP
|
$303.82
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.41 |
| Max. Negotiated Rate |
$273.44 |
| Rate for Payer: Aetna Commercial |
$258.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.48
|
| Rate for Payer: Cash Price |
$243.06
|
| Rate for Payer: Cofinity Advantage |
$212.67
|
| Rate for Payer: Cofinity Commercial |
$261.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.06
|
| Rate for Payer: Healthscope Commercial |
$273.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.87
|
| Rate for Payer: PHP Commercial |
$258.25
|
| Rate for Payer: Priority Health SBD |
$191.41
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
IP
|
$2,826.77
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,780.87 |
| Max. Negotiated Rate |
$2,544.09 |
| Rate for Payer: Aetna Commercial |
$2,402.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,837.40
|
| Rate for Payer: Cash Price |
$2,261.42
|
| Rate for Payer: Cofinity Advantage |
$1,978.74
|
| Rate for Payer: Cofinity Commercial |
$2,431.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,261.42
|
| Rate for Payer: Healthscope Commercial |
$2,544.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,402.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,120.08
|
| Rate for Payer: PHP Commercial |
$2,402.75
|
| Rate for Payer: Priority Health SBD |
$1,780.87
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,826.77
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,130.71 |
| Max. Negotiated Rate |
$2,544.09 |
| Rate for Payer: Aetna Commercial |
$2,402.75
|
| Rate for Payer: Aetna Medicare |
$1,413.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,837.40
|
| Rate for Payer: BCBS Complete |
$1,130.71
|
| Rate for Payer: Cash Price |
$2,261.42
|
| Rate for Payer: Cofinity Advantage |
$1,978.74
|
| Rate for Payer: Cofinity Commercial |
$2,431.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,261.42
|
| Rate for Payer: Healthscope Commercial |
$2,544.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,261.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,402.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,120.08
|
| Rate for Payer: PHP Commercial |
$2,402.75
|
| Rate for Payer: Priority Health SBD |
$1,780.87
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
OP
|
$8,177.54
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,271.02 |
| Max. Negotiated Rate |
$7,359.79 |
| Rate for Payer: Aetna Commercial |
$6,950.91
|
| Rate for Payer: Aetna Medicare |
$4,088.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,315.40
|
| Rate for Payer: BCBS Complete |
$3,271.02
|
| Rate for Payer: Cash Price |
$6,542.03
|
| Rate for Payer: Cofinity Advantage |
$5,724.28
|
| Rate for Payer: Cofinity Commercial |
$7,032.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,542.03
|
| Rate for Payer: Healthscope Commercial |
$7,359.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,542.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,950.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,133.15
|
| Rate for Payer: PHP Commercial |
$6,950.91
|
| Rate for Payer: Priority Health SBD |
$5,151.85
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
IP
|
$8,177.54
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,151.85 |
| Max. Negotiated Rate |
$7,359.79 |
| Rate for Payer: Aetna Commercial |
$6,950.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,315.40
|
| Rate for Payer: Cash Price |
$6,542.03
|
| Rate for Payer: Cofinity Advantage |
$5,724.28
|
| Rate for Payer: Cofinity Commercial |
$7,032.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,542.03
|
| Rate for Payer: Healthscope Commercial |
$7,359.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,950.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,133.15
|
| Rate for Payer: PHP Commercial |
$6,950.91
|
| Rate for Payer: Priority Health SBD |
$5,151.85
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
OP
|
$8,177.54
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,271.02 |
| Max. Negotiated Rate |
$7,359.79 |
| Rate for Payer: Aetna Commercial |
$6,950.91
|
| Rate for Payer: Aetna Medicare |
$4,088.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,315.40
|
| Rate for Payer: BCBS Complete |
$3,271.02
|
| Rate for Payer: Cash Price |
$6,542.03
|
| Rate for Payer: Cofinity Advantage |
$5,724.28
|
| Rate for Payer: Cofinity Commercial |
$7,032.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,542.03
|
| Rate for Payer: Healthscope Commercial |
$7,359.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,542.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,950.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,133.15
|
| Rate for Payer: PHP Commercial |
$6,950.91
|
| Rate for Payer: Priority Health SBD |
$5,151.85
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
IP
|
$8,177.54
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,151.85 |
| Max. Negotiated Rate |
$7,359.79 |
| Rate for Payer: Aetna Commercial |
$6,950.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,315.40
|
| Rate for Payer: Cash Price |
$6,542.03
|
| Rate for Payer: Cofinity Advantage |
$5,724.28
|
| Rate for Payer: Cofinity Commercial |
$7,032.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,542.03
|
| Rate for Payer: Healthscope Commercial |
$7,359.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,950.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,133.15
|
| Rate for Payer: PHP Commercial |
$6,950.91
|
| Rate for Payer: Priority Health SBD |
$5,151.85
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
IP
|
$5,204.08
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,278.57 |
| Max. Negotiated Rate |
$4,683.67 |
| Rate for Payer: Aetna Commercial |
$4,423.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,382.65
|
| Rate for Payer: Cash Price |
$4,163.26
|
| Rate for Payer: Cofinity Advantage |
$3,642.86
|
| Rate for Payer: Cofinity Commercial |
$4,475.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,163.26
|
| Rate for Payer: Healthscope Commercial |
$4,683.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,423.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,903.06
|
| Rate for Payer: PHP Commercial |
$4,423.47
|
| Rate for Payer: Priority Health SBD |
$3,278.57
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
OP
|
$5,204.08
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,081.63 |
| Max. Negotiated Rate |
$4,683.67 |
| Rate for Payer: Aetna Commercial |
$4,423.47
|
| Rate for Payer: Aetna Medicare |
$2,602.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,382.65
|
| Rate for Payer: BCBS Complete |
$2,081.63
|
| Rate for Payer: Cash Price |
$4,163.26
|
| Rate for Payer: Cofinity Advantage |
$3,642.86
|
| Rate for Payer: Cofinity Commercial |
$4,475.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,163.26
|
| Rate for Payer: Healthscope Commercial |
$4,683.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,163.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,423.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,903.06
|
| Rate for Payer: PHP Commercial |
$4,423.47
|
| Rate for Payer: Priority Health SBD |
$3,278.57
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
OP
|
$804.23
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.69 |
| Max. Negotiated Rate |
$723.81 |
| Rate for Payer: Aetna Commercial |
$683.60
|
| Rate for Payer: Aetna Medicare |
$402.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.75
|
| Rate for Payer: BCBS Complete |
$321.69
|
| Rate for Payer: Cash Price |
$643.38
|
| Rate for Payer: Cofinity Advantage |
$562.96
|
| Rate for Payer: Cofinity Commercial |
$691.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$643.38
|
| Rate for Payer: Healthscope Commercial |
$723.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$643.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.17
|
| Rate for Payer: PHP Commercial |
$683.60
|
| Rate for Payer: Priority Health SBD |
$506.66
|
|
