|
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 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 |
$42.66 |
| 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 |
$37.38
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health Narrow Network |
$29.90
|
| 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 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 |
$1,765.93
|
| 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 |
$1,765.93
|
| 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 |
$1,765.93
|
| 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 |
$1,765.93
|
| 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
|
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 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 |
$0.01 |
| 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: 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 |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$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
|
IP
|
$16.00
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: ASR ASR |
$15.52
|
| Rate for Payer: ASR Commercial |
$15.52
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| 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: UHC All Payor (Choice/PPO) + Core |
$14.08
|
|
|
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
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$230.72 |
| Rate for Payer: Aetna Commercial |
$207.65
|
| Rate for Payer: ASR ASR |
$223.80
|
| Rate for Payer: ASR Commercial |
$223.80
|
| Rate for Payer: BCBS Trust/PPO |
$188.01
|
| Rate for Payer: BCN Commercial |
$178.88
|
| Rate for Payer: Cash Price |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$216.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.58
|
| Rate for Payer: Healthscope Commercial |
$230.72
|
| Rate for Payer: Healthscope Whirlpool |
$223.80
|
| Rate for Payer: Mclaren Commercial |
$207.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.11
|
| Rate for Payer: Nomi Health Commercial |
$189.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.03
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$230.72
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.29 |
| Max. Negotiated Rate |
$230.72 |
| Rate for Payer: Aetna Commercial |
$207.65
|
| Rate for Payer: Aetna Medicare |
$115.36
|
| Rate for Payer: ASR ASR |
$223.80
|
| Rate for Payer: ASR Commercial |
$223.80
|
| Rate for Payer: BCBS Complete |
$92.29
|
| Rate for Payer: BCBS Trust/PPO |
$188.94
|
| Rate for Payer: BCN Commercial |
$178.88
|
| Rate for Payer: Cash Price |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$216.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.58
|
| Rate for Payer: Healthscope Commercial |
$230.72
|
| Rate for Payer: Healthscope Whirlpool |
$223.80
|
| Rate for Payer: Mclaren Commercial |
$207.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.11
|
| Rate for Payer: Nomi Health Commercial |
$189.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.16
|
| Rate for Payer: Priority Health Narrow Network |
$161.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.03
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$123.01
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$123.01 |
| Rate for Payer: Aetna Commercial |
$110.71
|
| Rate for Payer: ASR ASR |
$119.32
|
| Rate for Payer: ASR Commercial |
$119.32
|
| Rate for Payer: BCBS Trust/PPO |
$100.24
|
| Rate for Payer: BCN Commercial |
$95.37
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$115.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Healthscope Commercial |
$123.01
|
| Rate for Payer: Healthscope Whirlpool |
$119.32
|
| Rate for Payer: Mclaren Commercial |
$110.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: Nomi Health Commercial |
$100.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.25
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$123.01
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$123.01 |
| Rate for Payer: Aetna Commercial |
$110.71
|
| Rate for Payer: Aetna Medicare |
$16.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: ASR ASR |
$119.32
|
| Rate for Payer: ASR Commercial |
$119.32
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS MAPPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$100.73
|
| Rate for Payer: BCN Commercial |
$95.37
|
| Rate for Payer: BCN Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$115.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$123.01
|
| Rate for Payer: Healthscope Whirlpool |
$119.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.38
|
| Rate for Payer: Mclaren Commercial |
$110.71
|
| Rate for Payer: Mclaren Medicaid |
$8.78
|
| Rate for Payer: Mclaren Medicare |
$16.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.20
|
| Rate for Payer: Meridian Medicaid |
$9.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: Nomi Health Commercial |
$100.87
|
| Rate for Payer: PACE Medicare |
$15.56
|
| Rate for Payer: PACE SWMI |
$16.38
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: PHP Medicaid |
$8.78
|
| Rate for Payer: PHP Medicare Advantage |
$16.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.78
|
| Rate for Payer: Priority Health Medicare |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$86.23
|
| Rate for Payer: Railroad Medicare Medicare |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.38
|
| Rate for Payer: UHC Exchange |
$25.39
|
| Rate for Payer: UHC Medicare Advantage |
$16.38
|
| Rate for Payer: UHCCP DNSP |
$16.38
|
| Rate for Payer: UHCCP Medicaid |
$8.78
|
| Rate for Payer: VA VA |
$16.38
|
|
|
HC GGTP
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.00
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: BCN Medicare Advantage |
$7.20
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.20
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$3.86
|
| Rate for Payer: Mclaren Medicare |
$7.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.56
|
| Rate for Payer: Meridian Medicaid |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: PACE Medicare |
$6.84
|
| Rate for Payer: PACE SWMI |
$7.20
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: PHP Medicaid |
$3.86
|
| Rate for Payer: PHP Medicare Advantage |
$7.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.77
|
| Rate for Payer: Priority Health Medicare |
$7.20
|
| Rate for Payer: Priority Health Narrow Network |
$48.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.20
|
| Rate for Payer: UHC Exchange |
$11.16
|
| Rate for Payer: UHC Medicare Advantage |
$7.20
|
| Rate for Payer: UHCCP DNSP |
$7.20
|
| Rate for Payer: UHCCP Medicaid |
$3.86
|
| Rate for Payer: VA VA |
$7.20
|
|
|
HC GGTP
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.52
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC GIARDIA SCREEN
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC GIARDIA SCREEN
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.11
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$32.09
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.42
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
OP
|
$1,796.43
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$991.65 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Aetna Commercial |
$1,616.79
|
| Rate for Payer: Aetna Medicare |
$1,850.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,312.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,312.62
|
| Rate for Payer: ASR ASR |
$1,742.54
|
| Rate for Payer: ASR Commercial |
$1,742.54
|
| Rate for Payer: BCBS Complete |
$1,041.24
|
| Rate for Payer: BCBS MAPPO |
$1,850.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.10
|
| Rate for Payer: BCN Commercial |
$1,392.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.10
|
| Rate for Payer: Cash Price |
$1,437.14
|
| Rate for Payer: Cash Price |
$1,437.14
|
| Rate for Payer: Cofinity Commercial |
$1,688.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,437.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.10
|
| Rate for Payer: Healthscope Commercial |
$1,796.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,742.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,850.10
|
| Rate for Payer: Mclaren Commercial |
$1,616.79
|
| Rate for Payer: Mclaren Medicaid |
$991.65
|
| Rate for Payer: Mclaren Medicare |
$1,850.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,942.61
|
| Rate for Payer: Meridian Medicaid |
$1,041.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,127.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.97
|
| Rate for Payer: Nomi Health Commercial |
$1,473.07
|
| Rate for Payer: PACE Medicare |
$1,757.60
|
| Rate for Payer: PACE SWMI |
$1,850.10
|
| Rate for Payer: PHP Commercial |
$2,035.11
|
| Rate for Payer: PHP Medicaid |
$991.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,574.03
|
| Rate for Payer: Priority Health Medicare |
$1,850.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,259.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,850.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.10
|
| Rate for Payer: UHC Exchange |
$2,867.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.10
|
| Rate for Payer: UHCCP DNSP |
$1,850.10
|
| Rate for Payer: UHCCP Medicaid |
$991.65
|
| Rate for Payer: VA VA |
$1,850.10
|
|
