|
HC COGNITIVE EXAM
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna Commercial |
$265.50
|
| Rate for Payer: ASR ASR |
$286.15
|
| Rate for Payer: BCBS Trust/PPO |
$228.71
|
| Rate for Payer: BCN Commercial |
$228.71
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$277.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$295.00
|
| Rate for Payer: Healthscope Whirlpool |
$286.15
|
| Rate for Payer: Mclaren Commercial |
$265.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.60
|
|
|
HC COGNITIVE EXAM
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna Commercial |
$265.50
|
| Rate for Payer: ASR ASR |
$286.15
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS Trust/PPO |
$228.71
|
| Rate for Payer: BCN Commercial |
$228.71
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Commercial |
$277.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$295.00
|
| Rate for Payer: Healthscope Whirlpool |
$286.15
|
| Rate for Payer: Mclaren Commercial |
$265.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.84
|
| Rate for Payer: Priority Health Narrow Network |
$151.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.60
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
IP
|
$111.26
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Aetna Commercial |
$100.13
|
| Rate for Payer: ASR ASR |
$107.92
|
| Rate for Payer: BCBS Trust/PPO |
$86.26
|
| Rate for Payer: BCN Commercial |
$86.26
|
| Rate for Payer: Cash Price |
$89.01
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.01
|
| Rate for Payer: Healthscope Commercial |
$111.26
|
| Rate for Payer: Healthscope Whirlpool |
$107.92
|
| Rate for Payer: Mclaren Commercial |
$100.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.91
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
OP
|
$111.26
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Aetna Commercial |
$100.13
|
| Rate for Payer: ASR ASR |
$107.92
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Trust/PPO |
$86.26
|
| Rate for Payer: BCN Commercial |
$86.26
|
| Rate for Payer: Cash Price |
$89.01
|
| Rate for Payer: Cash Price |
$89.01
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.01
|
| Rate for Payer: Healthscope Commercial |
$111.26
|
| Rate for Payer: Healthscope Whirlpool |
$107.92
|
| Rate for Payer: Mclaren Commercial |
$100.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.10
|
| Rate for Payer: Priority Health Narrow Network |
$20.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.91
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
IP
|
$113.49
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$113.49 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: ASR ASR |
$110.09
|
| Rate for Payer: BCBS Trust/PPO |
$87.99
|
| Rate for Payer: BCN Commercial |
$87.99
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$106.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Healthscope Commercial |
$113.49
|
| Rate for Payer: Healthscope Whirlpool |
$110.09
|
| Rate for Payer: Mclaren Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.87
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
OP
|
$113.49
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$113.49 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: ASR ASR |
$110.09
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS Trust/PPO |
$87.99
|
| Rate for Payer: BCN Commercial |
$87.99
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$106.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Healthscope Commercial |
$113.49
|
| Rate for Payer: Healthscope Whirlpool |
$110.09
|
| Rate for Payer: Mclaren Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.87
|
| Rate for Payer: Priority Health Narrow Network |
$20.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.87
|
|
|
HC COLD AGGLUTININS
|
Facility
|
IP
|
$60.30
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.21 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$54.27
|
| Rate for Payer: ASR ASR |
$58.49
|
| Rate for Payer: BCBS Trust/PPO |
$46.75
|
| Rate for Payer: BCN Commercial |
$46.75
|
| Rate for Payer: Cash Price |
$48.24
|
| Rate for Payer: Cofinity Commercial |
$56.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.24
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Healthscope Whirlpool |
$58.49
|
| Rate for Payer: Mclaren Commercial |
$54.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.06
|
|
|
HC COLD AGGLUTININS
|
Facility
|
OP
|
$60.30
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$54.27
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.09
|
| Rate for Payer: ASR ASR |
$58.49
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.75
|
| Rate for Payer: BCN Commercial |
$46.75
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$48.24
|
| Rate for Payer: Cash Price |
$48.24
|
| Rate for Payer: Cofinity Commercial |
$56.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Healthscope Whirlpool |
$58.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.07
|
| Rate for Payer: Mclaren Commercial |
$54.27
|
| Rate for Payer: Mclaren Medicaid |
$4.41
|
| Rate for Payer: Mclaren Medicare |
$8.07
|
| Rate for Payer: Meridian Medicaid |
$4.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.26
|
| Rate for Payer: PACE Medicare |
$7.67
|
| Rate for Payer: PACE SWMI |
$8.07
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Medicaid |
$4.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.87
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Narrow Network |
$42.81
|
| Rate for Payer: Railroad Medicare Medicare |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.06
|
| Rate for Payer: UHC Medicare Advantage |
$8.31
|
| Rate for Payer: VA VA |
$8.07
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
OP
|
$534.47
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.79 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna Commercial |
$481.02
|
| Rate for Payer: ASR ASR |
$518.44
|
| Rate for Payer: BCBS Complete |
$213.79
|
| Rate for Payer: BCBS Trust/PPO |
$414.37
|
| Rate for Payer: BCN Commercial |
$414.37
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$502.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Healthscope Whirlpool |
$518.44
|
| Rate for Payer: Mclaren Commercial |
$481.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.37
|
| Rate for Payer: Priority Health Narrow Network |
$379.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.33
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
IP
|
$534.47
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.13 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Aetna Commercial |
$481.02
|
| Rate for Payer: ASR ASR |
$518.44
|
| Rate for Payer: BCBS Trust/PPO |
$414.37
|
| Rate for Payer: BCN Commercial |
$414.37
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$502.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$534.47
|
| Rate for Payer: Healthscope Whirlpool |
$518.44
|
| Rate for Payer: Mclaren Commercial |
$481.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$470.33
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
IP
|
$1,844.10
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.87 |
| Max. Negotiated Rate |
$1,844.10 |
| Rate for Payer: Aetna Commercial |
$1,659.69
|
| Rate for Payer: ASR ASR |
$1,788.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,429.73
|
| Rate for Payer: BCN Commercial |
$1,429.73
|
| Rate for Payer: Cash Price |
$1,475.28
|
| Rate for Payer: Cofinity Commercial |
$1,733.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,475.28
|
| Rate for Payer: Healthscope Commercial |
$1,844.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,788.78
|
| Rate for Payer: Mclaren Commercial |
$1,659.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,567.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,622.81
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
OP
|
$1,844.10
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.64 |
| Max. Negotiated Rate |
$1,844.10 |
| Rate for Payer: Aetna Commercial |
$1,659.69
|
| Rate for Payer: ASR ASR |
$1,788.78
|
| Rate for Payer: BCBS Complete |
$737.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,429.73
|
| Rate for Payer: BCN Commercial |
$1,429.73
|
| Rate for Payer: Cash Price |
$1,475.28
|
| Rate for Payer: Cofinity Commercial |
$1,733.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,475.28
|
| Rate for Payer: Healthscope Commercial |
$1,844.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,788.78
|
| Rate for Payer: Mclaren Commercial |
$1,659.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,567.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,678.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,622.81
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.57
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$7.71
|
| Rate for Payer: ASR ASR |
$8.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Healthscope Whirlpool |
$8.31
|
| Rate for Payer: Mclaren Commercial |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.54
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.57
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$7.71
|
| Rate for Payer: ASR ASR |
$8.31
|
| Rate for Payer: BCBS Complete |
$3.43
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Healthscope Whirlpool |
$8.31
|
| Rate for Payer: Mclaren Commercial |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.08
|
| Rate for Payer: Priority Health Narrow Network |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.54
|
|
|
HC COLON DECOMPRESSION
|
Facility
|
OP
|
$2,355.43
|
|
| Hospital Charge Code |
36000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$942.17 |
| Max. Negotiated Rate |
$2,355.43 |
| Rate for Payer: Aetna Commercial |
$2,119.89
|
| Rate for Payer: ASR ASR |
$2,284.77
|
| Rate for Payer: BCBS Complete |
$942.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,826.16
|
| Rate for Payer: BCN Commercial |
$1,826.16
|
| Rate for Payer: Cash Price |
$1,884.34
|
| Rate for Payer: Cofinity Commercial |
$2,214.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,884.34
|
| Rate for Payer: Healthscope Commercial |
$2,355.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,284.77
|
| Rate for Payer: Mclaren Commercial |
$2,119.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,002.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,143.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,672.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,072.78
|
|
|
HC COLON DECOMPRESSION
|
Facility
|
IP
|
$2,355.43
|
|
| Hospital Charge Code |
36000019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.80 |
| Max. Negotiated Rate |
$2,355.43 |
| Rate for Payer: Aetna Commercial |
$2,119.89
|
| Rate for Payer: ASR ASR |
$2,284.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,826.16
|
| Rate for Payer: BCN Commercial |
$1,826.16
|
| Rate for Payer: Cash Price |
$1,884.34
|
| Rate for Payer: Cofinity Commercial |
$2,214.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,884.34
|
| Rate for Payer: Healthscope Commercial |
$2,355.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,284.77
|
| Rate for Payer: Mclaren Commercial |
$2,119.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,002.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,072.78
|
|
|
HC COLON MOTILITY STUDY 6 HRS CONT RECORDING
|
Facility
|
IP
|
$359.40
|
|
|
Service Code
|
CPT 91117
|
| Hospital Charge Code |
75000011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$251.58 |
| Max. Negotiated Rate |
$359.40 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: ASR ASR |
$348.62
|
| Rate for Payer: BCBS Trust/PPO |
$278.64
|
| Rate for Payer: BCN Commercial |
$278.64
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$337.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Healthscope Commercial |
$359.40
|
| Rate for Payer: Healthscope Whirlpool |
$348.62
|
| Rate for Payer: Mclaren Commercial |
$323.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.27
|
|
|
HC COLON MOTILITY STUDY 6 HRS CONT RECORDING
|
Facility
|
OP
|
$359.40
|
|
|
Service Code
|
CPT 91117
|
| Hospital Charge Code |
75000011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$359.40 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$348.62
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$278.64
|
| Rate for Payer: BCN Commercial |
$278.64
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$337.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$359.40
|
| Rate for Payer: Healthscope Whirlpool |
$348.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$323.46
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.05
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$255.17
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.27
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC COLONOSCOPY
|
Facility
|
IP
|
$2,560.49
|
|
| Hospital Charge Code |
36000020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,792.34 |
| Max. Negotiated Rate |
$2,560.49 |
| Rate for Payer: Aetna Commercial |
$2,304.44
|
| Rate for Payer: ASR ASR |
$2,483.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,985.15
|
| Rate for Payer: BCN Commercial |
$1,985.15
|
| Rate for Payer: Cash Price |
$2,048.39
|
| Rate for Payer: Cofinity Commercial |
$2,406.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.39
|
| Rate for Payer: Healthscope Commercial |
$2,560.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,483.68
|
| Rate for Payer: Mclaren Commercial |
$2,304.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,176.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,792.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,253.23
|
|
|
HC COLONOSCOPY
|
Facility
|
OP
|
$2,560.49
|
|
| Hospital Charge Code |
36000020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,024.20 |
| Max. Negotiated Rate |
$2,560.49 |
| Rate for Payer: Aetna Commercial |
$2,304.44
|
| Rate for Payer: ASR ASR |
$2,483.68
|
| Rate for Payer: BCBS Complete |
$1,024.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,985.15
|
| Rate for Payer: BCN Commercial |
$1,985.15
|
| Rate for Payer: Cash Price |
$2,048.39
|
| Rate for Payer: Cofinity Commercial |
$2,406.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.39
|
| Rate for Payer: Healthscope Commercial |
$2,560.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,483.68
|
| Rate for Payer: Mclaren Commercial |
$2,304.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,176.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,792.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,330.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,817.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,253.23
|
|
|
HC COLONOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,745.16
|
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,921.61 |
| Max. Negotiated Rate |
$2,745.16 |
| Rate for Payer: Aetna Commercial |
$2,470.64
|
| Rate for Payer: ASR ASR |
$2,662.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,128.32
|
| Rate for Payer: BCN Commercial |
$2,128.32
|
| Rate for Payer: Cash Price |
$2,196.13
|
| Rate for Payer: Cofinity Commercial |
$2,580.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,196.13
|
| Rate for Payer: Healthscope Commercial |
$2,745.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,662.81
|
| Rate for Payer: Mclaren Commercial |
$2,470.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,333.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,921.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,415.74
|
|
|
HC COLONOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,745.16
|
|
| Hospital Charge Code |
36000022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,098.06 |
| Max. Negotiated Rate |
$2,745.16 |
| Rate for Payer: Aetna Commercial |
$2,470.64
|
| Rate for Payer: ASR ASR |
$2,662.81
|
| Rate for Payer: BCBS Complete |
$1,098.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,128.32
|
| Rate for Payer: BCN Commercial |
$2,128.32
|
| Rate for Payer: Cash Price |
$2,196.13
|
| Rate for Payer: Cofinity Commercial |
$2,580.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,196.13
|
| Rate for Payer: Healthscope Commercial |
$2,745.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,662.81
|
| Rate for Payer: Mclaren Commercial |
$2,470.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,333.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,921.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,498.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,949.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,415.74
|
|
|
HC COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Facility
|
IP
|
$6,832.88
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,783.02 |
| Max. Negotiated Rate |
$6,832.88 |
| Rate for Payer: Aetna Commercial |
$6,149.59
|
| Rate for Payer: ASR ASR |
$6,627.89
|
| Rate for Payer: BCBS Trust/PPO |
$5,297.53
|
| Rate for Payer: BCN Commercial |
$5,297.53
|
| Rate for Payer: Cash Price |
$5,466.30
|
| Rate for Payer: Cofinity Commercial |
$6,422.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,466.30
|
| Rate for Payer: Healthscope Commercial |
$6,832.88
|
| Rate for Payer: Healthscope Whirlpool |
$6,627.89
|
| Rate for Payer: Mclaren Commercial |
$6,149.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,807.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,783.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,012.93
|
|
|
HC COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Facility
|
OP
|
$6,832.88
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
76100328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.46 |
| Max. Negotiated Rate |
$6,832.88 |
| Rate for Payer: Aetna Commercial |
$6,149.59
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: ASR ASR |
$6,627.89
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$5,297.53
|
| Rate for Payer: BCCCP Commercial |
$370.46
|
| Rate for Payer: BCN Commercial |
$5,297.53
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$5,466.30
|
| Rate for Payer: Cash Price |
$5,466.30
|
| Rate for Payer: Cofinity Commercial |
$6,422.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,466.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$6,832.88
|
| Rate for Payer: Healthscope Whirlpool |
$6,627.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$6,149.59
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,807.95
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,783.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,217.92
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$4,851.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,012.93
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
HC COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX
|
Facility
|
OP
|
$7,950.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
76100395
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.36 |
| Max. Negotiated Rate |
$7,950.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: ASR ASR |
$7,711.50
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$6,163.64
|
| Rate for Payer: BCCCP Commercial |
$331.36
|
| Rate for Payer: BCN Commercial |
$6,163.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cash Price |
$6,360.00
|
| Rate for Payer: Cofinity Commercial |
$7,473.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$7,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,711.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$7,155.00
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,757.50
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,565.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,234.50
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$5,644.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,996.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
