|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.62
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$203.79
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$206.19
|
| Rate for Payer: Cofinity Commercial |
$167.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$203.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$151.04
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$177.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$177.41
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$151.04 |
| Max. Negotiated Rate |
$215.78 |
| Rate for Payer: Aetna Commercial |
$203.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.84
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$167.82
|
| Rate for Payer: Cofinity Commercial |
$206.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: PHP Commercial |
$203.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health SBD |
$151.04
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.03 |
| Max. Negotiated Rate |
$318.62 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.11
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$247.81
|
| Rate for Payer: Cofinity Commercial |
$304.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Healthscope Commercial |
$318.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: PHP Commercial |
$300.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health SBD |
$223.03
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$304.46
|
| Rate for Payer: Cofinity Commercial |
$247.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$318.62
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$300.92
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$223.03
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$351.38 |
| Rate for Payer: Aetna Commercial |
$331.86
|
| Rate for Payer: Aetna Medicare |
$195.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: BCBS Complete |
$156.17
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$273.29
|
| Rate for Payer: Cofinity Commercial |
$335.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: PHP Commercial |
$331.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health SBD |
$245.96
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.96 |
| Max. Negotiated Rate |
$351.38 |
| Rate for Payer: Aetna Commercial |
$331.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$273.29
|
| Rate for Payer: Cofinity Commercial |
$335.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: PHP Commercial |
$331.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health SBD |
$245.96
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,477.71 |
| Rate for Payer: Aetna Commercial |
$1,228.48
|
| Rate for Payer: Aetna Medicare |
$545.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,242.93
|
| Rate for Payer: Cofinity Commercial |
$1,011.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,011.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,300.74
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$1,228.48
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health SBD |
$910.52
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.71
|
| Rate for Payer: UHC Core |
$1,069.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$1,069.50
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$295.55
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$910.52 |
| Max. Negotiated Rate |
$1,300.74 |
| Rate for Payer: Aetna Commercial |
$1,228.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.43
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,011.69
|
| Rate for Payer: Cofinity Commercial |
$1,242.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,011.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Healthscope Commercial |
$1,300.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: PHP Commercial |
$1,228.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health SBD |
$910.52
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$948.47 |
| Max. Negotiated Rate |
$1,354.95 |
| Rate for Payer: Aetna Commercial |
$1,279.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.58
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,053.85
|
| Rate for Payer: Cofinity Commercial |
$1,294.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,053.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Commercial |
$1,354.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.67
|
| Rate for Payer: PHP Commercial |
$1,279.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: Priority Health SBD |
$948.47
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,354.95 |
| Rate for Payer: Aetna Commercial |
$1,279.67
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,294.73
|
| Rate for Payer: Cofinity Commercial |
$1,053.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,053.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,354.95
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.67
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,279.67
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$948.47
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$1,114.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$1,114.07
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.63
|
| Rate for Payer: UHC Medicare Advantage |
$17.63
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$17.63
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health SBD |
$26.88
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.19
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.26
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.19
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.86 |
| Max. Negotiated Rate |
$1,765.93 |
| Rate for Payer: Aetna Commercial |
$1,667.83
|
| Rate for Payer: Aetna Medicare |
$981.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.40
|
| Rate for Payer: BCBS Complete |
$784.86
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,373.51
|
| Rate for Payer: Cofinity Commercial |
$1,687.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,373.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,765.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: PHP Commercial |
$1,667.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health SBD |
$1,236.15
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,236.15 |
| Max. Negotiated Rate |
$1,765.93 |
| Rate for Payer: Aetna Commercial |
$1,667.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.40
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,373.51
|
| Rate for Payer: Cofinity Commercial |
$1,687.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,373.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,765.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: PHP Commercial |
$1,667.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health SBD |
$1,236.15
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
OP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.14
|
| Rate for Payer: BCBS Complete |
$32.09
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$56.15
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: PHP Commercial |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health SBD |
$50.54
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
IP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.54 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.14
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$56.15
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: PHP Commercial |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health SBD |
$50.54
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: Aetna Medicare |
$74.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.45
|
| Rate for Payer: BCBS Complete |
$59.97
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$134.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: PHP Commercial |
$127.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health SBD |
$94.45
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.45 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.45
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$104.94
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$134.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: PHP Commercial |
$127.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health SBD |
$94.45
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$371.52 |
| Max. Negotiated Rate |
$530.75 |
| Rate for Payer: Aetna Commercial |
$501.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.32
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$507.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$412.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$530.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: PHP Commercial |
$501.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health SBD |
$371.52
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$235.89 |
| Max. Negotiated Rate |
$530.75 |
| Rate for Payer: Aetna Commercial |
$501.26
|
| Rate for Payer: Aetna Medicare |
$294.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.32
|
| Rate for Payer: BCBS Complete |
$235.89
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$507.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$412.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$530.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: PHP Commercial |
$501.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health SBD |
$371.52
|
|
