|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
IP
|
$708.90
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.23 |
| Max. Negotiated Rate |
$708.90 |
| Rate for Payer: Aetna Commercial |
$638.01
|
| Rate for Payer: ASR ASR |
$687.63
|
| Rate for Payer: BCBS Trust/PPO |
$549.61
|
| Rate for Payer: BCN Commercial |
$549.61
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cofinity Commercial |
$666.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.12
|
| Rate for Payer: Healthscope Commercial |
$708.90
|
| Rate for Payer: Healthscope Whirlpool |
$687.63
|
| Rate for Payer: Mclaren Commercial |
$638.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$623.83
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
OP
|
$708.90
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$708.90 |
| Rate for Payer: Aetna Commercial |
$638.01
|
| Rate for Payer: ASR ASR |
$687.63
|
| Rate for Payer: BCBS Complete |
$283.56
|
| Rate for Payer: BCBS Trust/PPO |
$549.61
|
| Rate for Payer: BCCCP Commercial |
$53.05
|
| Rate for Payer: BCN Commercial |
$549.61
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cash Price |
$567.12
|
| Rate for Payer: Cofinity Commercial |
$666.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.12
|
| Rate for Payer: Healthscope Commercial |
$708.90
|
| Rate for Payer: Healthscope Whirlpool |
$687.63
|
| Rate for Payer: Mclaren Commercial |
$638.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$496.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$645.10
|
| Rate for Payer: Priority Health Narrow Network |
$503.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$623.83
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
IP
|
$215.22
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$215.22 |
| Rate for Payer: Aetna Commercial |
$193.70
|
| Rate for Payer: ASR ASR |
$208.76
|
| Rate for Payer: BCBS Trust/PPO |
$166.86
|
| Rate for Payer: BCN Commercial |
$166.86
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.18
|
| Rate for Payer: Healthscope Commercial |
$215.22
|
| Rate for Payer: Healthscope Whirlpool |
$208.76
|
| Rate for Payer: Mclaren Commercial |
$193.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.39
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$215.22
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$193.70
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$208.76
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$166.86
|
| Rate for Payer: BCCCP Commercial |
$107.56
|
| Rate for Payer: BCN Commercial |
$166.86
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$215.22
|
| Rate for Payer: Healthscope Whirlpool |
$208.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.12
|
| Rate for Payer: Mclaren Commercial |
$193.70
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.94
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Commercial |
$194.83
|
| Rate for Payer: PHP Medicaid |
$96.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.85
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$152.81
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.39
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,809.61
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$2,528.65
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$2,725.32
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,178.29
|
| Rate for Payer: BCN Commercial |
$2,178.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,247.69
|
| Rate for Payer: Cash Price |
$2,247.69
|
| Rate for Payer: Cofinity Commercial |
$2,641.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$2,809.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$2,528.65
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,388.17
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,966.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,556.75
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,994.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.46
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$2,809.61
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,966.73 |
| Max. Negotiated Rate |
$2,809.61 |
| Rate for Payer: Aetna Commercial |
$2,528.65
|
| Rate for Payer: ASR ASR |
$2,725.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,178.29
|
| Rate for Payer: BCN Commercial |
$2,178.29
|
| Rate for Payer: Cash Price |
$2,247.69
|
| Rate for Payer: Cofinity Commercial |
$2,641.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.69
|
| Rate for Payer: Healthscope Commercial |
$2,809.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,725.32
|
| Rate for Payer: Mclaren Commercial |
$2,528.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,388.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,966.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,472.46
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
OP
|
$78.54
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$212.42 |
| Rate for Payer: Aetna Commercial |
$70.69
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$76.18
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$60.89
|
| Rate for Payer: BCN Commercial |
$60.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Healthscope Whirlpool |
$76.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.69
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.76
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.12
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
IP
|
$78.54
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.98 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Aetna Commercial |
$70.69
|
| Rate for Payer: ASR ASR |
$76.18
|
| Rate for Payer: BCBS Trust/PPO |
$60.89
|
| Rate for Payer: BCN Commercial |
$60.89
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.83
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Healthscope Whirlpool |
$76.18
|
| Rate for Payer: Mclaren Commercial |
$70.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.12
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
IP
|
$156.90
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.83 |
| Max. Negotiated Rate |
$156.90 |
| Rate for Payer: Aetna Commercial |
$141.21
|
| Rate for Payer: ASR ASR |
$152.19
|
| Rate for Payer: BCBS Trust/PPO |
$121.64
|
| Rate for Payer: BCN Commercial |
$121.64
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cofinity Commercial |
$147.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.52
|
| Rate for Payer: Healthscope Commercial |
$156.90
|
| Rate for Payer: Healthscope Whirlpool |
$152.19
|
| Rate for Payer: Mclaren Commercial |
$141.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.07
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
OP
|
$156.90
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$156.90 |
| Rate for Payer: Aetna Commercial |
$141.21
|
| Rate for Payer: Aetna Medicare |
$12.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.11
|
| Rate for Payer: ASR ASR |
$152.19
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$121.64
|
| Rate for Payer: BCN Commercial |
$121.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cash Price |
$125.52
|
| Rate for Payer: Cofinity Commercial |
$147.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$156.90
|
| Rate for Payer: Healthscope Whirlpool |
$152.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.09
|
| Rate for Payer: Mclaren Commercial |
$141.21
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Mclaren Medicare |
$12.09
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.36
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$13.30
|
| Rate for Payer: PHP Medicaid |
$6.61
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.78
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health Narrow Network |
$111.40
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,194.83
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,077.93 |
| Max. Negotiated Rate |
$5,194.83 |
| Rate for Payer: Aetna Commercial |
$4,675.35
|
| Rate for Payer: ASR ASR |
$5,038.99
|
| Rate for Payer: BCBS Complete |
$2,077.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,027.55
|
| Rate for Payer: BCN Commercial |
$4,027.55
|
| Rate for Payer: Cash Price |
$4,155.86
|
| Rate for Payer: Cofinity Commercial |
$4,883.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,155.86
|
| Rate for Payer: Healthscope Commercial |
$5,194.83
|
| Rate for Payer: Healthscope Whirlpool |
$5,038.99
|
| Rate for Payer: Mclaren Commercial |
$4,675.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,415.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,636.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,727.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,688.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,571.45
|
|
|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,194.83
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,636.38 |
| Max. Negotiated Rate |
$5,194.83 |
| Rate for Payer: Aetna Commercial |
$4,675.35
|
| Rate for Payer: ASR ASR |
$5,038.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,027.55
|
| Rate for Payer: BCN Commercial |
$4,027.55
|
| Rate for Payer: Cash Price |
$4,155.86
|
| Rate for Payer: Cofinity Commercial |
$4,883.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,155.86
|
| Rate for Payer: Healthscope Commercial |
$5,194.83
|
| Rate for Payer: Healthscope Whirlpool |
$5,038.99
|
| Rate for Payer: Mclaren Commercial |
$4,675.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,415.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,636.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,571.45
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,288.24
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.03 |
| Max. Negotiated Rate |
$9,288.24 |
| Rate for Payer: Aetna Commercial |
$8,359.42
|
| Rate for Payer: Aetna Medicare |
$3,098.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: ASR ASR |
$9,009.59
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$7,201.17
|
| Rate for Payer: BCN Commercial |
$7,201.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cofinity Commercial |
$8,730.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,430.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Healthscope Commercial |
$9,288.24
|
| Rate for Payer: Healthscope Whirlpool |
$9,009.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,098.77
|
| Rate for Payer: Mclaren Commercial |
$8,359.42
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,895.00
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Commercial |
$3,408.65
|
| Rate for Payer: PHP Medicaid |
$1,695.03
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,501.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,452.30
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$6,594.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,173.65
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,288.24
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,501.77 |
| Max. Negotiated Rate |
$9,288.24 |
| Rate for Payer: Aetna Commercial |
$8,359.42
|
| Rate for Payer: ASR ASR |
$9,009.59
|
| Rate for Payer: BCBS Trust/PPO |
$7,201.17
|
| Rate for Payer: BCN Commercial |
$7,201.17
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cofinity Commercial |
$8,730.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,430.59
|
| Rate for Payer: Healthscope Commercial |
$9,288.24
|
| Rate for Payer: Healthscope Whirlpool |
$9,009.59
|
| Rate for Payer: Mclaren Commercial |
$8,359.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,895.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,501.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,173.65
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS Trust/PPO |
$383.77
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.45
|
| Rate for Payer: Priority Health Narrow Network |
$351.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: BCBS Trust/PPO |
$383.77
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: ASR ASR |
$266.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$213.21
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$258.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$275.00
|
| Rate for Payer: Healthscope Whirlpool |
$266.75
|
| Rate for Payer: Mclaren Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.25
|
| Rate for Payer: Priority Health Narrow Network |
$195.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.00
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: ASR ASR |
$266.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.21
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$258.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$275.00
|
| Rate for Payer: Healthscope Whirlpool |
$266.75
|
| Rate for Payer: Mclaren Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.00
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
IP
|
$2,717.00
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,901.90 |
| Max. Negotiated Rate |
$2,717.00 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: ASR ASR |
$2,635.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.49
|
| Rate for Payer: BCN Commercial |
$2,106.49
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cofinity Commercial |
$2,553.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,173.60
|
| Rate for Payer: Healthscope Commercial |
$2,717.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,635.49
|
| Rate for Payer: Mclaren Commercial |
$2,445.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,309.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,390.96
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,717.00
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,086.80 |
| Max. Negotiated Rate |
$2,717.00 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: ASR ASR |
$2,635.49
|
| Rate for Payer: BCBS Complete |
$1,086.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.49
|
| Rate for Payer: BCN Commercial |
$2,106.49
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cofinity Commercial |
$2,553.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,173.60
|
| Rate for Payer: Healthscope Commercial |
$2,717.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,635.49
|
| Rate for Payer: Mclaren Commercial |
$2,445.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,309.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,472.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,929.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,390.96
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
IP
|
$5,002.00
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,501.40 |
| Max. Negotiated Rate |
$5,002.00 |
| Rate for Payer: Aetna Commercial |
$4,501.80
|
| Rate for Payer: ASR ASR |
$4,851.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,878.05
|
| Rate for Payer: BCN Commercial |
$3,878.05
|
| Rate for Payer: Cash Price |
$4,001.60
|
| Rate for Payer: Cofinity Commercial |
$4,701.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,001.60
|
| Rate for Payer: Healthscope Commercial |
$5,002.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,851.94
|
| Rate for Payer: Mclaren Commercial |
$4,501.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,251.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,501.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,401.76
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
OP
|
$5,002.00
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,000.80 |
| Max. Negotiated Rate |
$5,002.00 |
| Rate for Payer: Aetna Commercial |
$4,501.80
|
| Rate for Payer: ASR ASR |
$4,851.94
|
| Rate for Payer: BCBS Complete |
$2,000.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,878.05
|
| Rate for Payer: BCN Commercial |
$3,878.05
|
| Rate for Payer: Cash Price |
$4,001.60
|
| Rate for Payer: Cofinity Commercial |
$4,701.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,001.60
|
| Rate for Payer: Healthscope Commercial |
$5,002.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,851.94
|
| Rate for Payer: Mclaren Commercial |
$4,501.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,251.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,501.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,551.82
|
| Rate for Payer: Priority Health Narrow Network |
$3,551.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,401.76
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
IP
|
$773.00
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$541.10 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: ASR ASR |
$749.81
|
| Rate for Payer: BCBS Trust/PPO |
$599.31
|
| Rate for Payer: BCN Commercial |
$599.31
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$726.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$773.00
|
| Rate for Payer: Healthscope Whirlpool |
$749.81
|
| Rate for Payer: Mclaren Commercial |
$695.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$680.24
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
OP
|
$773.00
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: ASR ASR |
$749.81
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: BCBS Trust/PPO |
$599.31
|
| Rate for Payer: BCN Commercial |
$599.31
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$726.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$773.00
|
| Rate for Payer: Healthscope Whirlpool |
$749.81
|
| Rate for Payer: Mclaren Commercial |
$695.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.43
|
| Rate for Payer: Priority Health Narrow Network |
$548.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$680.24
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,175.20 |
| Max. Negotiated Rate |
$2,938.00 |
| Rate for Payer: Aetna Commercial |
$2,644.20
|
| Rate for Payer: ASR ASR |
$2,849.86
|
| Rate for Payer: BCBS Complete |
$1,175.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,277.83
|
| Rate for Payer: BCN Commercial |
$2,277.83
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$2,761.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,350.40
|
| Rate for Payer: Healthscope Commercial |
$2,938.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,849.86
|
| Rate for Payer: Mclaren Commercial |
$2,644.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,497.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,673.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,085.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,585.44
|
|
