|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
OP
|
$1,074.53
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$429.81 |
| Max. Negotiated Rate |
$1,074.53 |
| Rate for Payer: Aetna Commercial |
$967.08
|
| Rate for Payer: Aetna Medicare |
$537.26
|
| Rate for Payer: ASR ASR |
$1,042.29
|
| Rate for Payer: ASR Commercial |
$1,042.29
|
| Rate for Payer: BCBS Complete |
$429.81
|
| Rate for Payer: BCBS Trust/PPO |
$879.93
|
| Rate for Payer: BCN Commercial |
$833.08
|
| Rate for Payer: Cash Price |
$859.62
|
| Rate for Payer: Cofinity Commercial |
$1,010.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.62
|
| Rate for Payer: Healthscope Commercial |
$1,074.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.29
|
| Rate for Payer: Mclaren Commercial |
$967.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.35
|
| Rate for Payer: Nomi Health Commercial |
$881.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.50
|
| Rate for Payer: Priority Health Narrow Network |
$753.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$945.59
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
IP
|
$1,074.53
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.44 |
| Max. Negotiated Rate |
$1,074.53 |
| Rate for Payer: Aetna Commercial |
$967.08
|
| Rate for Payer: ASR ASR |
$1,042.29
|
| Rate for Payer: ASR Commercial |
$1,042.29
|
| Rate for Payer: BCBS Trust/PPO |
$875.63
|
| Rate for Payer: BCN Commercial |
$833.08
|
| Rate for Payer: Cash Price |
$859.62
|
| Rate for Payer: Cofinity Commercial |
$1,010.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.62
|
| Rate for Payer: Healthscope Commercial |
$1,074.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.29
|
| Rate for Payer: Mclaren Commercial |
$967.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.35
|
| Rate for Payer: Nomi Health Commercial |
$881.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$945.59
|
|
|
HC ENDOFORM 2X2
|
Facility
|
OP
|
$39.02
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$39.02 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: Aetna Medicare |
$19.51
|
| Rate for Payer: ASR ASR |
$37.85
|
| Rate for Payer: ASR Commercial |
$37.85
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$31.95
|
| Rate for Payer: BCN Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$36.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$39.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.85
|
| Rate for Payer: Mclaren Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.17
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.19
|
| Rate for Payer: Priority Health Narrow Network |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.34
|
|
|
HC ENDOFORM 2X2
|
Facility
|
IP
|
$39.02
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$39.02 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: ASR ASR |
$37.85
|
| Rate for Payer: ASR Commercial |
$37.85
|
| Rate for Payer: BCBS Trust/PPO |
$31.80
|
| Rate for Payer: BCN Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$36.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$39.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.85
|
| Rate for Payer: Mclaren Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.17
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.34
|
|
|
HC ENDOFORM 4X4
|
Facility
|
IP
|
$135.72
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Aetna Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$131.65
|
| Rate for Payer: ASR Commercial |
$131.65
|
| Rate for Payer: BCBS Trust/PPO |
$110.60
|
| Rate for Payer: BCN Commercial |
$105.22
|
| Rate for Payer: Cash Price |
$108.58
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.58
|
| Rate for Payer: Healthscope Commercial |
$135.72
|
| Rate for Payer: Healthscope Whirlpool |
$131.65
|
| Rate for Payer: Mclaren Commercial |
$122.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.36
|
| Rate for Payer: Nomi Health Commercial |
$111.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.43
|
|
|
HC ENDOFORM 4X4
|
Facility
|
OP
|
$135.72
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Aetna Commercial |
$122.15
|
| Rate for Payer: Aetna Medicare |
$67.86
|
| Rate for Payer: ASR ASR |
$131.65
|
| Rate for Payer: ASR Commercial |
$131.65
|
| Rate for Payer: BCBS Complete |
$54.29
|
| Rate for Payer: BCBS Trust/PPO |
$111.14
|
| Rate for Payer: BCN Commercial |
$105.22
|
| Rate for Payer: Cash Price |
$108.58
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.58
|
| Rate for Payer: Healthscope Commercial |
$135.72
|
| Rate for Payer: Healthscope Whirlpool |
$131.65
|
| Rate for Payer: Mclaren Commercial |
$122.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.36
|
| Rate for Payer: Nomi Health Commercial |
$111.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.92
|
| Rate for Payer: Priority Health Narrow Network |
$95.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.43
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
OP
|
$125.46
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Aetna Commercial |
$112.91
|
| Rate for Payer: Aetna Medicare |
$62.73
|
| Rate for Payer: ASR ASR |
$121.70
|
| Rate for Payer: ASR Commercial |
$121.70
|
| Rate for Payer: BCBS Complete |
$50.18
|
| Rate for Payer: BCBS Trust/PPO |
$102.74
|
| Rate for Payer: BCN Commercial |
$97.27
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$117.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.37
|
| Rate for Payer: Healthscope Commercial |
$125.46
|
| Rate for Payer: Healthscope Whirlpool |
$121.70
|
| Rate for Payer: Mclaren Commercial |
$112.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.64
|
| Rate for Payer: Nomi Health Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.93
|
| Rate for Payer: Priority Health Narrow Network |
$87.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.40
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
IP
|
$125.46
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Aetna Commercial |
$112.91
|
| Rate for Payer: ASR ASR |
$121.70
|
| Rate for Payer: ASR Commercial |
$121.70
|
| Rate for Payer: BCBS Trust/PPO |
$102.24
|
| Rate for Payer: BCN Commercial |
$97.27
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$117.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.37
|
| Rate for Payer: Healthscope Commercial |
$125.46
|
| Rate for Payer: Healthscope Whirlpool |
$121.70
|
| Rate for Payer: Mclaren Commercial |
$112.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.64
|
| Rate for Payer: Nomi Health Commercial |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.40
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.96 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$596.17
|
| Rate for Payer: Aetna Medicare |
$331.20
|
| Rate for Payer: ASR ASR |
$642.54
|
| Rate for Payer: ASR Commercial |
$642.54
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: BCBS Trust/PPO |
$542.45
|
| Rate for Payer: BCN Commercial |
$513.57
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Healthscope Whirlpool |
$642.54
|
| Rate for Payer: Mclaren Commercial |
$596.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.40
|
| Rate for Payer: Priority Health Narrow Network |
$464.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.92
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.57 |
| Max. Negotiated Rate |
$662.41 |
| Rate for Payer: Aetna Commercial |
$596.17
|
| Rate for Payer: ASR ASR |
$642.54
|
| Rate for Payer: ASR Commercial |
$642.54
|
| Rate for Payer: BCBS Trust/PPO |
$539.80
|
| Rate for Payer: BCN Commercial |
$513.57
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$622.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$662.41
|
| Rate for Payer: Healthscope Whirlpool |
$642.54
|
| Rate for Payer: Mclaren Commercial |
$596.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$582.92
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
IP
|
$5,097.96
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,313.67 |
| Max. Negotiated Rate |
$5,097.96 |
| Rate for Payer: Aetna Commercial |
$4,588.16
|
| Rate for Payer: ASR ASR |
$4,945.02
|
| Rate for Payer: ASR Commercial |
$4,945.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,154.33
|
| Rate for Payer: BCN Commercial |
$3,952.45
|
| Rate for Payer: Cash Price |
$4,078.37
|
| Rate for Payer: Cofinity Commercial |
$4,792.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,078.37
|
| Rate for Payer: Healthscope Commercial |
$5,097.96
|
| Rate for Payer: Healthscope Whirlpool |
$4,945.02
|
| Rate for Payer: Mclaren Commercial |
$4,588.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,333.27
|
| Rate for Payer: Nomi Health Commercial |
$4,180.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,313.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,486.20
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
OP
|
$5,097.96
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,039.18 |
| Max. Negotiated Rate |
$5,097.96 |
| Rate for Payer: Aetna Commercial |
$4,588.16
|
| Rate for Payer: Aetna Medicare |
$2,548.98
|
| Rate for Payer: ASR ASR |
$4,945.02
|
| Rate for Payer: ASR Commercial |
$4,945.02
|
| Rate for Payer: BCBS Complete |
$2,039.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,174.72
|
| Rate for Payer: BCN Commercial |
$3,952.45
|
| Rate for Payer: Cash Price |
$4,078.37
|
| Rate for Payer: Cofinity Commercial |
$4,792.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,078.37
|
| Rate for Payer: Healthscope Commercial |
$5,097.96
|
| Rate for Payer: Healthscope Whirlpool |
$4,945.02
|
| Rate for Payer: Mclaren Commercial |
$4,588.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,333.27
|
| Rate for Payer: Nomi Health Commercial |
$4,180.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,313.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,466.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,573.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,486.20
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,679.79 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,881.79
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,580.53 |
| Max. Negotiated Rate |
$13,353.53 |
| Rate for Payer: Aetna Commercial |
$12,018.18
|
| Rate for Payer: Aetna Medicare |
$4,814.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,018.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,018.02
|
| Rate for Payer: ASR ASR |
$12,952.92
|
| Rate for Payer: ASR Commercial |
$12,952.92
|
| Rate for Payer: BCBS Complete |
$2,709.56
|
| Rate for Payer: BCBS MAPPO |
$4,814.42
|
| Rate for Payer: BCBS Trust/PPO |
$10,935.21
|
| Rate for Payer: BCN Commercial |
$10,352.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,814.42
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$12,552.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,814.42
|
| Rate for Payer: Healthscope Commercial |
$13,353.53
|
| Rate for Payer: Healthscope Whirlpool |
$12,952.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,814.42
|
| Rate for Payer: Mclaren Commercial |
$12,018.18
|
| Rate for Payer: Mclaren Medicaid |
$2,580.53
|
| Rate for Payer: Mclaren Medicare |
$4,814.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,055.14
|
| Rate for Payer: Meridian Medicaid |
$2,709.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,536.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: PACE Medicare |
$4,573.70
|
| Rate for Payer: PACE SWMI |
$4,814.42
|
| Rate for Payer: PHP Commercial |
$5,295.86
|
| Rate for Payer: PHP Medicaid |
$2,580.53
|
| Rate for Payer: PHP Medicare Advantage |
$4,814.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,580.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,700.36
|
| Rate for Payer: Priority Health Medicare |
$4,814.42
|
| Rate for Payer: Priority Health Narrow Network |
$9,360.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4,814.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,751.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,814.42
|
| Rate for Payer: UHC Exchange |
$7,462.35
|
| Rate for Payer: UHC Medicare Advantage |
$4,814.42
|
| Rate for Payer: UHCCP DNSP |
$4,814.42
|
| Rate for Payer: UHCCP Medicaid |
$2,580.53
|
| Rate for Payer: VA VA |
$4,814.42
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
IP
|
$723.08
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$723.08 |
| Rate for Payer: Aetna Commercial |
$650.77
|
| Rate for Payer: ASR ASR |
$701.39
|
| Rate for Payer: ASR Commercial |
$701.39
|
| Rate for Payer: BCBS Trust/PPO |
$589.24
|
| 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: UHC All Payor (Choice/PPO) + Core |
$636.31
|
|
|
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
|
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 ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$304.11 |
| Rate for Payer: Aetna Commercial |
$197.57
|
| Rate for Payer: Aetna Medicare |
$196.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: ASR ASR |
$212.93
|
| Rate for Payer: ASR Commercial |
$212.93
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCBS Trust/PPO |
$179.76
|
| Rate for Payer: BCN Commercial |
$170.19
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| 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 |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$219.52
|
| Rate for Payer: Healthscope Whirlpool |
$212.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$196.20
|
| Rate for Payer: Mclaren Commercial |
$197.57
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: Nomi Health Commercial |
$180.01
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$215.82
|
| Rate for Payer: PHP Medicaid |
$105.16
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| 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 |
$196.20
|
| Rate for Payer: Priority Health Narrow Network |
$153.88
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$304.11
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP DNSP |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$4,758.02 |
| Rate for Payer: Aetna Commercial |
$2,579.22
|
| Rate for Payer: Aetna Medicare |
$3,069.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: ASR ASR |
$2,779.83
|
| Rate for Payer: ASR Commercial |
$2,779.83
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,346.80
|
| Rate for Payer: BCN Commercial |
$2,221.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| 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 |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$2,865.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,779.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,069.69
|
| Rate for Payer: Mclaren Commercial |
$2,579.22
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| 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 |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,376.66
|
| Rate for Payer: PHP Medicaid |
$1,645.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| 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 |
$3,069.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,008.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,521.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$4,758.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP DNSP |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
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 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 |
$80.11 |
| 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 |
$70.19
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$56.16
|
| 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 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 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
|
|
