|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$239.75 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$232.56
|
| Rate for Payer: ASR Commercial |
$232.56
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$196.33
|
| Rate for Payer: BCN Commercial |
$185.88
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$225.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$239.75
|
| Rate for Payer: Healthscope Whirlpool |
$232.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$215.78
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$196.60
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.07
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$168.06
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$239.75 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: ASR ASR |
$232.56
|
| Rate for Payer: ASR Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$195.37
|
| Rate for Payer: BCN Commercial |
$185.88
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$225.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Healthscope Commercial |
$239.75
|
| Rate for Payer: Healthscope Whirlpool |
$232.56
|
| Rate for Payer: Mclaren Commercial |
$215.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.98
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.82 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Aetna Commercial |
$318.62
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$343.40
|
| Rate for Payer: ASR Commercial |
$343.40
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$289.91
|
| Rate for Payer: BCN Commercial |
$274.47
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$332.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$354.02
|
| Rate for Payer: Healthscope Whirlpool |
$343.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$318.62
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$290.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.02
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$80.82
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.11 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$318.62
|
| Rate for Payer: ASR ASR |
$343.40
|
| Rate for Payer: ASR Commercial |
$343.40
|
| Rate for Payer: BCBS Trust/PPO |
$288.49
|
| Rate for Payer: BCN Commercial |
$274.47
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$332.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Healthscope Commercial |
$354.02
|
| Rate for Payer: Healthscope Whirlpool |
$343.40
|
| Rate for Payer: Mclaren Commercial |
$318.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$290.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.54
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.77 |
| Max. Negotiated Rate |
$390.42 |
| Rate for Payer: Aetna Commercial |
$351.38
|
| Rate for Payer: ASR ASR |
$378.71
|
| Rate for Payer: ASR Commercial |
$378.71
|
| Rate for Payer: BCBS Trust/PPO |
$318.15
|
| Rate for Payer: BCN Commercial |
$302.69
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$366.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$390.42
|
| Rate for Payer: Healthscope Whirlpool |
$378.71
|
| Rate for Payer: Mclaren Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: Nomi Health Commercial |
$320.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.57
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$390.42 |
| Rate for Payer: Aetna Commercial |
$351.38
|
| Rate for Payer: Aetna Medicare |
$195.21
|
| Rate for Payer: ASR ASR |
$378.71
|
| Rate for Payer: ASR Commercial |
$378.71
|
| Rate for Payer: BCBS Complete |
$156.17
|
| Rate for Payer: BCBS Trust/PPO |
$319.71
|
| Rate for Payer: BCN Commercial |
$302.69
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$366.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$390.42
|
| Rate for Payer: Healthscope Whirlpool |
$378.71
|
| Rate for Payer: Mclaren Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: Nomi Health Commercial |
$320.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$342.09
|
| Rate for Payer: Priority Health Narrow Network |
$273.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.57
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$939.43 |
| Max. Negotiated Rate |
$1,445.27 |
| Rate for Payer: Aetna Commercial |
$1,300.74
|
| Rate for Payer: ASR ASR |
$1,401.91
|
| Rate for Payer: ASR Commercial |
$1,401.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,177.75
|
| Rate for Payer: BCN Commercial |
$1,120.52
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,358.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Healthscope Commercial |
$1,445.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,401.91
|
| Rate for Payer: Mclaren Commercial |
$1,300.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,185.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,271.84
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,445.27 |
| Rate for Payer: Aetna Commercial |
$1,300.74
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$1,401.91
|
| Rate for Payer: ASR Commercial |
$1,401.91
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.53
|
| Rate for Payer: BCN Commercial |
$1,120.52
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,358.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,445.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,401.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,300.74
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,185.12
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,266.35
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,013.13
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,271.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,505.50 |
| Rate for Payer: Aetna Commercial |
$1,354.95
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,460.34
|
| Rate for Payer: ASR Commercial |
$1,460.34
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.85
|
| Rate for Payer: BCN Commercial |
$1,167.21
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,505.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,460.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,354.95
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.68
|
| Rate for Payer: Nomi Health Commercial |
$1,234.51
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.12
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,055.36
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,324.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$978.58 |
| Max. Negotiated Rate |
$1,505.50 |
| Rate for Payer: Aetna Commercial |
$1,354.95
|
| Rate for Payer: ASR ASR |
$1,460.34
|
| Rate for Payer: ASR Commercial |
$1,460.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.83
|
| Rate for Payer: BCN Commercial |
$1,167.21
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,415.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Commercial |
$1,505.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,460.34
|
| Rate for Payer: Mclaren Commercial |
$1,354.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.68
|
| Rate for Payer: Nomi Health Commercial |
$1,234.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,324.84
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$68.07 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: Aetna Medicare |
$17.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: ASR ASR |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$34.93
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.63
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$19.39
|
| Rate for Payer: PHP Medicaid |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.07
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health Narrow Network |
$54.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.63
|
| Rate for Payer: UHC Exchange |
$27.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.63
|
| Rate for Payer: UHCCP DNSP |
$17.63
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: VA VA |
$17.63
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$38.39
|
| Rate for Payer: ASR ASR |
$41.38
|
| Rate for Payer: ASR Commercial |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$33.07
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$42.66
|
| Rate for Payer: Healthscope Whirlpool |
$41.38
|
| Rate for Payer: Mclaren Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.54
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: ASR ASR |
$3.38
|
| Rate for Payer: ASR Commercial |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Healthscope Whirlpool |
$3.38
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.06
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: ASR ASR |
$3.38
|
| Rate for Payer: ASR Commercial |
$3.38
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.85
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Healthscope Whirlpool |
$3.38
|
| Rate for Payer: Mclaren Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.05
|
| Rate for Payer: Priority Health Narrow Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.06
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,275.40 |
| Max. Negotiated Rate |
$1,962.15 |
| Rate for Payer: Aetna Commercial |
$1,765.94
|
| Rate for Payer: ASR ASR |
$1,903.29
|
| Rate for Payer: ASR Commercial |
$1,903.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.96
|
| Rate for Payer: BCN Commercial |
$1,521.25
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,844.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,962.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,903.29
|
| Rate for Payer: Mclaren Commercial |
$1,765.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: Nomi Health Commercial |
$1,608.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,726.69
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.86 |
| Max. Negotiated Rate |
$1,962.15 |
| Rate for Payer: Aetna Commercial |
$1,765.94
|
| Rate for Payer: Aetna Medicare |
$981.08
|
| Rate for Payer: ASR ASR |
$1,903.29
|
| Rate for Payer: ASR Commercial |
$1,903.29
|
| Rate for Payer: BCBS Complete |
$784.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,606.80
|
| Rate for Payer: BCN Commercial |
$1,521.25
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,844.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,962.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,903.29
|
| Rate for Payer: Mclaren Commercial |
$1,765.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: Nomi Health Commercial |
$1,608.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,719.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,375.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,726.69
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
OP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$80.22 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: ASR ASR |
$77.81
|
| Rate for Payer: ASR Commercial |
$77.81
|
| Rate for Payer: BCBS Complete |
$32.09
|
| Rate for Payer: BCBS Trust/PPO |
$65.69
|
| Rate for Payer: BCN Commercial |
$62.19
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$80.22
|
| Rate for Payer: Healthscope Whirlpool |
$77.81
|
| Rate for Payer: Mclaren Commercial |
$72.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: Nomi Health Commercial |
$65.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.29
|
| Rate for Payer: Priority Health Narrow Network |
$56.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.59
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
IP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$80.22 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: ASR ASR |
$77.81
|
| Rate for Payer: ASR Commercial |
$77.81
|
| Rate for Payer: BCBS Trust/PPO |
$65.37
|
| Rate for Payer: BCN Commercial |
$62.19
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$80.22
|
| Rate for Payer: Healthscope Whirlpool |
$77.81
|
| Rate for Payer: Mclaren Commercial |
$72.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: Nomi Health Commercial |
$65.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.59
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$97.45 |
| Max. Negotiated Rate |
$149.92 |
| Rate for Payer: Aetna Commercial |
$134.93
|
| Rate for Payer: ASR ASR |
$145.42
|
| Rate for Payer: ASR Commercial |
$145.42
|
| Rate for Payer: BCBS Trust/PPO |
$122.17
|
| Rate for Payer: BCN Commercial |
$116.23
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$140.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$149.92
|
| Rate for Payer: Healthscope Whirlpool |
$145.42
|
| Rate for Payer: Mclaren Commercial |
$134.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: Nomi Health Commercial |
$122.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.93
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$149.92 |
| Rate for Payer: Aetna Commercial |
$134.93
|
| Rate for Payer: Aetna Medicare |
$74.96
|
| Rate for Payer: ASR ASR |
$145.42
|
| Rate for Payer: ASR Commercial |
$145.42
|
| Rate for Payer: BCBS Complete |
$59.97
|
| Rate for Payer: BCBS Trust/PPO |
$122.77
|
| Rate for Payer: BCN Commercial |
$116.23
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$140.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$149.92
|
| Rate for Payer: Healthscope Whirlpool |
$145.42
|
| Rate for Payer: Mclaren Commercial |
$134.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: Nomi Health Commercial |
$122.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.36
|
| Rate for Payer: Priority Health Narrow Network |
$105.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.93
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$383.32 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna Commercial |
$530.75
|
| Rate for Payer: ASR ASR |
$572.03
|
| Rate for Payer: ASR Commercial |
$572.03
|
| Rate for Payer: BCBS Trust/PPO |
$480.56
|
| Rate for Payer: BCN Commercial |
$457.21
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$554.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$589.72
|
| Rate for Payer: Healthscope Whirlpool |
$572.03
|
| Rate for Payer: Mclaren Commercial |
$530.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: Nomi Health Commercial |
$483.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$518.95
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$235.89 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna Commercial |
$530.75
|
| Rate for Payer: Aetna Medicare |
$294.86
|
| Rate for Payer: ASR ASR |
$572.03
|
| Rate for Payer: ASR Commercial |
$572.03
|
| Rate for Payer: BCBS Complete |
$235.89
|
| Rate for Payer: BCBS Trust/PPO |
$482.92
|
| Rate for Payer: BCN Commercial |
$457.21
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$554.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$589.72
|
| Rate for Payer: Healthscope Whirlpool |
$572.03
|
| Rate for Payer: Mclaren Commercial |
$530.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: Nomi Health Commercial |
$483.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.71
|
| Rate for Payer: Priority Health Narrow Network |
$413.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$518.95
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: ASR ASR |
$15.52
|
| Rate for Payer: ASR Commercial |
$15.52
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.10
|
| Rate for Payer: BCN Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Whirlpool |
$15.52
|
| Rate for Payer: Mclaren Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.02
|
| Rate for Payer: Priority Health Narrow Network |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.08
|
|
