|
HC DTPA PER STUDY
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$170.17 |
| Rate for Payer: Aetna Commercial |
$153.15
|
| Rate for Payer: ASR ASR |
$165.06
|
| Rate for Payer: ASR Commercial |
$165.06
|
| Rate for Payer: BCBS Trust/PPO |
$138.67
|
| Rate for Payer: BCN Commercial |
$131.93
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$170.17
|
| Rate for Payer: Healthscope Whirlpool |
$165.06
|
| Rate for Payer: Mclaren Commercial |
$153.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: Nomi Health Commercial |
$139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.75
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.07 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: Aetna Commercial |
$153.15
|
| Rate for Payer: Aetna Medicare |
$85.08
|
| Rate for Payer: ASR ASR |
$165.06
|
| Rate for Payer: ASR Commercial |
$165.06
|
| Rate for Payer: BCBS Complete |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$139.35
|
| Rate for Payer: BCN Commercial |
$131.93
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$170.17
|
| Rate for Payer: Healthscope Whirlpool |
$165.06
|
| Rate for Payer: Mclaren Commercial |
$153.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: Nomi Health Commercial |
$139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.70
|
| Rate for Payer: Priority Health Narrow Network |
$154.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.75
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,261.73 |
| Max. Negotiated Rate |
$12,710.35 |
| Rate for Payer: Aetna Commercial |
$11,439.32
|
| Rate for Payer: ASR ASR |
$12,329.04
|
| Rate for Payer: ASR Commercial |
$12,329.04
|
| Rate for Payer: BCBS Trust/PPO |
$10,357.66
|
| Rate for Payer: BCN Commercial |
$9,854.33
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$11,947.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Healthscope Commercial |
$12,710.35
|
| Rate for Payer: Healthscope Whirlpool |
$12,329.04
|
| Rate for Payer: Mclaren Commercial |
$11,439.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: Nomi Health Commercial |
$10,422.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,185.11
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,346.23 |
| Max. Negotiated Rate |
$12,710.35 |
| Rate for Payer: Aetna Commercial |
$11,439.32
|
| Rate for Payer: Aetna Medicare |
$8,108.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,135.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,135.80
|
| Rate for Payer: ASR ASR |
$12,329.04
|
| Rate for Payer: ASR Commercial |
$12,329.04
|
| Rate for Payer: BCBS Complete |
$4,563.54
|
| Rate for Payer: BCBS MAPPO |
$8,108.64
|
| Rate for Payer: BCBS Trust/PPO |
$10,408.51
|
| Rate for Payer: BCN Commercial |
$9,854.33
|
| Rate for Payer: BCN Medicare Advantage |
$8,108.64
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$11,947.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,108.64
|
| Rate for Payer: Healthscope Commercial |
$12,710.35
|
| Rate for Payer: Healthscope Whirlpool |
$12,329.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,108.64
|
| Rate for Payer: Mclaren Commercial |
$11,439.32
|
| Rate for Payer: Mclaren Medicaid |
$4,346.23
|
| Rate for Payer: Mclaren Medicare |
$8,108.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,514.07
|
| Rate for Payer: Meridian Medicaid |
$4,563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,324.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: Nomi Health Commercial |
$10,422.49
|
| Rate for Payer: PACE Medicare |
$7,703.21
|
| Rate for Payer: PACE SWMI |
$8,108.64
|
| Rate for Payer: PHP Commercial |
$8,919.50
|
| Rate for Payer: PHP Medicaid |
$4,346.23
|
| Rate for Payer: PHP Medicare Advantage |
$8,108.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,346.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,136.81
|
| Rate for Payer: Priority Health Medicare |
$8,108.64
|
| Rate for Payer: Priority Health Narrow Network |
$8,909.96
|
| Rate for Payer: Railroad Medicare Medicare |
$8,108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,185.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,108.64
|
| Rate for Payer: UHC Exchange |
$12,568.39
|
| Rate for Payer: UHC Medicare Advantage |
$8,108.64
|
| Rate for Payer: UHCCP DNSP |
$8,108.64
|
| Rate for Payer: UHCCP Medicaid |
$4,346.23
|
| Rate for Payer: VA VA |
$8,108.64
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,859.85 |
| Max. Negotiated Rate |
$4,399.77 |
| Rate for Payer: Aetna Commercial |
$3,959.79
|
| Rate for Payer: ASR ASR |
$4,267.78
|
| Rate for Payer: ASR Commercial |
$4,267.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,585.37
|
| Rate for Payer: BCN Commercial |
$3,411.14
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$4,135.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$4,399.77
|
| Rate for Payer: Healthscope Whirlpool |
$4,267.78
|
| Rate for Payer: Mclaren Commercial |
$3,959.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: Nomi Health Commercial |
$3,607.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,871.80
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,759.91 |
| Max. Negotiated Rate |
$4,399.77 |
| Rate for Payer: Aetna Commercial |
$3,959.79
|
| Rate for Payer: Aetna Medicare |
$2,199.88
|
| Rate for Payer: ASR ASR |
$4,267.78
|
| Rate for Payer: ASR Commercial |
$4,267.78
|
| Rate for Payer: BCBS Complete |
$1,759.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,602.97
|
| Rate for Payer: BCN Commercial |
$3,411.14
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$4,135.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$4,399.77
|
| Rate for Payer: Healthscope Whirlpool |
$4,267.78
|
| Rate for Payer: Mclaren Commercial |
$3,959.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: Nomi Health Commercial |
$3,607.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,855.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,084.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,871.80
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,193.58
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,425.83 |
| Max. Negotiated Rate |
$2,193.58 |
| Rate for Payer: Aetna Commercial |
$1,974.22
|
| Rate for Payer: ASR ASR |
$2,127.77
|
| Rate for Payer: ASR Commercial |
$2,127.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.55
|
| Rate for Payer: BCN Commercial |
$1,700.68
|
| Rate for Payer: Cash Price |
$1,754.86
|
| Rate for Payer: Cofinity Commercial |
$2,061.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.86
|
| Rate for Payer: Healthscope Commercial |
$2,193.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,127.77
|
| Rate for Payer: Mclaren Commercial |
$1,974.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.54
|
| Rate for Payer: Nomi Health Commercial |
$1,798.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,930.35
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,193.58
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$877.43 |
| Max. Negotiated Rate |
$2,193.58 |
| Rate for Payer: Aetna Commercial |
$1,974.22
|
| Rate for Payer: Aetna Medicare |
$1,096.79
|
| Rate for Payer: ASR ASR |
$2,127.77
|
| Rate for Payer: ASR Commercial |
$2,127.77
|
| Rate for Payer: BCBS Complete |
$877.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.32
|
| Rate for Payer: BCN Commercial |
$1,700.68
|
| Rate for Payer: Cash Price |
$1,754.86
|
| Rate for Payer: Cofinity Commercial |
$2,061.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,754.86
|
| Rate for Payer: Healthscope Commercial |
$2,193.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,127.77
|
| Rate for Payer: Mclaren Commercial |
$1,974.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,864.54
|
| Rate for Payer: Nomi Health Commercial |
$1,798.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,425.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,922.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,537.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,930.35
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$3,894.00
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$3,894.00 |
| Rate for Payer: Aetna Commercial |
$3,504.60
|
| Rate for Payer: Aetna Medicare |
$1,947.00
|
| Rate for Payer: ASR ASR |
$3,777.18
|
| Rate for Payer: ASR Commercial |
$3,777.18
|
| Rate for Payer: BCBS Complete |
$1,557.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,188.80
|
| Rate for Payer: BCN Commercial |
$3,019.02
|
| Rate for Payer: Cash Price |
$3,115.20
|
| Rate for Payer: Cofinity Commercial |
$3,660.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.20
|
| Rate for Payer: Healthscope Commercial |
$3,894.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,777.18
|
| Rate for Payer: Mclaren Commercial |
$3,504.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,309.90
|
| Rate for Payer: Nomi Health Commercial |
$3,193.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,411.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,729.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,426.72
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$3,894.00
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,531.10 |
| Max. Negotiated Rate |
$3,894.00 |
| Rate for Payer: Aetna Commercial |
$3,504.60
|
| Rate for Payer: ASR ASR |
$3,777.18
|
| Rate for Payer: ASR Commercial |
$3,777.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,173.22
|
| Rate for Payer: BCN Commercial |
$3,019.02
|
| Rate for Payer: Cash Price |
$3,115.20
|
| Rate for Payer: Cofinity Commercial |
$3,660.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.20
|
| Rate for Payer: Healthscope Commercial |
$3,894.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,777.18
|
| Rate for Payer: Mclaren Commercial |
$3,504.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,309.90
|
| Rate for Payer: Nomi Health Commercial |
$3,193.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,426.72
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$47.73
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$47.73 |
| Rate for Payer: Aetna Commercial |
$42.96
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: ASR ASR |
$46.30
|
| Rate for Payer: ASR Commercial |
$46.30
|
| Rate for Payer: BCBS Complete |
$19.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.09
|
| Rate for Payer: BCN Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$44.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$47.73
|
| Rate for Payer: Healthscope Whirlpool |
$46.30
|
| Rate for Payer: Mclaren Commercial |
$42.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.57
|
| Rate for Payer: Nomi Health Commercial |
$39.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.82
|
| Rate for Payer: Priority Health Narrow Network |
$33.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.00
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$47.73
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$47.73 |
| Rate for Payer: Aetna Commercial |
$42.96
|
| Rate for Payer: ASR ASR |
$46.30
|
| Rate for Payer: ASR Commercial |
$46.30
|
| Rate for Payer: BCBS Trust/PPO |
$38.90
|
| Rate for Payer: BCN Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$44.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$47.73
|
| Rate for Payer: Healthscope Whirlpool |
$46.30
|
| Rate for Payer: Mclaren Commercial |
$42.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.57
|
| Rate for Payer: Nomi Health Commercial |
$39.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.00
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$75.60
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$68.04
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: ASR ASR |
$73.33
|
| Rate for Payer: ASR Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$30.24
|
| Rate for Payer: BCBS Trust/PPO |
$61.91
|
| Rate for Payer: BCN Commercial |
$58.61
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Healthscope Whirlpool |
$73.33
|
| Rate for Payer: Mclaren Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Nomi Health Commercial |
$61.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.24
|
| Rate for Payer: Priority Health Narrow Network |
$53.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.53
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
IP
|
$75.60
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$68.04
|
| Rate for Payer: ASR ASR |
$73.33
|
| Rate for Payer: ASR Commercial |
$73.33
|
| Rate for Payer: BCBS Trust/PPO |
$61.61
|
| Rate for Payer: BCN Commercial |
$58.61
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$75.60
|
| Rate for Payer: Healthscope Whirlpool |
$73.33
|
| Rate for Payer: Mclaren Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Nomi Health Commercial |
$61.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.53
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
IP
|
$105.53
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$105.53 |
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: ASR ASR |
$102.36
|
| Rate for Payer: ASR Commercial |
$102.36
|
| Rate for Payer: BCBS Trust/PPO |
$86.00
|
| Rate for Payer: BCN Commercial |
$81.82
|
| Rate for Payer: Cash Price |
$84.42
|
| Rate for Payer: Cofinity Commercial |
$99.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.42
|
| Rate for Payer: Healthscope Commercial |
$105.53
|
| Rate for Payer: Healthscope Whirlpool |
$102.36
|
| Rate for Payer: Mclaren Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: Nomi Health Commercial |
$86.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.87
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
OP
|
$105.53
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.21 |
| Max. Negotiated Rate |
$105.53 |
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: Aetna Medicare |
$52.76
|
| Rate for Payer: ASR ASR |
$102.36
|
| Rate for Payer: ASR Commercial |
$102.36
|
| Rate for Payer: BCBS Complete |
$42.21
|
| Rate for Payer: BCBS Trust/PPO |
$86.42
|
| Rate for Payer: BCN Commercial |
$81.82
|
| Rate for Payer: Cash Price |
$84.42
|
| Rate for Payer: Cofinity Commercial |
$99.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.42
|
| Rate for Payer: Healthscope Commercial |
$105.53
|
| Rate for Payer: Healthscope Whirlpool |
$102.36
|
| Rate for Payer: Mclaren Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: Nomi Health Commercial |
$86.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.47
|
| Rate for Payer: Priority Health Narrow Network |
$73.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.87
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
OP
|
$650.22
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.09 |
| Max. Negotiated Rate |
$650.22 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Aetna Medicare |
$325.11
|
| Rate for Payer: ASR ASR |
$630.71
|
| Rate for Payer: ASR Commercial |
$630.71
|
| Rate for Payer: BCBS Complete |
$260.09
|
| Rate for Payer: BCBS Trust/PPO |
$532.47
|
| Rate for Payer: BCN Commercial |
$504.12
|
| Rate for Payer: Cash Price |
$520.18
|
| Rate for Payer: Cofinity Commercial |
$611.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.18
|
| Rate for Payer: Healthscope Commercial |
$650.22
|
| Rate for Payer: Healthscope Whirlpool |
$630.71
|
| Rate for Payer: Mclaren Commercial |
$585.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.69
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$569.72
|
| Rate for Payer: Priority Health Narrow Network |
$455.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.19
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
IP
|
$650.22
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.64 |
| Max. Negotiated Rate |
$650.22 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: ASR ASR |
$630.71
|
| Rate for Payer: ASR Commercial |
$630.71
|
| Rate for Payer: BCBS Trust/PPO |
$529.86
|
| Rate for Payer: BCN Commercial |
$504.12
|
| Rate for Payer: Cash Price |
$520.18
|
| Rate for Payer: Cofinity Commercial |
$611.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.18
|
| Rate for Payer: Healthscope Commercial |
$650.22
|
| Rate for Payer: Healthscope Whirlpool |
$630.71
|
| Rate for Payer: Mclaren Commercial |
$585.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.69
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.19
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$967.42
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.82 |
| Max. Negotiated Rate |
$967.42 |
| Rate for Payer: Aetna Commercial |
$870.68
|
| Rate for Payer: ASR ASR |
$938.40
|
| Rate for Payer: ASR Commercial |
$938.40
|
| Rate for Payer: BCBS Trust/PPO |
$788.35
|
| Rate for Payer: BCN Commercial |
$750.04
|
| Rate for Payer: Cash Price |
$773.94
|
| Rate for Payer: Cofinity Commercial |
$909.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.94
|
| Rate for Payer: Healthscope Commercial |
$967.42
|
| Rate for Payer: Healthscope Whirlpool |
$938.40
|
| Rate for Payer: Mclaren Commercial |
$870.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.31
|
| Rate for Payer: Nomi Health Commercial |
$793.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.33
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$967.42
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$967.42 |
| Rate for Payer: Aetna Commercial |
$870.68
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$938.40
|
| Rate for Payer: ASR Commercial |
$938.40
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$792.22
|
| Rate for Payer: BCN Commercial |
$750.04
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$773.94
|
| Rate for Payer: Cash Price |
$773.94
|
| Rate for Payer: Cofinity Commercial |
$909.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$967.42
|
| Rate for Payer: Healthscope Whirlpool |
$938.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$870.68
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.31
|
| Rate for Payer: Nomi Health Commercial |
$793.28
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$847.65
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$678.16
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$851.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC DUST MITE DF IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC DUST MITE DF IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUST MITE DP IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
