|
HC GIARDIA SCREEN
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: Priority Health SBD |
$29.42
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
OP
|
$1,886.25
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Commercial |
$1,603.31
|
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,662.69
|
| Rate for Payer: BCN Commercial |
$1,662.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cofinity Advantage |
$1,320.38
|
| Rate for Payer: Cofinity Commercial |
$1,622.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Healthscope Commercial |
$1,697.62
|
| Rate for Payer: Mclaren Medicaid |
$999.98
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.31
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.69
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Commercial |
$1,603.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health SBD |
$1,188.34
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
IP
|
$1,886.25
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,188.34 |
| Max. Negotiated Rate |
$1,697.62 |
| Rate for Payer: Aetna Commercial |
$1,603.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.06
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cofinity Advantage |
$1,320.38
|
| Rate for Payer: Cofinity Commercial |
$1,622.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.00
|
| Rate for Payer: Healthscope Commercial |
$1,697.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.69
|
| Rate for Payer: PHP Commercial |
$1,603.31
|
| Rate for Payer: Priority Health SBD |
$1,188.34
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,847.32
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$738.93 |
| Max. Negotiated Rate |
$1,662.59 |
| Rate for Payer: Aetna Commercial |
$1,570.22
|
| Rate for Payer: Aetna Medicare |
$923.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.76
|
| Rate for Payer: BCBS Complete |
$738.93
|
| Rate for Payer: Cash Price |
$1,477.86
|
| Rate for Payer: Cofinity Advantage |
$1,293.12
|
| Rate for Payer: Cofinity Commercial |
$1,588.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.86
|
| Rate for Payer: Healthscope Commercial |
$1,662.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,477.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.49
|
| Rate for Payer: PHP Commercial |
$1,570.22
|
| Rate for Payer: Priority Health SBD |
$1,163.81
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,847.32
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,163.81 |
| Max. Negotiated Rate |
$1,662.59 |
| Rate for Payer: Aetna Commercial |
$1,570.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.76
|
| Rate for Payer: Cash Price |
$1,477.86
|
| Rate for Payer: Cofinity Advantage |
$1,293.12
|
| Rate for Payer: Cofinity Commercial |
$1,588.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.86
|
| Rate for Payer: Healthscope Commercial |
$1,662.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.49
|
| Rate for Payer: PHP Commercial |
$1,570.22
|
| Rate for Payer: Priority Health SBD |
$1,163.81
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
OP
|
$1,293.30
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$1,163.97 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$393.48
|
| Rate for Payer: BCN Commercial |
$393.48
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$1,034.64
|
| Rate for Payer: Cash Price |
$1,034.64
|
| Rate for Payer: Cash Price |
$1,034.64
|
| Rate for Payer: Cofinity Advantage |
$905.31
|
| Rate for Payer: Cofinity Commercial |
$1,112.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$1,163.97
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.31
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.98
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$1,099.31
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$814.78
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
IP
|
$1,293.30
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.78 |
| Max. Negotiated Rate |
$1,163.97 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.64
|
| Rate for Payer: Cash Price |
$1,034.64
|
| Rate for Payer: Cofinity Advantage |
$905.31
|
| Rate for Payer: Cofinity Commercial |
$1,112.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.64
|
| Rate for Payer: Healthscope Commercial |
$1,163.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.98
|
| Rate for Payer: PHP Commercial |
$1,099.31
|
| Rate for Payer: Priority Health SBD |
$814.78
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
OP
|
$1,251.04
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Advantage |
$875.73
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$788.16
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
IP
|
$1,251.04
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$788.16 |
| Max. Negotiated Rate |
$1,125.94 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.18
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Advantage |
$875.73
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: Priority Health SBD |
$788.16
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
OP
|
$1,376.14
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$1,169.72
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$772.42
|
| Rate for Payer: BCN Commercial |
$772.42
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,100.91
|
| Rate for Payer: Cash Price |
$1,100.91
|
| Rate for Payer: Cash Price |
$1,100.91
|
| Rate for Payer: Cofinity Advantage |
$963.30
|
| Rate for Payer: Cofinity Commercial |
$1,183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$1,238.53
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.72
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.11
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$1,169.72
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$866.97
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
IP
|
$1,376.14
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$1,238.53 |
| Rate for Payer: Aetna Commercial |
$1,169.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.49
|
| Rate for Payer: Cash Price |
$1,100.91
|
| Rate for Payer: Cofinity Advantage |
$963.30
|
| Rate for Payer: Cofinity Commercial |
$1,183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.91
|
| Rate for Payer: Healthscope Commercial |
$1,238.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.11
|
| Rate for Payer: PHP Commercial |
$1,169.72
|
| Rate for Payer: Priority Health SBD |
$866.97
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
OP
|
$1,302.04
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$1,106.73
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$950.25
|
| Rate for Payer: BCN Commercial |
$950.25
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cofinity Advantage |
$911.43
|
| Rate for Payer: Cofinity Commercial |
$1,119.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$1,171.84
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.73
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$976.53
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$1,106.73
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$820.29
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
IP
|
$1,302.04
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.29 |
| Max. Negotiated Rate |
$1,171.84 |
| Rate for Payer: Aetna Commercial |
$1,106.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.33
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cofinity Advantage |
$911.43
|
| Rate for Payer: Cofinity Commercial |
$1,119.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.63
|
| Rate for Payer: Healthscope Commercial |
$1,171.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$976.53
|
| Rate for Payer: PHP Commercial |
$1,106.73
|
| Rate for Payer: Priority Health SBD |
$820.29
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
OP
|
$905.11
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.96 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$432.96
|
| Rate for Payer: BCN Commercial |
$432.96
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Advantage |
$633.58
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$570.22
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
IP
|
$905.11
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.22 |
| Max. Negotiated Rate |
$814.60 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.32
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Advantage |
$633.58
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: Priority Health SBD |
$570.22
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$733.08
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$461.84 |
| Max. Negotiated Rate |
$659.77 |
| Rate for Payer: Aetna Commercial |
$623.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.50
|
| Rate for Payer: Cash Price |
$586.46
|
| Rate for Payer: Cofinity Advantage |
$513.16
|
| Rate for Payer: Cofinity Commercial |
$630.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.46
|
| Rate for Payer: Healthscope Commercial |
$659.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.81
|
| Rate for Payer: PHP Commercial |
$623.12
|
| Rate for Payer: Priority Health SBD |
$461.84
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$733.08
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$217.98 |
| Max. Negotiated Rate |
$659.77 |
| Rate for Payer: Aetna Commercial |
$623.12
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.50
|
| 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 |
$228.90
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$586.46
|
| Rate for Payer: Cash Price |
$586.46
|
| Rate for Payer: Cofinity Advantage |
$513.16
|
| Rate for Payer: Cofinity Commercial |
$630.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$659.77
|
| Rate for Payer: Mclaren Medicaid |
$217.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.12
|
| Rate for Payer: Nomi Health Commercial |
$625.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.81
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$623.12
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$416.78
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health SBD |
$461.84
|
| Rate for Payer: Priority Health Tiered Network |
$333.42
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.17
|
| Rate for Payer: UHC Core |
$625.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.78
|
| Rate for Payer: UHC Exchange |
$625.17
|
| Rate for Payer: UHC Medicaid |
$217.98
|
| Rate for Payer: UHCCP Medicaid |
$217.98
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$905.11
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$886.46
|
| Rate for Payer: BCN Commercial |
$886.46
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Advantage |
$633.58
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$570.22
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$905.11
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.22 |
| Max. Negotiated Rate |
$814.60 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.32
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Advantage |
$633.58
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: Priority Health SBD |
$570.22
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$931.73
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$586.99 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$791.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.62
|
| Rate for Payer: Cash Price |
$745.38
|
| Rate for Payer: Cofinity Advantage |
$652.21
|
| Rate for Payer: Cofinity Commercial |
$801.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.38
|
| Rate for Payer: Healthscope Commercial |
$838.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.80
|
| Rate for Payer: PHP Commercial |
$791.97
|
| Rate for Payer: Priority Health SBD |
$586.99
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$931.73
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$791.97
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$680.63
|
| Rate for Payer: BCN Commercial |
$680.63
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$745.38
|
| Rate for Payer: Cash Price |
$745.38
|
| Rate for Payer: Cash Price |
$745.38
|
| Rate for Payer: Cofinity Advantage |
$652.21
|
| Rate for Payer: Cofinity Commercial |
$801.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$838.56
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.97
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.80
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$791.97
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$586.99
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$959.13
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.25 |
| Max. Negotiated Rate |
$863.22 |
| Rate for Payer: Aetna Commercial |
$815.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.43
|
| Rate for Payer: Cash Price |
$767.30
|
| Rate for Payer: Cofinity Advantage |
$671.39
|
| Rate for Payer: Cofinity Commercial |
$824.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.30
|
| Rate for Payer: Healthscope Commercial |
$863.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$719.35
|
| Rate for Payer: PHP Commercial |
$815.26
|
| Rate for Payer: Priority Health SBD |
$604.25
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$959.13
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$815.26
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$745.06
|
| Rate for Payer: BCN Commercial |
$745.06
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$767.30
|
| Rate for Payer: Cash Price |
$767.30
|
| Rate for Payer: Cash Price |
$767.30
|
| Rate for Payer: Cofinity Advantage |
$671.39
|
| Rate for Payer: Cofinity Commercial |
$824.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$863.22
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.26
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$719.35
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$815.26
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$604.25
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,251.04
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$788.16 |
| Max. Negotiated Rate |
$1,125.94 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.18
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Advantage |
$875.73
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: Priority Health SBD |
$788.16
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
OP
|
$1,251.04
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Advantage |
$875.73
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$788.16
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
