|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$235.05
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$164.54 |
| Max. Negotiated Rate |
$235.05 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: ASR ASR |
$228.00
|
| Rate for Payer: BCBS Trust/PPO |
$182.23
|
| Rate for Payer: BCN Commercial |
$182.23
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cofinity Commercial |
$220.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.04
|
| Rate for Payer: Healthscope Commercial |
$235.05
|
| Rate for Payer: Healthscope Whirlpool |
$228.00
|
| Rate for Payer: Mclaren Commercial |
$211.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.84
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$235.05
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$235.05 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$228.00
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$182.23
|
| Rate for Payer: BCN Commercial |
$182.23
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cofinity Commercial |
$220.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$235.05
|
| Rate for Payer: Healthscope Whirlpool |
$228.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$211.54
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.79
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.90
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$166.89
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.84
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$347.08
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.53 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$312.37
|
| 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 |
$336.67
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$269.09
|
| Rate for Payer: BCN Commercial |
$269.09
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cofinity Commercial |
$326.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$347.08
|
| Rate for Payer: Healthscope Whirlpool |
$336.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$312.37
|
| 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 |
$295.02
|
| 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 |
$242.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.41
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$75.53
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.43
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$347.08
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.96 |
| Max. Negotiated Rate |
$347.08 |
| Rate for Payer: Aetna Commercial |
$312.37
|
| Rate for Payer: ASR ASR |
$336.67
|
| Rate for Payer: BCBS Trust/PPO |
$269.09
|
| Rate for Payer: BCN Commercial |
$269.09
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cofinity Commercial |
$326.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.66
|
| Rate for Payer: Healthscope Commercial |
$347.08
|
| Rate for Payer: Healthscope Whirlpool |
$336.67
|
| Rate for Payer: Mclaren Commercial |
$312.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.43
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$382.76
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.10 |
| Max. Negotiated Rate |
$382.76 |
| Rate for Payer: Aetna Commercial |
$344.48
|
| Rate for Payer: ASR ASR |
$371.28
|
| Rate for Payer: BCBS Complete |
$153.10
|
| Rate for Payer: BCBS Trust/PPO |
$296.75
|
| Rate for Payer: BCN Commercial |
$296.75
|
| Rate for Payer: Cash Price |
$306.21
|
| Rate for Payer: Cofinity Commercial |
$359.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.21
|
| Rate for Payer: Healthscope Commercial |
$382.76
|
| Rate for Payer: Healthscope Whirlpool |
$371.28
|
| Rate for Payer: Mclaren Commercial |
$344.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.31
|
| Rate for Payer: Priority Health Narrow Network |
$271.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.83
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$382.76
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.93 |
| Max. Negotiated Rate |
$382.76 |
| Rate for Payer: Aetna Commercial |
$344.48
|
| Rate for Payer: ASR ASR |
$371.28
|
| Rate for Payer: BCBS Trust/PPO |
$296.75
|
| Rate for Payer: BCN Commercial |
$296.75
|
| Rate for Payer: Cash Price |
$306.21
|
| Rate for Payer: Cofinity Commercial |
$359.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.21
|
| Rate for Payer: Healthscope Commercial |
$382.76
|
| Rate for Payer: Healthscope Whirlpool |
$371.28
|
| Rate for Payer: Mclaren Commercial |
$344.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.83
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,416.93
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,416.93 |
| Rate for Payer: Aetna Commercial |
$1,275.24
|
| Rate for Payer: Aetna Medicare |
$480.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.55
|
| Rate for Payer: ASR ASR |
$1,374.42
|
| Rate for Payer: BCBS Complete |
$275.96
|
| Rate for Payer: BCBS MAPPO |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.55
|
| Rate for Payer: BCN Commercial |
$1,098.55
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cofinity Commercial |
$1,331.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,416.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,374.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$480.44
|
| Rate for Payer: Mclaren Commercial |
$1,275.24
|
| Rate for Payer: Mclaren Medicaid |
$262.80
|
| Rate for Payer: Mclaren Medicare |
$480.44
|
| Rate for Payer: Meridian Medicaid |
$275.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.39
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$528.48
|
| Rate for Payer: PHP Medicaid |
$262.80
|
| Rate for Payer: PHP Medicare Advantage |
$480.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,289.41
|
| Rate for Payer: Priority Health Medicare |
$480.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,006.02
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,246.90
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: VA VA |
$480.44
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,416.93
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$991.85 |
| Max. Negotiated Rate |
$1,416.93 |
| Rate for Payer: Aetna Commercial |
$1,275.24
|
| Rate for Payer: ASR ASR |
$1,374.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.55
|
| Rate for Payer: BCN Commercial |
$1,098.55
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cofinity Commercial |
$1,331.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.54
|
| Rate for Payer: Healthscope Commercial |
$1,416.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,374.42
|
| Rate for Payer: Mclaren Commercial |
$1,275.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,246.90
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,475.98
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,033.19 |
| Max. Negotiated Rate |
$1,475.98 |
| Rate for Payer: Aetna Commercial |
$1,328.38
|
| Rate for Payer: ASR ASR |
$1,431.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.33
|
| Rate for Payer: BCN Commercial |
$1,144.33
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,387.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.78
|
| Rate for Payer: Healthscope Commercial |
$1,475.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.70
|
| Rate for Payer: Mclaren Commercial |
$1,328.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.86
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,475.98
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,475.98 |
| Rate for Payer: Aetna Commercial |
$1,328.38
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,431.70
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.33
|
| Rate for Payer: BCN Commercial |
$1,144.33
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,387.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,475.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,328.38
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.58
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,343.14
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.95
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.86
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$41.82 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: ASR ASR |
$40.57
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$41.82
|
| Rate for Payer: Healthscope Whirlpool |
$40.57
|
| Rate for Payer: Mclaren Commercial |
$37.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.80
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna Medicare |
$17.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: ASR ASR |
$40.57
|
| Rate for Payer: BCBS Complete |
$10.13
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$32.42
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$39.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$41.82
|
| Rate for Payer: Healthscope Whirlpool |
$40.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.63
|
| Rate for Payer: Mclaren Commercial |
$37.64
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Medicaid |
$10.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$19.39
|
| Rate for Payer: PHP Medicaid |
$9.64
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.62
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health Narrow Network |
$50.90
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.80
|
| Rate for Payer: UHC Medicare Advantage |
$18.16
|
| Rate for Payer: VA VA |
$17.63
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: ASR ASR |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.41
|
| Rate for Payer: Healthscope Whirlpool |
$3.31
|
| Rate for Payer: Mclaren Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.00
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.41 |
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: ASR ASR |
$3.31
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.41
|
| Rate for Payer: Healthscope Whirlpool |
$3.31
|
| Rate for Payer: Mclaren Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.10
|
| Rate for Payer: Priority Health Narrow Network |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.00
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,923.68
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,346.58 |
| Max. Negotiated Rate |
$1,923.68 |
| Rate for Payer: Aetna Commercial |
$1,731.31
|
| Rate for Payer: ASR ASR |
$1,865.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.43
|
| Rate for Payer: BCN Commercial |
$1,491.43
|
| Rate for Payer: Cash Price |
$1,538.94
|
| Rate for Payer: Cofinity Commercial |
$1,808.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.94
|
| Rate for Payer: Healthscope Commercial |
$1,923.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,865.97
|
| Rate for Payer: Mclaren Commercial |
$1,731.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,692.84
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,923.68
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.47 |
| Max. Negotiated Rate |
$1,923.68 |
| Rate for Payer: Aetna Commercial |
$1,731.31
|
| Rate for Payer: ASR ASR |
$1,865.97
|
| Rate for Payer: BCBS Complete |
$769.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.43
|
| Rate for Payer: BCN Commercial |
$1,491.43
|
| Rate for Payer: Cash Price |
$1,538.94
|
| Rate for Payer: Cofinity Commercial |
$1,808.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.94
|
| Rate for Payer: Healthscope Commercial |
$1,923.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,865.97
|
| Rate for Payer: Mclaren Commercial |
$1,731.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,750.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,692.84
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$146.98
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.89 |
| Max. Negotiated Rate |
$146.98 |
| Rate for Payer: Aetna Commercial |
$132.28
|
| Rate for Payer: ASR ASR |
$142.57
|
| Rate for Payer: BCBS Trust/PPO |
$113.95
|
| Rate for Payer: BCN Commercial |
$113.95
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$146.98
|
| Rate for Payer: Healthscope Whirlpool |
$142.57
|
| Rate for Payer: Mclaren Commercial |
$132.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.34
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$146.98
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$146.98 |
| Rate for Payer: Aetna Commercial |
$132.28
|
| Rate for Payer: ASR ASR |
$142.57
|
| Rate for Payer: BCBS Complete |
$58.79
|
| Rate for Payer: BCBS Trust/PPO |
$113.95
|
| Rate for Payer: BCN Commercial |
$113.95
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$146.98
|
| Rate for Payer: Healthscope Whirlpool |
$142.57
|
| Rate for Payer: Mclaren Commercial |
$132.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.75
|
| Rate for Payer: Priority Health Narrow Network |
$104.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.34
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$578.16
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$231.26 |
| Max. Negotiated Rate |
$578.16 |
| Rate for Payer: Aetna Commercial |
$520.34
|
| Rate for Payer: ASR ASR |
$560.82
|
| Rate for Payer: BCBS Complete |
$231.26
|
| Rate for Payer: BCBS Trust/PPO |
$448.25
|
| Rate for Payer: BCN Commercial |
$448.25
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$543.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Healthscope Commercial |
$578.16
|
| Rate for Payer: Healthscope Whirlpool |
$560.82
|
| Rate for Payer: Mclaren Commercial |
$520.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.13
|
| Rate for Payer: Priority Health Narrow Network |
$410.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.78
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$578.16
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$404.71 |
| Max. Negotiated Rate |
$578.16 |
| Rate for Payer: Aetna Commercial |
$520.34
|
| Rate for Payer: ASR ASR |
$560.82
|
| Rate for Payer: BCBS Trust/PPO |
$448.25
|
| Rate for Payer: BCN Commercial |
$448.25
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$543.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Healthscope Commercial |
$578.16
|
| Rate for Payer: Healthscope Whirlpool |
$560.82
|
| Rate for Payer: Mclaren Commercial |
$520.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.78
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$226.20
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$226.20 |
| Rate for Payer: Aetna Commercial |
$203.58
|
| Rate for Payer: ASR ASR |
$219.41
|
| Rate for Payer: BCBS Complete |
$90.48
|
| Rate for Payer: BCBS Trust/PPO |
$175.37
|
| Rate for Payer: BCN Commercial |
$175.37
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cofinity Commercial |
$212.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.96
|
| Rate for Payer: Healthscope Commercial |
$226.20
|
| Rate for Payer: Healthscope Whirlpool |
$219.41
|
| Rate for Payer: Mclaren Commercial |
$203.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.84
|
| Rate for Payer: Priority Health Narrow Network |
$160.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.06
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$226.20
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$226.20 |
| Rate for Payer: Aetna Commercial |
$203.58
|
| Rate for Payer: ASR ASR |
$219.41
|
| Rate for Payer: BCBS Trust/PPO |
$175.37
|
| Rate for Payer: BCN Commercial |
$175.37
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cofinity Commercial |
$212.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.96
|
| Rate for Payer: Healthscope Commercial |
$226.20
|
| Rate for Payer: Healthscope Whirlpool |
$219.41
|
| Rate for Payer: Mclaren Commercial |
$203.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.06
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$120.60
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$121.61 |
| Rate for Payer: Aetna Commercial |
$108.54
|
| Rate for Payer: Aetna Medicare |
$16.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: ASR ASR |
$116.98
|
| Rate for Payer: BCBS Complete |
$9.41
|
| Rate for Payer: BCBS MAPPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$93.50
|
| Rate for Payer: BCN Commercial |
$93.50
|
| Rate for Payer: BCN Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$120.60
|
| Rate for Payer: Healthscope Whirlpool |
$116.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.38
|
| Rate for Payer: Mclaren Commercial |
$108.54
|
| Rate for Payer: Mclaren Medicaid |
$8.96
|
| Rate for Payer: Mclaren Medicare |
$16.38
|
| Rate for Payer: Meridian Medicaid |
$9.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.51
|
| Rate for Payer: PACE Medicare |
$15.56
|
| Rate for Payer: PACE SWMI |
$16.38
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: PHP Medicaid |
$8.96
|
| Rate for Payer: PHP Medicare Advantage |
$16.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.61
|
| Rate for Payer: Priority Health Medicare |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$97.29
|
| Rate for Payer: Railroad Medicare Medicare |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.13
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: VA VA |
$16.38
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$120.60
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna Commercial |
$108.54
|
| Rate for Payer: ASR ASR |
$116.98
|
| Rate for Payer: BCBS Trust/PPO |
$93.50
|
| Rate for Payer: BCN Commercial |
$93.50
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.48
|
| Rate for Payer: Healthscope Commercial |
$120.60
|
| Rate for Payer: Healthscope Whirlpool |
$116.98
|
| Rate for Payer: Mclaren Commercial |
$108.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.13
|
|
|
HC GGTP
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.72
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
