|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,313.50
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,019.45 |
| Max. Negotiated Rate |
$4,313.50 |
| Rate for Payer: Aetna Commercial |
$3,882.15
|
| Rate for Payer: ASR ASR |
$4,184.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,344.26
|
| Rate for Payer: BCN Commercial |
$3,344.26
|
| Rate for Payer: Cash Price |
$3,450.80
|
| Rate for Payer: Cofinity Commercial |
$4,054.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,450.80
|
| Rate for Payer: Healthscope Commercial |
$4,313.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,184.10
|
| Rate for Payer: Mclaren Commercial |
$3,882.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,666.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,019.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,795.88
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,313.50
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,725.40 |
| Max. Negotiated Rate |
$4,313.50 |
| Rate for Payer: Aetna Commercial |
$3,882.15
|
| Rate for Payer: ASR ASR |
$4,184.10
|
| Rate for Payer: BCBS Complete |
$1,725.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,344.26
|
| Rate for Payer: BCN Commercial |
$3,344.26
|
| Rate for Payer: Cash Price |
$3,450.80
|
| Rate for Payer: Cofinity Commercial |
$4,054.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,450.80
|
| Rate for Payer: Healthscope Commercial |
$4,313.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,184.10
|
| Rate for Payer: Mclaren Commercial |
$3,882.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,666.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,019.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,925.28
|
| Rate for Payer: Priority Health Narrow Network |
$3,062.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,795.88
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,150.57
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.40 |
| Max. Negotiated Rate |
$2,150.57 |
| Rate for Payer: Aetna Commercial |
$1,935.51
|
| Rate for Payer: ASR ASR |
$2,086.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,667.34
|
| Rate for Payer: BCN Commercial |
$1,667.34
|
| Rate for Payer: Cash Price |
$1,720.46
|
| Rate for Payer: Cofinity Commercial |
$2,021.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.46
|
| Rate for Payer: Healthscope Commercial |
$2,150.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,086.05
|
| Rate for Payer: Mclaren Commercial |
$1,935.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,827.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,892.50
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,150.57
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.23 |
| Max. Negotiated Rate |
$2,150.57 |
| Rate for Payer: Aetna Commercial |
$1,935.51
|
| Rate for Payer: ASR ASR |
$2,086.05
|
| Rate for Payer: BCBS Complete |
$860.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,667.34
|
| Rate for Payer: BCN Commercial |
$1,667.34
|
| Rate for Payer: Cash Price |
$1,720.46
|
| Rate for Payer: Cofinity Commercial |
$2,021.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.46
|
| Rate for Payer: Healthscope Commercial |
$2,150.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,086.05
|
| Rate for Payer: Mclaren Commercial |
$1,935.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,827.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,957.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,526.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,892.50
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$1,679.56
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,175.69 |
| Max. Negotiated Rate |
$1,679.56 |
| Rate for Payer: Aetna Commercial |
$1,511.60
|
| Rate for Payer: ASR ASR |
$1,629.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.16
|
| Rate for Payer: BCN Commercial |
$1,302.16
|
| Rate for Payer: Cash Price |
$1,343.65
|
| Rate for Payer: Cofinity Commercial |
$1,578.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.65
|
| Rate for Payer: Healthscope Commercial |
$1,679.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,629.17
|
| Rate for Payer: Mclaren Commercial |
$1,511.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,427.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,478.01
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$1,679.56
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$671.82 |
| Max. Negotiated Rate |
$1,679.56 |
| Rate for Payer: Aetna Commercial |
$1,511.60
|
| Rate for Payer: ASR ASR |
$1,629.17
|
| Rate for Payer: BCBS Complete |
$671.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.16
|
| Rate for Payer: BCN Commercial |
$1,302.16
|
| Rate for Payer: Cash Price |
$1,343.65
|
| Rate for Payer: Cofinity Commercial |
$1,578.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.65
|
| Rate for Payer: Healthscope Commercial |
$1,679.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,629.17
|
| Rate for Payer: Mclaren Commercial |
$1,511.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,427.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,192.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,478.01
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$46.79
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$46.79 |
| Rate for Payer: Aetna Commercial |
$42.11
|
| Rate for Payer: ASR ASR |
$45.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.28
|
| Rate for Payer: BCN Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$43.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Healthscope Commercial |
$46.79
|
| Rate for Payer: Healthscope Whirlpool |
$45.39
|
| Rate for Payer: Mclaren Commercial |
$42.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.18
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$46.79
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$46.79 |
| Rate for Payer: Aetna Commercial |
$42.11
|
| Rate for Payer: ASR ASR |
$45.39
|
| Rate for Payer: BCBS Complete |
$18.72
|
| Rate for Payer: BCBS Trust/PPO |
$36.28
|
| Rate for Payer: BCN Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$43.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Healthscope Commercial |
$46.79
|
| Rate for Payer: Healthscope Whirlpool |
$45.39
|
| Rate for Payer: Mclaren Commercial |
$42.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.58
|
| Rate for Payer: Priority Health Narrow Network |
$33.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.18
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$74.12
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$74.12 |
| Rate for Payer: Aetna Commercial |
$66.71
|
| Rate for Payer: ASR ASR |
$71.90
|
| Rate for Payer: BCBS Complete |
$29.65
|
| Rate for Payer: BCBS Trust/PPO |
$57.47
|
| Rate for Payer: BCN Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$59.30
|
| Rate for Payer: Cofinity Commercial |
$69.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.30
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$71.90
|
| Rate for Payer: Mclaren Commercial |
$66.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.45
|
| Rate for Payer: Priority Health Narrow Network |
$52.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.23
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
IP
|
$74.12
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$74.12 |
| Rate for Payer: Aetna Commercial |
$66.71
|
| Rate for Payer: ASR ASR |
$71.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.47
|
| Rate for Payer: BCN Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$59.30
|
| Rate for Payer: Cofinity Commercial |
$69.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.30
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$71.90
|
| Rate for Payer: Mclaren Commercial |
$66.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.23
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
IP
|
$103.46
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$103.46 |
| Rate for Payer: Aetna Commercial |
$93.11
|
| Rate for Payer: ASR ASR |
$100.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.21
|
| Rate for Payer: BCN Commercial |
$80.21
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cofinity Commercial |
$97.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$103.46
|
| Rate for Payer: Healthscope Whirlpool |
$100.36
|
| Rate for Payer: Mclaren Commercial |
$93.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.04
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
OP
|
$103.46
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$103.46 |
| Rate for Payer: Aetna Commercial |
$93.11
|
| Rate for Payer: ASR ASR |
$100.36
|
| Rate for Payer: BCBS Complete |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$80.21
|
| Rate for Payer: BCN Commercial |
$80.21
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cofinity Commercial |
$97.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$103.46
|
| Rate for Payer: Healthscope Whirlpool |
$100.36
|
| Rate for Payer: Mclaren Commercial |
$93.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.15
|
| Rate for Payer: Priority Health Narrow Network |
$73.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.04
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
OP
|
$637.47
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.99 |
| Max. Negotiated Rate |
$637.47 |
| Rate for Payer: Aetna Commercial |
$573.72
|
| Rate for Payer: ASR ASR |
$618.35
|
| Rate for Payer: BCBS Complete |
$254.99
|
| Rate for Payer: BCBS Trust/PPO |
$494.23
|
| Rate for Payer: BCN Commercial |
$494.23
|
| Rate for Payer: Cash Price |
$509.98
|
| Rate for Payer: Cofinity Commercial |
$599.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.98
|
| Rate for Payer: Healthscope Commercial |
$637.47
|
| Rate for Payer: Healthscope Whirlpool |
$618.35
|
| Rate for Payer: Mclaren Commercial |
$573.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.10
|
| Rate for Payer: Priority Health Narrow Network |
$452.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$560.97
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
IP
|
$637.47
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.23 |
| Max. Negotiated Rate |
$637.47 |
| Rate for Payer: Aetna Commercial |
$573.72
|
| Rate for Payer: ASR ASR |
$618.35
|
| Rate for Payer: BCBS Trust/PPO |
$494.23
|
| Rate for Payer: BCN Commercial |
$494.23
|
| Rate for Payer: Cash Price |
$509.98
|
| Rate for Payer: Cofinity Commercial |
$599.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.98
|
| Rate for Payer: Healthscope Commercial |
$637.47
|
| Rate for Payer: Healthscope Whirlpool |
$618.35
|
| Rate for Payer: Mclaren Commercial |
$573.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$560.97
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$948.45
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$948.45 |
| Rate for Payer: Aetna Commercial |
$853.60
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$920.00
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$735.33
|
| Rate for Payer: BCN Commercial |
$735.33
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cofinity Commercial |
$891.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$948.45
|
| Rate for Payer: Healthscope Whirlpool |
$920.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$853.60
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.18
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$863.09
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$673.40
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$834.64
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$948.45
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$663.92 |
| Max. Negotiated Rate |
$948.45 |
| Rate for Payer: Aetna Commercial |
$853.60
|
| Rate for Payer: ASR ASR |
$920.00
|
| Rate for Payer: BCBS Trust/PPO |
$735.33
|
| Rate for Payer: BCN Commercial |
$735.33
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cofinity Commercial |
$891.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.76
|
| Rate for Payer: Healthscope Commercial |
$948.45
|
| Rate for Payer: Healthscope Whirlpool |
$920.00
|
| Rate for Payer: Mclaren Commercial |
$853.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$834.64
|
|
|
HC DUST MITE DF IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUST MITE DF IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC DUST MITE DP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC DUST MITE DP IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
OP
|
$767.51
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$767.51 |
| Rate for Payer: Aetna Commercial |
$690.76
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$744.48
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$595.05
|
| Rate for Payer: BCN Commercial |
$595.05
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cofinity Commercial |
$721.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$767.51
|
| Rate for Payer: Healthscope Whirlpool |
$744.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$690.76
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.38
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$698.43
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$544.93
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$675.41
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
IP
|
$767.51
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$537.26 |
| Max. Negotiated Rate |
$767.51 |
| Rate for Payer: Aetna Commercial |
$690.76
|
| Rate for Payer: ASR ASR |
$744.48
|
| Rate for Payer: BCBS Trust/PPO |
$595.05
|
| Rate for Payer: BCN Commercial |
$595.05
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cofinity Commercial |
$721.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.01
|
| Rate for Payer: Healthscope Commercial |
$767.51
|
| Rate for Payer: Healthscope Whirlpool |
$744.48
|
| Rate for Payer: Mclaren Commercial |
$690.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$675.41
|
|
|
HC E72 MOUSE URINE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC E72 MOUSE URINE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
