|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
OP
|
$723.08
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.23 |
| Max. Negotiated Rate |
$650.77 |
| Rate for Payer: Aetna Commercial |
$614.62
|
| Rate for Payer: Aetna Medicare |
$361.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.00
|
| Rate for Payer: BCBS Complete |
$289.23
|
| Rate for Payer: Cash Price |
$578.46
|
| Rate for Payer: Cofinity Commercial |
$506.16
|
| Rate for Payer: Cofinity Commercial |
$621.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$506.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.46
|
| Rate for Payer: Healthscope Commercial |
$650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.62
|
| Rate for Payer: PHP Commercial |
$614.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.00
|
| Rate for Payer: Priority Health SBD |
$455.54
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
IP
|
$723.08
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.54 |
| Max. Negotiated Rate |
$650.77 |
| Rate for Payer: Aetna Commercial |
$614.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.00
|
| Rate for Payer: Cash Price |
$578.46
|
| Rate for Payer: Cofinity Commercial |
$506.16
|
| Rate for Payer: Cofinity Commercial |
$621.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$506.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.46
|
| Rate for Payer: Healthscope Commercial |
$650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.62
|
| Rate for Payer: PHP Commercial |
$614.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.00
|
| Rate for Payer: Priority Health SBD |
$455.54
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Commercial |
$186.59
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$188.79
|
| Rate for Payer: Cofinity Commercial |
$153.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$197.57
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$186.59
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.69
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$138.30
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
IP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.30 |
| Max. Negotiated Rate |
$197.57 |
| Rate for Payer: Aetna Commercial |
$186.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.69
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$153.66
|
| Rate for Payer: Cofinity Commercial |
$188.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$197.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: PHP Commercial |
$186.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.69
|
| Rate for Payer: Priority Health SBD |
$138.30
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,805.45 |
| Max. Negotiated Rate |
$2,579.22 |
| Rate for Payer: Aetna Commercial |
$2,435.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.77
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cofinity Commercial |
$2,006.06
|
| Rate for Payer: Cofinity Commercial |
$2,464.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.64
|
| Rate for Payer: Healthscope Commercial |
$2,579.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,435.93
|
| Rate for Payer: PHP Commercial |
$2,435.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,862.77
|
| Rate for Payer: Priority Health SBD |
$1,805.45
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$2,435.93
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cofinity Commercial |
$2,464.59
|
| Rate for Payer: Cofinity Commercial |
$2,006.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,579.22
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,435.93
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$2,435.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,862.77
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$1,805.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.07
|
| 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 |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Commercial |
$56.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$50.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.07
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$56.08
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health SBD |
$50.47
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
OP
|
$160.04
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$144.04 |
| Rate for Payer: Aetna Commercial |
$136.03
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.03
|
| 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 |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Commercial |
$112.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$144.04
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| 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 |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.03
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$136.03
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.03
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health SBD |
$100.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$12.09
|
| Rate for Payer: UHCCP Medicaid |
$6.81
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
IP
|
$160.04
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$144.04 |
| Rate for Payer: Aetna Commercial |
$136.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.03
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$112.03
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.03
|
| Rate for Payer: Healthscope Commercial |
$144.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.03
|
| Rate for Payer: PHP Commercial |
$136.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.03
|
| Rate for Payer: Priority Health SBD |
$100.83
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,119.49 |
| Max. Negotiated Rate |
$4,768.86 |
| Rate for Payer: Aetna Commercial |
$4,503.92
|
| Rate for Payer: Aetna Medicare |
$2,649.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,444.17
|
| Rate for Payer: BCBS Complete |
$2,119.49
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$3,709.11
|
| Rate for Payer: Cofinity Commercial |
$4,556.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,709.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Healthscope Commercial |
$4,768.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: PHP Commercial |
$4,503.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: Priority Health SBD |
$3,338.20
|
|
|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,338.20 |
| Max. Negotiated Rate |
$4,768.86 |
| Rate for Payer: Aetna Commercial |
$4,503.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,444.17
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$3,709.11
|
| Rate for Payer: Cofinity Commercial |
$4,556.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,709.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Healthscope Commercial |
$4,768.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: PHP Commercial |
$4,503.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: Priority Health SBD |
$3,338.20
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Commercial |
$8,052.90
|
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,158.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,147.64
|
| Rate for Payer: Cofinity Commercial |
$6,631.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,631.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Healthscope Commercial |
$8,526.60
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Commercial |
$8,052.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Priority Health SBD |
$5,968.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,893.77
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,968.62 |
| Max. Negotiated Rate |
$8,526.60 |
| Rate for Payer: Aetna Commercial |
$8,052.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,158.10
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$6,631.80
|
| Rate for Payer: Cofinity Commercial |
$8,147.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,631.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Healthscope Commercial |
$8,526.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: PHP Commercial |
$8,052.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health SBD |
$5,968.62
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna Medicare |
$247.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.75
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$346.50
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health SBD |
$311.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.24
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$311.85 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.75
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$346.50
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$346.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health SBD |
$311.85
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.43
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: PHP Commercial |
$238.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UHC Core |
$207.57
|
| Rate for Payer: UHC Exchange |
$207.57
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.72 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.32
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: PHP Commercial |
$238.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,771.34
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,108.54 |
| Max. Negotiated Rate |
$2,494.21 |
| Rate for Payer: Aetna Commercial |
$2,355.64
|
| Rate for Payer: Aetna Medicare |
$1,385.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,801.37
|
| Rate for Payer: BCBS Complete |
$1,108.54
|
| Rate for Payer: Cash Price |
$2,217.07
|
| Rate for Payer: Cofinity Commercial |
$1,939.94
|
| Rate for Payer: Cofinity Commercial |
$2,383.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,939.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.07
|
| Rate for Payer: Healthscope Commercial |
$2,494.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.64
|
| Rate for Payer: PHP Commercial |
$2,355.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.37
|
| Rate for Payer: Priority Health SBD |
$1,745.94
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
IP
|
$2,771.34
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,745.94 |
| Max. Negotiated Rate |
$2,494.21 |
| Rate for Payer: Aetna Commercial |
$2,355.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,801.37
|
| Rate for Payer: Cash Price |
$2,217.07
|
| Rate for Payer: Cofinity Commercial |
$1,939.94
|
| Rate for Payer: Cofinity Commercial |
$2,383.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,939.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.07
|
| Rate for Payer: Healthscope Commercial |
$2,494.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.64
|
| Rate for Payer: PHP Commercial |
$2,355.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.37
|
| Rate for Payer: Priority Health SBD |
$1,745.94
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
OP
|
$8,017.20
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,206.88 |
| Max. Negotiated Rate |
$7,215.48 |
| Rate for Payer: Aetna Commercial |
$6,814.62
|
| Rate for Payer: Aetna Medicare |
$4,008.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,211.18
|
| Rate for Payer: BCBS Complete |
$3,206.88
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$5,612.04
|
| Rate for Payer: Cofinity Commercial |
$6,894.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,612.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: PHP Commercial |
$6,814.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health SBD |
$5,050.84
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
IP
|
$8,017.20
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,050.84 |
| Max. Negotiated Rate |
$7,215.48 |
| Rate for Payer: Aetna Commercial |
$6,814.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,211.18
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$5,612.04
|
| Rate for Payer: Cofinity Commercial |
$6,894.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,612.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: PHP Commercial |
$6,814.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health SBD |
$5,050.84
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
OP
|
$8,017.20
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,206.88 |
| Max. Negotiated Rate |
$7,215.48 |
| Rate for Payer: Aetna Commercial |
$6,814.62
|
| Rate for Payer: Aetna Medicare |
$4,008.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,211.18
|
| Rate for Payer: BCBS Complete |
$3,206.88
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$5,612.04
|
| Rate for Payer: Cofinity Commercial |
$6,894.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,612.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: PHP Commercial |
$6,814.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health SBD |
$5,050.84
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
IP
|
$8,017.20
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,050.84 |
| Max. Negotiated Rate |
$7,215.48 |
| Rate for Payer: Aetna Commercial |
$6,814.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,211.18
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$5,612.04
|
| Rate for Payer: Cofinity Commercial |
$6,894.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,612.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: PHP Commercial |
$6,814.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health SBD |
$5,050.84
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
OP
|
$5,102.04
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,040.82 |
| Max. Negotiated Rate |
$4,591.84 |
| Rate for Payer: Aetna Commercial |
$4,336.73
|
| Rate for Payer: Aetna Medicare |
$2,551.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,316.33
|
| Rate for Payer: BCBS Complete |
$2,040.82
|
| Rate for Payer: Cash Price |
$4,081.63
|
| Rate for Payer: Cofinity Commercial |
$3,571.43
|
| Rate for Payer: Cofinity Commercial |
$4,387.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,571.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,081.63
|
| Rate for Payer: Healthscope Commercial |
$4,591.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,336.73
|
| Rate for Payer: PHP Commercial |
$4,336.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.33
|
| Rate for Payer: Priority Health SBD |
$3,214.29
|
|
