|
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: BCBS Trust/PPO |
$10.71
|
| Rate for Payer: BCN Commercial |
$10.71
|
| 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: Nomi Health Commercial |
$18.14
|
| 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 HMO/PPO/Tiered Network |
$12.09
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health Narrow Network |
$9.67
|
| Rate for Payer: Priority Health SBD |
$100.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.51
|
| 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 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 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 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 |
$211.02 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Commercial |
$8,052.90
|
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,158.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,792.08
|
| Rate for Payer: BCN Commercial |
$1,792.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$7,579.20
|
| 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 |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$8,526.60
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$8,052.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Priority Health SBD |
$5,968.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.02
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
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 |
$0.03 |
| 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: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$396.00
|
| 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
|
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 |
$238.42
|
| 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 |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
|
|
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 |
$238.42
|
| 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: BCBS Trust/PPO |
$150.24
|
| Rate for Payer: BCN Commercial |
$150.24
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Cofinity Commercial |
$196.35
|
| 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 |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health SBD |
$176.72
|
| Rate for Payer: UHC Exchange |
$207.57
|
|
|
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
|
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 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
|
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 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 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
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
IP
|
$5,102.04
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,214.29 |
| Max. Negotiated Rate |
$4,591.84 |
| Rate for Payer: Aetna Commercial |
$4,336.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,316.33
|
| 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
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
IP
|
$788.46
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.73 |
| Max. Negotiated Rate |
$709.61 |
| Rate for Payer: Aetna Commercial |
$670.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.50
|
| Rate for Payer: Cash Price |
$630.77
|
| Rate for Payer: Cofinity Commercial |
$551.92
|
| Rate for Payer: Cofinity Commercial |
$678.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$551.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.77
|
| Rate for Payer: Healthscope Commercial |
$709.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.19
|
| Rate for Payer: PHP Commercial |
$670.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.50
|
| Rate for Payer: Priority Health SBD |
$496.73
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
OP
|
$788.46
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.38 |
| Max. Negotiated Rate |
$709.61 |
| Rate for Payer: Aetna Commercial |
$670.19
|
| Rate for Payer: Aetna Medicare |
$394.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.50
|
| Rate for Payer: BCBS Complete |
$315.38
|
| Rate for Payer: Cash Price |
$630.77
|
| Rate for Payer: Cofinity Commercial |
$551.92
|
| Rate for Payer: Cofinity Commercial |
$678.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$551.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.77
|
| Rate for Payer: Healthscope Commercial |
$709.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.19
|
| Rate for Payer: PHP Commercial |
$670.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.50
|
| Rate for Payer: Priority Health SBD |
$496.73
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
IP
|
$2,996.76
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,887.96 |
| Max. Negotiated Rate |
$2,697.08 |
| Rate for Payer: Aetna Commercial |
$2,547.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,947.89
|
| Rate for Payer: Cash Price |
$2,397.41
|
| Rate for Payer: Cofinity Commercial |
$2,097.73
|
| Rate for Payer: Cofinity Commercial |
$2,577.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,097.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,397.41
|
| Rate for Payer: Healthscope Commercial |
$2,697.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,547.25
|
| Rate for Payer: PHP Commercial |
$2,547.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.89
|
| Rate for Payer: Priority Health SBD |
$1,887.96
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
OP
|
$2,996.76
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.28 |
| Max. Negotiated Rate |
$2,697.08 |
| Rate for Payer: Aetna Commercial |
$2,547.25
|
| Rate for Payer: Aetna Medicare |
$1,498.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,947.89
|
| Rate for Payer: BCBS Complete |
$1,198.70
|
| Rate for Payer: BCBS Trust/PPO |
$638.83
|
| Rate for Payer: BCN Commercial |
$638.83
|
| Rate for Payer: Cash Price |
$2,397.41
|
| Rate for Payer: Cash Price |
$2,397.41
|
| Rate for Payer: Cash Price |
$2,397.41
|
| Rate for Payer: Cofinity Commercial |
$2,097.73
|
| Rate for Payer: Cofinity Commercial |
$2,577.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,097.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,397.41
|
| Rate for Payer: Healthscope Commercial |
$2,697.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,547.25
|
| Rate for Payer: PHP Commercial |
$2,547.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.89
|
| Rate for Payer: Priority Health SBD |
$1,887.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.28
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC ENDOVENOUS ABLAT EXTR W IMAGING PERC FIRST VEIN
|
Facility
|
IP
|
$4,078.88
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
36100523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,569.69 |
| Max. Negotiated Rate |
$3,670.99 |
| Rate for Payer: Aetna Commercial |
$3,467.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,651.27
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cofinity Commercial |
$2,855.22
|
| Rate for Payer: Cofinity Commercial |
$3,507.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,855.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,263.10
|
| Rate for Payer: Healthscope Commercial |
$3,670.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,467.05
|
| Rate for Payer: PHP Commercial |
$3,467.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.27
|
| Rate for Payer: Priority Health SBD |
$2,569.69
|
|
|
HC ENDOVENOUS ABLAT EXTR W IMAGING PERC FIRST VEIN
|
Facility
|
OP
|
$4,078.88
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
36100523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.76 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Commercial |
$3,467.05
|
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,651.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cash Price |
$3,263.10
|
| Rate for Payer: Cofinity Commercial |
$3,507.84
|
| Rate for Payer: Cofinity Commercial |
$2,855.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,855.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,263.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,670.99
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,467.05
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,467.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Priority Health SBD |
$2,569.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.76
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,736.21
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC ENDOVENOUS ABLAT SUBS VEIN SEP ACCESS SITE EXTR
|
Facility
|
IP
|
$261.53
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
36100524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.76 |
| Max. Negotiated Rate |
$235.38 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.99
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cofinity Commercial |
$183.07
|
| Rate for Payer: Cofinity Commercial |
$224.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$235.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.30
|
| Rate for Payer: PHP Commercial |
$222.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: Priority Health SBD |
$164.76
|
|
|
HC ENDOVENOUS ABLAT SUBS VEIN SEP ACCESS SITE EXTR
|
Facility
|
OP
|
$261.53
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
36100524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.13 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Medicare |
$130.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.99
|
| Rate for Payer: BCBS Complete |
$104.61
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cash Price |
$209.22
|
| Rate for Payer: Cofinity Commercial |
$183.07
|
| Rate for Payer: Cofinity Commercial |
$224.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.22
|
| Rate for Payer: Healthscope Commercial |
$235.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.30
|
| Rate for Payer: PHP Commercial |
$222.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.99
|
| Rate for Payer: Priority Health SBD |
$164.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.13
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
