|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
OP
|
$723.08
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.23 |
| Max. Negotiated Rate |
$723.08 |
| Rate for Payer: Aetna Commercial |
$650.77
|
| Rate for Payer: Aetna Medicare |
$361.54
|
| Rate for Payer: ASR ASR |
$701.39
|
| Rate for Payer: ASR Commercial |
$701.39
|
| Rate for Payer: BCBS Complete |
$289.23
|
| Rate for Payer: BCBS Trust/PPO |
$592.13
|
| Rate for Payer: BCN Commercial |
$560.60
|
| Rate for Payer: Cash Price |
$578.46
|
| Rate for Payer: Cofinity Commercial |
$679.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.46
|
| Rate for Payer: Healthscope Commercial |
$723.08
|
| Rate for Payer: Healthscope Whirlpool |
$701.39
|
| Rate for Payer: Mclaren Commercial |
$650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.62
|
| Rate for Payer: Nomi Health Commercial |
$592.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.56
|
| Rate for Payer: Priority Health Narrow Network |
$506.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.31
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$197.57
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$212.93
|
| Rate for Payer: ASR Commercial |
$212.93
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$179.76
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$170.19
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$206.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$219.52
|
| Rate for Payer: Healthscope Whirlpool |
$212.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$197.57
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: Nomi Health Commercial |
$180.01
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.34
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$153.88
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
IP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$219.52 |
| Rate for Payer: Aetna Commercial |
$197.57
|
| Rate for Payer: ASR ASR |
$212.93
|
| Rate for Payer: ASR Commercial |
$212.93
|
| Rate for Payer: BCBS Trust/PPO |
$178.89
|
| Rate for Payer: BCN Commercial |
$170.19
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$206.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$219.52
|
| Rate for Payer: Healthscope Whirlpool |
$212.93
|
| Rate for Payer: Mclaren Commercial |
$197.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: Nomi Health Commercial |
$180.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.18
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,862.77 |
| Max. Negotiated Rate |
$2,865.80 |
| Rate for Payer: Aetna Commercial |
$2,579.22
|
| Rate for Payer: ASR ASR |
$2,779.83
|
| Rate for Payer: ASR Commercial |
$2,779.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,335.34
|
| Rate for Payer: BCN Commercial |
$2,221.85
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cofinity Commercial |
$2,693.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.64
|
| Rate for Payer: Healthscope Commercial |
$2,865.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,779.83
|
| Rate for Payer: Mclaren Commercial |
$2,579.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,435.93
|
| Rate for Payer: Nomi Health Commercial |
$2,349.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,862.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,521.90
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$2,579.22
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$2,779.83
|
| Rate for Payer: ASR Commercial |
$2,779.83
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,346.80
|
| Rate for Payer: BCN Commercial |
$2,221.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cofinity Commercial |
$2,693.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$2,865.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,779.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$2,579.22
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,435.93
|
| Rate for Payer: Nomi Health Commercial |
$2,349.96
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,862.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,511.01
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,008.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,521.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$80.11 |
| Rate for Payer: Aetna Commercial |
$72.10
|
| Rate for Payer: ASR ASR |
$77.71
|
| Rate for Payer: ASR Commercial |
$77.71
|
| Rate for Payer: BCBS Trust/PPO |
$65.28
|
| Rate for Payer: BCN Commercial |
$62.11
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$80.11
|
| Rate for Payer: Healthscope Whirlpool |
$77.71
|
| Rate for Payer: Mclaren Commercial |
$72.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.50
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$227.29 |
| Rate for Payer: Aetna Commercial |
$72.10
|
| 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 |
$77.71
|
| Rate for Payer: ASR Commercial |
$77.71
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$65.60
|
| Rate for Payer: BCN Commercial |
$62.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$75.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$80.11
|
| Rate for Payer: Healthscope Whirlpool |
$77.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$72.10
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
IP
|
$160.04
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.03 |
| Max. Negotiated Rate |
$160.04 |
| Rate for Payer: Aetna Commercial |
$144.04
|
| Rate for Payer: ASR ASR |
$155.24
|
| Rate for Payer: ASR Commercial |
$155.24
|
| Rate for Payer: BCBS Trust/PPO |
$130.42
|
| Rate for Payer: BCN Commercial |
$124.08
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$150.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.03
|
| Rate for Payer: Healthscope Commercial |
$160.04
|
| Rate for Payer: Healthscope Whirlpool |
$155.24
|
| Rate for Payer: Mclaren Commercial |
$144.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.03
|
| Rate for Payer: Nomi Health Commercial |
$131.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.84
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
OP
|
$160.04
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$160.04 |
| Rate for Payer: Aetna Commercial |
$144.04
|
| Rate for Payer: Aetna Medicare |
$12.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.11
|
| Rate for Payer: ASR ASR |
$155.24
|
| Rate for Payer: ASR Commercial |
$155.24
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$131.06
|
| Rate for Payer: BCN Commercial |
$124.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$150.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$160.04
|
| Rate for Payer: Healthscope Whirlpool |
$155.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.09
|
| Rate for Payer: Mclaren Commercial |
$144.04
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$12.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.03
|
| Rate for Payer: Nomi Health Commercial |
$131.23
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$13.30
|
| Rate for Payer: PHP Medicaid |
$6.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.23
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health Narrow Network |
$112.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Exchange |
$18.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.09
|
| Rate for Payer: UHCCP DNSP |
$12.09
|
| Rate for Payer: UHCCP Medicaid |
$6.48
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,444.17 |
| Max. Negotiated Rate |
$5,298.73 |
| Rate for Payer: Aetna Commercial |
$4,768.86
|
| Rate for Payer: ASR ASR |
$5,139.77
|
| Rate for Payer: ASR Commercial |
$5,139.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,317.94
|
| Rate for Payer: BCN Commercial |
$4,108.11
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$4,980.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Healthscope Commercial |
$5,298.73
|
| Rate for Payer: Healthscope Whirlpool |
$5,139.77
|
| Rate for Payer: Mclaren Commercial |
$4,768.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: Nomi Health Commercial |
$4,344.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,662.88
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,119.49 |
| Max. Negotiated Rate |
$5,298.73 |
| Rate for Payer: Aetna Commercial |
$4,768.86
|
| Rate for Payer: Aetna Medicare |
$2,649.36
|
| Rate for Payer: ASR ASR |
$5,139.77
|
| Rate for Payer: ASR Commercial |
$5,139.77
|
| Rate for Payer: BCBS Complete |
$2,119.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.13
|
| Rate for Payer: BCN Commercial |
$4,108.11
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$4,980.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Healthscope Commercial |
$5,298.73
|
| Rate for Payer: Healthscope Whirlpool |
$5,139.77
|
| Rate for Payer: Mclaren Commercial |
$4,768.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: Nomi Health Commercial |
$4,344.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,642.75
|
| Rate for Payer: Priority Health Narrow Network |
$3,714.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,662.88
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,811.27 |
| Max. Negotiated Rate |
$9,474.00 |
| Rate for Payer: Aetna Commercial |
$8,526.60
|
| Rate for Payer: Aetna Medicare |
$3,379.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: ASR ASR |
$9,189.78
|
| Rate for Payer: ASR Commercial |
$9,189.78
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,758.26
|
| Rate for Payer: BCN Commercial |
$7,345.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,905.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$9,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,189.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,379.23
|
| Rate for Payer: Mclaren Commercial |
$8,526.60
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,768.68
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$3,717.15
|
| Rate for Payer: PHP Medicaid |
$1,811.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,301.12
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$6,641.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,337.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,237.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP DNSP |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,158.10 |
| Max. Negotiated Rate |
$9,474.00 |
| Rate for Payer: Aetna Commercial |
$8,526.60
|
| Rate for Payer: ASR ASR |
$9,189.78
|
| Rate for Payer: ASR Commercial |
$9,189.78
|
| Rate for Payer: BCBS Trust/PPO |
$7,720.36
|
| Rate for Payer: BCN Commercial |
$7,345.19
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,905.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Healthscope Commercial |
$9,474.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,189.78
|
| Rate for Payer: Mclaren Commercial |
$8,526.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,768.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,337.12
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: ASR Commercial |
$480.15
|
| Rate for Payer: BCBS Trust/PPO |
$403.38
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: Aetna Medicare |
$247.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: ASR Commercial |
$480.15
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS Trust/PPO |
$405.36
|
| Rate for Payer: BCN Commercial |
$383.77
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$495.00
|
| Rate for Payer: Healthscope Whirlpool |
$480.15
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.72
|
| Rate for Payer: Priority Health Narrow Network |
$347.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$229.70
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.77
|
| Rate for Payer: Priority Health Narrow Network |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Aetna Commercial |
$252.45
|
| Rate for Payer: ASR ASR |
$272.08
|
| Rate for Payer: ASR Commercial |
$272.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.58
|
| Rate for Payer: BCN Commercial |
$217.47
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$263.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$280.50
|
| Rate for Payer: Healthscope Whirlpool |
$272.08
|
| Rate for Payer: Mclaren Commercial |
$252.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.84
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,771.34
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,108.54 |
| Max. Negotiated Rate |
$2,771.34 |
| Rate for Payer: Aetna Commercial |
$2,494.21
|
| Rate for Payer: Aetna Medicare |
$1,385.67
|
| Rate for Payer: ASR ASR |
$2,688.20
|
| Rate for Payer: ASR Commercial |
$2,688.20
|
| Rate for Payer: BCBS Complete |
$1,108.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,269.45
|
| Rate for Payer: BCN Commercial |
$2,148.62
|
| Rate for Payer: Cash Price |
$2,217.07
|
| Rate for Payer: Cofinity Commercial |
$2,605.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.07
|
| Rate for Payer: Healthscope Commercial |
$2,771.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,688.20
|
| Rate for Payer: Mclaren Commercial |
$2,494.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.64
|
| Rate for Payer: Nomi Health Commercial |
$2,272.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,428.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,942.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,438.78
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
IP
|
$2,771.34
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,801.37 |
| Max. Negotiated Rate |
$2,771.34 |
| Rate for Payer: Aetna Commercial |
$2,494.21
|
| Rate for Payer: ASR ASR |
$2,688.20
|
| Rate for Payer: ASR Commercial |
$2,688.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,258.36
|
| Rate for Payer: BCN Commercial |
$2,148.62
|
| Rate for Payer: Cash Price |
$2,217.07
|
| Rate for Payer: Cofinity Commercial |
$2,605.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,217.07
|
| Rate for Payer: Healthscope Commercial |
$2,771.34
|
| Rate for Payer: Healthscope Whirlpool |
$2,688.20
|
| Rate for Payer: Mclaren Commercial |
$2,494.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.64
|
| Rate for Payer: Nomi Health Commercial |
$2,272.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,438.78
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
OP
|
$8,017.20
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,206.88 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: Aetna Medicare |
$4,008.60
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Complete |
$3,206.88
|
| Rate for Payer: BCBS Trust/PPO |
$6,565.29
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,024.67
|
| Rate for Payer: Priority Health Narrow Network |
$5,620.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION COLD
|
Facility
|
IP
|
$8,017.20
|
|
| Hospital Charge Code |
36000121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,211.18 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,533.22
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
IP
|
$8,017.20
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,211.18 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,533.22
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION HOT
|
Facility
|
OP
|
$8,017.20
|
|
| Hospital Charge Code |
36000122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,206.88 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Aetna Commercial |
$7,215.48
|
| Rate for Payer: Aetna Medicare |
$4,008.60
|
| Rate for Payer: ASR ASR |
$7,776.68
|
| Rate for Payer: ASR Commercial |
$7,776.68
|
| Rate for Payer: BCBS Complete |
$3,206.88
|
| Rate for Payer: BCBS Trust/PPO |
$6,565.29
|
| Rate for Payer: BCN Commercial |
$6,215.74
|
| Rate for Payer: Cash Price |
$6,413.76
|
| Rate for Payer: Cofinity Commercial |
$7,536.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,413.76
|
| Rate for Payer: Healthscope Commercial |
$8,017.20
|
| Rate for Payer: Healthscope Whirlpool |
$7,776.68
|
| Rate for Payer: Mclaren Commercial |
$7,215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,814.62
|
| Rate for Payer: Nomi Health Commercial |
$6,574.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,211.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,024.67
|
| Rate for Payer: Priority Health Narrow Network |
$5,620.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,055.14
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
OP
|
$5,102.04
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,040.82 |
| Max. Negotiated Rate |
$5,102.04 |
| Rate for Payer: Aetna Commercial |
$4,591.84
|
| Rate for Payer: Aetna Medicare |
$2,551.02
|
| Rate for Payer: ASR ASR |
$4,948.98
|
| Rate for Payer: ASR Commercial |
$4,948.98
|
| Rate for Payer: BCBS Complete |
$2,040.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,178.06
|
| Rate for Payer: BCN Commercial |
$3,955.61
|
| Rate for Payer: Cash Price |
$4,081.63
|
| Rate for Payer: Cofinity Commercial |
$4,795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,081.63
|
| Rate for Payer: Healthscope Commercial |
$5,102.04
|
| Rate for Payer: Healthscope Whirlpool |
$4,948.98
|
| Rate for Payer: Mclaren Commercial |
$4,591.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,336.73
|
| Rate for Payer: Nomi Health Commercial |
$4,183.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,470.41
|
| Rate for Payer: Priority Health Narrow Network |
$3,576.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,489.80
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
IP
|
$5,102.04
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,316.33 |
| Max. Negotiated Rate |
$5,102.04 |
| Rate for Payer: Aetna Commercial |
$4,591.84
|
| Rate for Payer: ASR ASR |
$4,948.98
|
| Rate for Payer: ASR Commercial |
$4,948.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,157.65
|
| Rate for Payer: BCN Commercial |
$3,955.61
|
| Rate for Payer: Cash Price |
$4,081.63
|
| Rate for Payer: Cofinity Commercial |
$4,795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,081.63
|
| Rate for Payer: Healthscope Commercial |
$5,102.04
|
| Rate for Payer: Healthscope Whirlpool |
$4,948.98
|
| Rate for Payer: Mclaren Commercial |
$4,591.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,336.73
|
| Rate for Payer: Nomi Health Commercial |
$4,183.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,489.80
|
|
