|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Trust/PPO |
$81.41
|
| Rate for Payer: BCN Commercial |
$81.41
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$105.00
|
| Rate for Payer: Healthscope Whirlpool |
$101.85
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.40
|
|
|
HC ENDO BIOPSY
|
Facility
|
IP
|
$281.85
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.30 |
| Max. Negotiated Rate |
$281.85 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: ASR ASR |
$273.39
|
| Rate for Payer: BCBS Trust/PPO |
$218.52
|
| Rate for Payer: BCN Commercial |
$218.52
|
| Rate for Payer: Cash Price |
$225.48
|
| Rate for Payer: Cofinity Commercial |
$264.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.48
|
| Rate for Payer: Healthscope Commercial |
$281.85
|
| Rate for Payer: Healthscope Whirlpool |
$273.39
|
| Rate for Payer: Mclaren Commercial |
$253.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.03
|
|
|
HC ENDO BIOPSY
|
Facility
|
OP
|
$281.85
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.74 |
| Max. Negotiated Rate |
$281.85 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: ASR ASR |
$273.39
|
| Rate for Payer: BCBS Complete |
$112.74
|
| Rate for Payer: BCBS Trust/PPO |
$218.52
|
| Rate for Payer: BCN Commercial |
$218.52
|
| Rate for Payer: Cash Price |
$225.48
|
| Rate for Payer: Cofinity Commercial |
$264.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.48
|
| Rate for Payer: Healthscope Commercial |
$281.85
|
| Rate for Payer: Healthscope Whirlpool |
$273.39
|
| Rate for Payer: Mclaren Commercial |
$253.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.48
|
| Rate for Payer: Priority Health Narrow Network |
$200.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.03
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.36 |
| Max. Negotiated Rate |
$893.22 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: Aetna Medicare |
$714.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$893.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$893.22
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: BCBS Complete |
$410.45
|
| Rate for Payer: BCBS MAPPO |
$714.58
|
| Rate for Payer: BCBS Trust/PPO |
$514.02
|
| Rate for Payer: BCCCP Commercial |
$162.36
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: BCN Medicare Advantage |
$714.58
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.58
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$714.58
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Mclaren Medicaid |
$390.88
|
| Rate for Payer: Mclaren Medicare |
$714.58
|
| Rate for Payer: Meridian Medicaid |
$410.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$750.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PACE Medicare |
$678.85
|
| Rate for Payer: PACE SWMI |
$714.58
|
| Rate for Payer: PHP Commercial |
$786.04
|
| Rate for Payer: PHP Medicaid |
$390.88
|
| Rate for Payer: PHP Medicare Advantage |
$714.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$603.33
|
| Rate for Payer: Priority Health Medicare |
$714.58
|
| Rate for Payer: Priority Health Narrow Network |
$470.73
|
| Rate for Payer: Railroad Medicare Medicare |
$714.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
| Rate for Payer: UHC Medicare Advantage |
$736.02
|
| Rate for Payer: VA VA |
$714.58
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: BCBS Trust/PPO |
$514.02
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
|
|
HC ENDO CLIPPING
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: ASR ASR |
$307.49
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS Trust/PPO |
$245.77
|
| Rate for Payer: BCN Commercial |
$245.77
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$297.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.60
|
| Rate for Payer: Healthscope Commercial |
$317.00
|
| Rate for Payer: Healthscope Whirlpool |
$307.49
|
| Rate for Payer: Mclaren Commercial |
$285.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.47
|
| Rate for Payer: Priority Health Narrow Network |
$225.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.96
|
|
|
HC ENDO CLIPPING
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: ASR ASR |
$307.49
|
| Rate for Payer: BCBS Trust/PPO |
$245.77
|
| Rate for Payer: BCN Commercial |
$245.77
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$297.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.60
|
| Rate for Payer: Healthscope Commercial |
$317.00
|
| Rate for Payer: Healthscope Whirlpool |
$307.49
|
| Rate for Payer: Mclaren Commercial |
$285.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$278.96
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
IP
|
$1,770.06
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,239.04 |
| Max. Negotiated Rate |
$1,770.06 |
| Rate for Payer: Aetna Commercial |
$1,593.05
|
| Rate for Payer: ASR ASR |
$1,716.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.33
|
| Rate for Payer: BCN Commercial |
$1,372.33
|
| Rate for Payer: Cash Price |
$1,416.05
|
| Rate for Payer: Cofinity Commercial |
$1,663.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.05
|
| Rate for Payer: Healthscope Commercial |
$1,770.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,716.96
|
| Rate for Payer: Mclaren Commercial |
$1,593.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,504.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,557.65
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
OP
|
$1,770.06
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$708.02 |
| Max. Negotiated Rate |
$1,770.06 |
| Rate for Payer: Aetna Commercial |
$1,593.05
|
| Rate for Payer: ASR ASR |
$1,716.96
|
| Rate for Payer: BCBS Complete |
$708.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.33
|
| Rate for Payer: BCN Commercial |
$1,372.33
|
| Rate for Payer: Cash Price |
$1,416.05
|
| Rate for Payer: Cofinity Commercial |
$1,663.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.05
|
| Rate for Payer: Healthscope Commercial |
$1,770.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,716.96
|
| Rate for Payer: Mclaren Commercial |
$1,593.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,504.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,610.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,256.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,557.65
|
|
|
HC ENDO DILATATION
|
Facility
|
IP
|
$1,304.30
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$913.01 |
| Max. Negotiated Rate |
$1,304.30 |
| Rate for Payer: Aetna Commercial |
$1,173.87
|
| Rate for Payer: ASR ASR |
$1,265.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.22
|
| Rate for Payer: BCN Commercial |
$1,011.22
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,226.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,043.44
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.17
|
| Rate for Payer: Mclaren Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,147.78
|
|
|
HC ENDO DILATATION
|
Facility
|
OP
|
$1,304.30
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.72 |
| Max. Negotiated Rate |
$1,304.30 |
| Rate for Payer: Aetna Commercial |
$1,173.87
|
| Rate for Payer: ASR ASR |
$1,265.17
|
| Rate for Payer: BCBS Complete |
$521.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.22
|
| Rate for Payer: BCN Commercial |
$1,011.22
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,226.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,043.44
|
| Rate for Payer: Healthscope Commercial |
$1,304.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.17
|
| Rate for Payer: Mclaren Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,186.91
|
| Rate for Payer: Priority Health Narrow Network |
$926.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,147.78
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
IP
|
$1,053.46
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$737.42 |
| Max. Negotiated Rate |
$1,053.46 |
| Rate for Payer: Aetna Commercial |
$948.11
|
| Rate for Payer: ASR ASR |
$1,021.86
|
| Rate for Payer: BCBS Trust/PPO |
$816.75
|
| Rate for Payer: BCN Commercial |
$816.75
|
| Rate for Payer: Cash Price |
$842.77
|
| Rate for Payer: Cofinity Commercial |
$990.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.77
|
| Rate for Payer: Healthscope Commercial |
$1,053.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,021.86
|
| Rate for Payer: Mclaren Commercial |
$948.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$927.04
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
OP
|
$1,053.46
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.38 |
| Max. Negotiated Rate |
$1,053.46 |
| Rate for Payer: Aetna Commercial |
$948.11
|
| Rate for Payer: ASR ASR |
$1,021.86
|
| Rate for Payer: BCBS Complete |
$421.38
|
| Rate for Payer: BCBS Trust/PPO |
$816.75
|
| Rate for Payer: BCN Commercial |
$816.75
|
| Rate for Payer: Cash Price |
$842.77
|
| Rate for Payer: Cofinity Commercial |
$990.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.77
|
| Rate for Payer: Healthscope Commercial |
$1,053.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,021.86
|
| Rate for Payer: Mclaren Commercial |
$948.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.65
|
| Rate for Payer: Priority Health Narrow Network |
$747.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$927.04
|
|
|
HC ENDOFORM 2X2
|
Facility
|
IP
|
$38.25
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: ASR ASR |
$37.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
|
|
HC ENDOFORM 2X2
|
Facility
|
OP
|
$38.25
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: ASR ASR |
$37.10
|
| Rate for Payer: BCBS Complete |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$27.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
|
|
HC ENDOFORM 4X4
|
Facility
|
IP
|
$133.06
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.14 |
| Max. Negotiated Rate |
$133.06 |
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$129.07
|
| Rate for Payer: BCBS Trust/PPO |
$103.16
|
| Rate for Payer: BCN Commercial |
$103.16
|
| Rate for Payer: Cash Price |
$106.45
|
| Rate for Payer: Cofinity Commercial |
$125.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.45
|
| Rate for Payer: Healthscope Commercial |
$133.06
|
| Rate for Payer: Healthscope Whirlpool |
$129.07
|
| Rate for Payer: Mclaren Commercial |
$119.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.09
|
|
|
HC ENDOFORM 4X4
|
Facility
|
OP
|
$133.06
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$133.06 |
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: ASR ASR |
$129.07
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$103.16
|
| Rate for Payer: BCN Commercial |
$103.16
|
| Rate for Payer: Cash Price |
$106.45
|
| Rate for Payer: Cofinity Commercial |
$125.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.45
|
| Rate for Payer: Healthscope Commercial |
$133.06
|
| Rate for Payer: Healthscope Whirlpool |
$129.07
|
| Rate for Payer: Mclaren Commercial |
$119.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.08
|
| Rate for Payer: Priority Health Narrow Network |
$94.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.09
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
OP
|
$123.00
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: ASR ASR |
$119.31
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Trust/PPO |
$95.36
|
| Rate for Payer: BCN Commercial |
$95.36
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Healthscope Commercial |
$123.00
|
| Rate for Payer: Healthscope Whirlpool |
$119.31
|
| Rate for Payer: Mclaren Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.93
|
| Rate for Payer: Priority Health Narrow Network |
$87.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.24
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
IP
|
$123.00
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: ASR ASR |
$119.31
|
| Rate for Payer: BCBS Trust/PPO |
$95.36
|
| Rate for Payer: BCN Commercial |
$95.36
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Healthscope Commercial |
$123.00
|
| Rate for Payer: Healthscope Whirlpool |
$119.31
|
| Rate for Payer: Mclaren Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.24
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$454.59 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna Commercial |
$584.48
|
| Rate for Payer: ASR ASR |
$629.94
|
| Rate for Payer: BCBS Trust/PPO |
$503.50
|
| Rate for Payer: BCN Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Healthscope Whirlpool |
$629.94
|
| Rate for Payer: Mclaren Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.49
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.77 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna Commercial |
$584.48
|
| Rate for Payer: ASR ASR |
$629.94
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS Trust/PPO |
$503.50
|
| Rate for Payer: BCN Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Healthscope Whirlpool |
$629.94
|
| Rate for Payer: Mclaren Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.97
|
| Rate for Payer: Priority Health Narrow Network |
$461.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.49
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,999.20 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,498.20
|
| Rate for Payer: ASR ASR |
$4,848.06
|
| Rate for Payer: BCBS Complete |
$1,999.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,874.95
|
| Rate for Payer: BCN Commercial |
$3,874.95
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cofinity Commercial |
$4,698.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,998.40
|
| Rate for Payer: Healthscope Commercial |
$4,998.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,848.06
|
| Rate for Payer: Mclaren Commercial |
$4,498.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,248.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,548.18
|
| Rate for Payer: Priority Health Narrow Network |
$3,548.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,398.24
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
IP
|
$4,998.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,498.60 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,498.20
|
| Rate for Payer: ASR ASR |
$4,848.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,874.95
|
| Rate for Payer: BCN Commercial |
$3,874.95
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cofinity Commercial |
$4,698.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,998.40
|
| Rate for Payer: Healthscope Commercial |
$4,998.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,848.06
|
| Rate for Payer: Mclaren Commercial |
$4,498.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,248.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,398.24
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
IP
|
$13,091.70
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9,164.19 |
| Max. Negotiated Rate |
$13,091.70 |
| Rate for Payer: Aetna Commercial |
$11,782.53
|
| Rate for Payer: ASR ASR |
$12,698.95
|
| Rate for Payer: BCBS Trust/PPO |
$10,150.00
|
| Rate for Payer: BCN Commercial |
$10,150.00
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cofinity Commercial |
$12,306.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,473.36
|
| Rate for Payer: Healthscope Commercial |
$13,091.70
|
| Rate for Payer: Healthscope Whirlpool |
$12,698.95
|
| Rate for Payer: Mclaren Commercial |
$11,782.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,164.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,520.70
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
OP
|
$13,091.70
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,418.40 |
| Max. Negotiated Rate |
$13,091.70 |
| Rate for Payer: Aetna Commercial |
$11,782.53
|
| Rate for Payer: Aetna Medicare |
$4,421.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: ASR ASR |
$12,698.95
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$10,150.00
|
| Rate for Payer: BCN Commercial |
$10,150.00
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cofinity Commercial |
$12,306.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,473.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Healthscope Commercial |
$13,091.70
|
| Rate for Payer: Healthscope Whirlpool |
$12,698.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,421.20
|
| Rate for Payer: Mclaren Commercial |
$11,782.53
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Commercial |
$4,863.32
|
| Rate for Payer: PHP Medicaid |
$2,418.40
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,164.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,913.45
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$9,295.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,520.70
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
