|
HC ENCEPHALOPATHY EVAL, S CMPT 2
|
Facility
|
OP
|
$96.76
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$250.58 |
| Rate for Payer: Aetna Commercial |
$87.08
|
| 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 |
$93.86
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$79.78
|
| Rate for Payer: BCN Commercial |
$79.78
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$90.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$93.86
|
| Rate for Payer: Healthscope Whirlpool |
$96.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$87.08
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$79.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENCEPHALOPATHY EVAL, S CMPT 2
|
Facility
|
IP
|
$96.76
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.57 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: ASR ASR |
$93.86
|
| Rate for Payer: BCBS Trust/PPO |
$79.46
|
| Rate for Payer: BCN Commercial |
$79.46
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$90.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Healthscope Commercial |
$93.86
|
| Rate for Payer: Healthscope Whirlpool |
$96.76
|
| Rate for Payer: Mclaren Commercial |
$87.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$79.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.15
|
|
|
HC ENCEPHALOPATHY EVAL, SERUM
|
Facility
|
OP
|
$213.50
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$213.50 |
| Rate for Payer: Aetna Commercial |
$192.15
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$207.09
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$176.03
|
| Rate for Payer: BCN Commercial |
$176.03
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$170.80
|
| Rate for Payer: Cash Price |
$170.80
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$207.09
|
| Rate for Payer: Healthscope Whirlpool |
$213.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$192.15
|
| Rate for Payer: Mclaren Medicaid |
$23.57
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.47
|
| Rate for Payer: Nomi Health Commercial |
$175.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.12
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$187.07
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$149.66
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ENCEPHALOPATHY EVAL, SERUM
|
Facility
|
IP
|
$213.50
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$160.12 |
| Max. Negotiated Rate |
$213.50 |
| Rate for Payer: Aetna Commercial |
$192.15
|
| Rate for Payer: ASR ASR |
$207.09
|
| Rate for Payer: BCBS Trust/PPO |
$175.33
|
| Rate for Payer: BCN Commercial |
$175.33
|
| Rate for Payer: Cash Price |
$170.80
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.80
|
| Rate for Payer: Healthscope Commercial |
$207.09
|
| Rate for Payer: Healthscope Whirlpool |
$213.50
|
| Rate for Payer: Mclaren Commercial |
$192.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.47
|
| Rate for Payer: Nomi Health Commercial |
$175.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.88
|
|
|
HC ENCEPH AUTOIMMUNE EVAL
|
Facility
|
OP
|
$158.14
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$158.14 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$153.40
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$130.39
|
| Rate for Payer: BCN Commercial |
$130.39
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$148.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$153.40
|
| Rate for Payer: Healthscope Whirlpool |
$158.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$142.33
|
| Rate for Payer: Mclaren Medicaid |
$23.57
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: Nomi Health Commercial |
$129.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.61
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.56
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$110.86
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ENCEPH AUTOIMMUNE EVAL
|
Facility
|
IP
|
$158.14
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$118.61 |
| Max. Negotiated Rate |
$158.14 |
| Rate for Payer: Aetna Commercial |
$142.33
|
| Rate for Payer: ASR ASR |
$153.40
|
| Rate for Payer: BCBS Trust/PPO |
$129.86
|
| Rate for Payer: BCN Commercial |
$129.86
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$148.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Healthscope Commercial |
$153.40
|
| Rate for Payer: Healthscope Whirlpool |
$158.14
|
| Rate for Payer: Mclaren Commercial |
$142.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: Nomi Health Commercial |
$129.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.16
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT
|
Facility
|
IP
|
$76.41
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200469
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$76.41 |
| Rate for Payer: Aetna Commercial |
$68.77
|
| Rate for Payer: ASR ASR |
$74.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.75
|
| Rate for Payer: BCN Commercial |
$62.75
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Commercial |
$71.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$76.41
|
| Rate for Payer: Mclaren Commercial |
$68.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.24
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT
|
Facility
|
OP
|
$76.41
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200469
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$250.58 |
| Rate for Payer: Aetna Commercial |
$68.77
|
| 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 |
$74.12
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$63.00
|
| Rate for Payer: BCN Commercial |
$63.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Commercial |
$71.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$76.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$68.77
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$29.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Complete |
$16.04
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.07
|
| Rate for Payer: BCN Commercial |
$90.07
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.21
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$29.21
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Meridian Medicaid |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$32.13
|
| Rate for Payer: PHP Medicaid |
$15.66
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health Narrow Network |
$76.58
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.21
|
| Rate for Payer: UHC Exchange |
$45.28
|
| Rate for Payer: UHC Medicaid |
$15.28
|
| Rate for Payer: UHCCP DNSP |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$15.28
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.71
|
| Rate for Payer: BCN Commercial |
$89.71
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC ENDO BIOPSY
|
Facility
|
OP
|
$293.24
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$293.24 |
| Rate for Payer: Aetna Commercial |
$263.92
|
| Rate for Payer: Aetna Medicare |
$108.50
|
| Rate for Payer: ASR ASR |
$284.44
|
| Rate for Payer: BCBS Complete |
$117.30
|
| Rate for Payer: BCBS Trust/PPO |
$241.78
|
| Rate for Payer: BCN Commercial |
$241.78
|
| Rate for Payer: Cash Price |
$234.59
|
| Rate for Payer: Cofinity Commercial |
$275.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.59
|
| Rate for Payer: Healthscope Commercial |
$284.44
|
| Rate for Payer: Healthscope Whirlpool |
$293.24
|
| Rate for Payer: Mclaren Commercial |
$263.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.25
|
| Rate for Payer: Nomi Health Commercial |
$240.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$256.94
|
| Rate for Payer: Priority Health Narrow Network |
$205.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.05
|
|
|
HC ENDO BIOPSY
|
Facility
|
IP
|
$293.24
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$219.93 |
| Max. Negotiated Rate |
$293.24 |
| Rate for Payer: Aetna Commercial |
$263.92
|
| Rate for Payer: ASR ASR |
$284.44
|
| Rate for Payer: BCBS Trust/PPO |
$240.81
|
| Rate for Payer: BCN Commercial |
$240.81
|
| Rate for Payer: Cash Price |
$234.59
|
| Rate for Payer: Cofinity Commercial |
$275.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.59
|
| Rate for Payer: Healthscope Commercial |
$284.44
|
| Rate for Payer: Healthscope Whirlpool |
$293.24
|
| Rate for Payer: Mclaren Commercial |
$263.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.25
|
| Rate for Payer: Nomi Health Commercial |
$240.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.05
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$689.79
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.34 |
| Max. Negotiated Rate |
$689.79 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: ASR ASR |
$669.10
|
| Rate for Payer: BCBS Trust/PPO |
$566.46
|
| Rate for Payer: BCN Commercial |
$566.46
|
| Rate for Payer: Cash Price |
$551.83
|
| Rate for Payer: Cofinity Commercial |
$648.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.83
|
| Rate for Payer: Healthscope Commercial |
$669.10
|
| Rate for Payer: Healthscope Whirlpool |
$689.79
|
| Rate for Payer: Mclaren Commercial |
$620.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.32
|
| Rate for Payer: Nomi Health Commercial |
$565.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.02
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$689.79
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$1,422.50 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: Aetna Medicare |
$917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,147.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,147.17
|
| Rate for Payer: ASR ASR |
$669.10
|
| Rate for Payer: BCBS Complete |
$504.02
|
| Rate for Payer: BCBS MAPPO |
$917.74
|
| Rate for Payer: BCBS Trust/PPO |
$568.73
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$568.73
|
| Rate for Payer: BCN Medicare Advantage |
$917.74
|
| Rate for Payer: Cash Price |
$551.83
|
| Rate for Payer: Cash Price |
$551.83
|
| Rate for Payer: Cofinity Commercial |
$648.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.74
|
| Rate for Payer: Healthscope Commercial |
$669.10
|
| Rate for Payer: Healthscope Whirlpool |
$689.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$917.74
|
| Rate for Payer: Mclaren Commercial |
$620.81
|
| Rate for Payer: Mclaren Medicaid |
$917.74
|
| Rate for Payer: Mclaren Medicare |
$917.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.63
|
| Rate for Payer: Meridian Medicaid |
$504.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,009.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.32
|
| Rate for Payer: Nomi Health Commercial |
$565.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.34
|
| Rate for Payer: PACE Medicare |
$871.85
|
| Rate for Payer: PACE SWMI |
$917.74
|
| Rate for Payer: PHP Commercial |
$1,009.51
|
| Rate for Payer: PHP Medicaid |
$491.91
|
| Rate for Payer: PHP Medicare Advantage |
$917.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$604.39
|
| Rate for Payer: Priority Health Medicare |
$917.74
|
| Rate for Payer: Priority Health Narrow Network |
$483.54
|
| Rate for Payer: Railroad Medicare Medicare |
$917.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$917.74
|
| Rate for Payer: UHC Exchange |
$1,422.50
|
| Rate for Payer: UHC Medicaid |
$479.98
|
| Rate for Payer: UHCCP DNSP |
$917.74
|
| Rate for Payer: UHCCP Medicaid |
$479.98
|
| Rate for Payer: VA VA |
$917.74
|
|
|
HC ENDO CLIPPING
|
Facility
|
IP
|
$329.81
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.36 |
| Max. Negotiated Rate |
$329.81 |
| Rate for Payer: Aetna Commercial |
$296.83
|
| Rate for Payer: ASR ASR |
$319.92
|
| Rate for Payer: BCBS Trust/PPO |
$270.84
|
| Rate for Payer: BCN Commercial |
$270.84
|
| Rate for Payer: Cash Price |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$310.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.85
|
| Rate for Payer: Healthscope Commercial |
$319.92
|
| Rate for Payer: Healthscope Whirlpool |
$329.81
|
| Rate for Payer: Mclaren Commercial |
$296.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$270.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.23
|
|
|
HC ENDO CLIPPING
|
Facility
|
OP
|
$329.81
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$122.03 |
| Max. Negotiated Rate |
$329.81 |
| Rate for Payer: Aetna Commercial |
$296.83
|
| Rate for Payer: Aetna Medicare |
$122.03
|
| Rate for Payer: ASR ASR |
$319.92
|
| Rate for Payer: BCBS Complete |
$131.92
|
| Rate for Payer: BCBS Trust/PPO |
$271.93
|
| Rate for Payer: BCN Commercial |
$271.93
|
| Rate for Payer: Cash Price |
$263.85
|
| Rate for Payer: Cofinity Commercial |
$310.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.85
|
| Rate for Payer: Healthscope Commercial |
$319.92
|
| Rate for Payer: Healthscope Whirlpool |
$329.81
|
| Rate for Payer: Mclaren Commercial |
$296.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.34
|
| Rate for Payer: Nomi Health Commercial |
$270.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$288.98
|
| Rate for Payer: Priority Health Narrow Network |
$231.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.23
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
IP
|
$1,841.57
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,381.18 |
| Max. Negotiated Rate |
$1,841.57 |
| Rate for Payer: Aetna Commercial |
$1,657.41
|
| Rate for Payer: ASR ASR |
$1,786.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.30
|
| Rate for Payer: BCN Commercial |
$1,512.30
|
| Rate for Payer: Cash Price |
$1,473.26
|
| Rate for Payer: Cofinity Commercial |
$1,731.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.26
|
| Rate for Payer: Healthscope Commercial |
$1,786.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,841.57
|
| Rate for Payer: Mclaren Commercial |
$1,657.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.33
|
| Rate for Payer: Nomi Health Commercial |
$1,510.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,620.58
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
OP
|
$1,841.57
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.38 |
| Max. Negotiated Rate |
$1,841.57 |
| Rate for Payer: Aetna Commercial |
$1,657.41
|
| Rate for Payer: Aetna Medicare |
$681.38
|
| Rate for Payer: ASR ASR |
$1,786.32
|
| Rate for Payer: BCBS Complete |
$736.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.37
|
| Rate for Payer: BCN Commercial |
$1,518.37
|
| Rate for Payer: Cash Price |
$1,473.26
|
| Rate for Payer: Cofinity Commercial |
$1,731.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,473.26
|
| Rate for Payer: Healthscope Commercial |
$1,786.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,841.57
|
| Rate for Payer: Mclaren Commercial |
$1,657.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,473.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,565.33
|
| Rate for Payer: Nomi Health Commercial |
$1,510.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,613.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,290.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,620.58
|
|
|
HC ENDO DILATATION
|
Facility
|
OP
|
$1,357.00
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$502.09 |
| Max. Negotiated Rate |
$1,357.00 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Aetna Medicare |
$502.09
|
| Rate for Payer: ASR ASR |
$1,316.29
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.85
|
| Rate for Payer: BCN Commercial |
$1,118.85
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,275.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.60
|
| Rate for Payer: Healthscope Commercial |
$1,316.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.00
|
| Rate for Payer: Mclaren Commercial |
$1,221.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,085.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.45
|
| Rate for Payer: Nomi Health Commercial |
$1,112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,189.00
|
| Rate for Payer: Priority Health Narrow Network |
$951.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,194.16
|
|
|
HC ENDO DILATATION
|
Facility
|
IP
|
$1,357.00
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.75 |
| Max. Negotiated Rate |
$1,357.00 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: ASR ASR |
$1,316.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.37
|
| Rate for Payer: BCN Commercial |
$1,114.37
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cofinity Commercial |
$1,275.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,085.60
|
| Rate for Payer: Healthscope Commercial |
$1,316.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.00
|
| Rate for Payer: Mclaren Commercial |
$1,221.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,153.45
|
| Rate for Payer: Nomi Health Commercial |
$1,112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,194.16
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
IP
|
$1,096.02
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$822.01 |
| Max. Negotiated Rate |
$1,096.02 |
| Rate for Payer: Aetna Commercial |
$986.42
|
| Rate for Payer: ASR ASR |
$1,063.14
|
| Rate for Payer: BCBS Trust/PPO |
$900.05
|
| Rate for Payer: BCN Commercial |
$900.05
|
| Rate for Payer: Cash Price |
$876.82
|
| Rate for Payer: Cofinity Commercial |
$1,030.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$876.82
|
| Rate for Payer: Healthscope Commercial |
$1,063.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,096.02
|
| Rate for Payer: Mclaren Commercial |
$986.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$931.62
|
| Rate for Payer: Nomi Health Commercial |
$898.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$822.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$964.50
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
OP
|
$1,096.02
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$405.53 |
| Max. Negotiated Rate |
$1,096.02 |
| Rate for Payer: Aetna Commercial |
$986.42
|
| Rate for Payer: Aetna Medicare |
$405.53
|
| Rate for Payer: ASR ASR |
$1,063.14
|
| Rate for Payer: BCBS Complete |
$438.41
|
| Rate for Payer: BCBS Trust/PPO |
$903.67
|
| Rate for Payer: BCN Commercial |
$903.67
|
| Rate for Payer: Cash Price |
$876.82
|
| Rate for Payer: Cofinity Commercial |
$1,030.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$876.82
|
| Rate for Payer: Healthscope Commercial |
$1,063.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,096.02
|
| Rate for Payer: Mclaren Commercial |
$986.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$876.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$931.62
|
| Rate for Payer: Nomi Health Commercial |
$898.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$822.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$960.33
|
| Rate for Payer: Priority Health Narrow Network |
$768.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$964.50
|
|
|
HC ENDOFORM 2X2
|
Facility
|
OP
|
$39.80
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: Aetna Medicare |
$14.73
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$32.82
|
| Rate for Payer: BCN Commercial |
$32.82
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$38.61
|
| Rate for Payer: Healthscope Whirlpool |
$39.80
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.87
|
| Rate for Payer: Priority Health Narrow Network |
$27.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
HC ENDOFORM 2X2
|
Facility
|
IP
|
$39.80
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$32.68
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$38.61
|
| Rate for Payer: Healthscope Whirlpool |
$39.80
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
HC ENDOFORM 4X4
|
Facility
|
OP
|
$138.43
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$138.43 |
| Rate for Payer: Aetna Commercial |
$124.59
|
| Rate for Payer: Aetna Medicare |
$51.22
|
| Rate for Payer: ASR ASR |
$134.28
|
| Rate for Payer: BCBS Complete |
$55.37
|
| Rate for Payer: BCBS Trust/PPO |
$114.14
|
| Rate for Payer: BCN Commercial |
$114.14
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$130.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$134.28
|
| Rate for Payer: Healthscope Whirlpool |
$138.43
|
| Rate for Payer: Mclaren Commercial |
$124.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: Nomi Health Commercial |
$113.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.29
|
| Rate for Payer: Priority Health Narrow Network |
$97.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.82
|
|
