|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
IP
|
$1,796.43
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,167.68 |
| Max. Negotiated Rate |
$1,796.43 |
| Rate for Payer: Aetna Commercial |
$1,616.79
|
| Rate for Payer: ASR ASR |
$1,742.54
|
| Rate for Payer: ASR Commercial |
$1,742.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.91
|
| Rate for Payer: BCN Commercial |
$1,392.77
|
| 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: Healthscope Commercial |
$1,796.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,742.54
|
| Rate for Payer: Mclaren Commercial |
$1,616.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.97
|
| Rate for Payer: Nomi Health Commercial |
$1,473.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.86
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,811.10
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,177.21 |
| Max. Negotiated Rate |
$1,811.10 |
| Rate for Payer: Aetna Commercial |
$1,629.99
|
| Rate for Payer: ASR ASR |
$1,756.77
|
| Rate for Payer: ASR Commercial |
$1,756.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.87
|
| Rate for Payer: BCN Commercial |
$1,404.15
|
| Rate for Payer: Cash Price |
$1,448.88
|
| Rate for Payer: Cofinity Commercial |
$1,702.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.88
|
| Rate for Payer: Healthscope Commercial |
$1,811.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,756.77
|
| Rate for Payer: Mclaren Commercial |
$1,629.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.43
|
| Rate for Payer: Nomi Health Commercial |
$1,485.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,593.77
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,811.10
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.44 |
| Max. Negotiated Rate |
$1,811.10 |
| Rate for Payer: Aetna Commercial |
$1,629.99
|
| Rate for Payer: Aetna Medicare |
$905.55
|
| Rate for Payer: ASR ASR |
$1,756.77
|
| Rate for Payer: ASR Commercial |
$1,756.77
|
| Rate for Payer: BCBS Complete |
$724.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,483.11
|
| Rate for Payer: BCN Commercial |
$1,404.15
|
| Rate for Payer: Cash Price |
$1,448.88
|
| Rate for Payer: Cofinity Commercial |
$1,702.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.88
|
| Rate for Payer: Healthscope Commercial |
$1,811.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,756.77
|
| Rate for Payer: Mclaren Commercial |
$1,629.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.43
|
| Rate for Payer: Nomi Health Commercial |
$1,485.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,593.77
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
IP
|
$1,267.94
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$824.16 |
| Max. Negotiated Rate |
$1,267.94 |
| Rate for Payer: Aetna Commercial |
$1,141.15
|
| Rate for Payer: ASR ASR |
$1,229.90
|
| Rate for Payer: ASR Commercial |
$1,229.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.24
|
| Rate for Payer: BCN Commercial |
$983.03
|
| Rate for Payer: Cash Price |
$1,014.35
|
| Rate for Payer: Cofinity Commercial |
$1,191.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.35
|
| Rate for Payer: Healthscope Commercial |
$1,267.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.90
|
| Rate for Payer: Mclaren Commercial |
$1,141.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.75
|
| Rate for Payer: Nomi Health Commercial |
$1,039.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.79
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
OP
|
$1,267.94
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$1,267.94 |
| Rate for Payer: Aetna Commercial |
$1,141.15
|
| Rate for Payer: Aetna Medicare |
$237.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: ASR ASR |
$1,229.90
|
| Rate for Payer: ASR Commercial |
$1,229.90
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.32
|
| Rate for Payer: BCN Commercial |
$983.03
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$1,014.35
|
| Rate for Payer: Cash Price |
$1,014.35
|
| Rate for Payer: Cofinity Commercial |
$1,191.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$1,267.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.20
|
| Rate for Payer: Mclaren Commercial |
$1,141.15
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.75
|
| Rate for Payer: Nomi Health Commercial |
$1,039.71
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$260.92
|
| Rate for Payer: PHP Medicaid |
$127.14
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.97
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health Narrow Network |
$888.83
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$367.66
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP DNSP |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
OP
|
$1,226.51
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$1,103.86
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$1,189.71
|
| Rate for Payer: ASR Commercial |
$1,189.71
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.39
|
| Rate for Payer: BCN Commercial |
$950.91
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,152.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,226.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$1,103.86
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,074.67
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$859.78
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,079.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
IP
|
$1,226.51
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$797.23 |
| Max. Negotiated Rate |
$1,226.51 |
| Rate for Payer: Aetna Commercial |
$1,103.86
|
| Rate for Payer: ASR ASR |
$1,189.71
|
| Rate for Payer: ASR Commercial |
$1,189.71
|
| Rate for Payer: BCBS Trust/PPO |
$999.48
|
| Rate for Payer: BCN Commercial |
$950.91
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,152.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Healthscope Commercial |
$1,226.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.71
|
| Rate for Payer: Mclaren Commercial |
$1,103.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,079.33
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
OP
|
$1,349.16
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$1,214.24
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$1,308.69
|
| Rate for Payer: ASR Commercial |
$1,308.69
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.83
|
| Rate for Payer: BCN Commercial |
$1,046.00
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$1,079.33
|
| Rate for Payer: Cash Price |
$1,079.33
|
| Rate for Payer: Cofinity Commercial |
$1,268.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,349.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$1,214.24
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,146.79
|
| Rate for Payer: Nomi Health Commercial |
$1,106.31
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,182.13
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$945.76
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
IP
|
$1,349.16
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$876.95 |
| Max. Negotiated Rate |
$1,349.16 |
| Rate for Payer: Aetna Commercial |
$1,214.24
|
| Rate for Payer: ASR ASR |
$1,308.69
|
| Rate for Payer: ASR Commercial |
$1,308.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.43
|
| Rate for Payer: BCN Commercial |
$1,046.00
|
| Rate for Payer: Cash Price |
$1,079.33
|
| Rate for Payer: Cofinity Commercial |
$1,268.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.33
|
| Rate for Payer: Healthscope Commercial |
$1,349.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.69
|
| Rate for Payer: Mclaren Commercial |
$1,214.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,146.79
|
| Rate for Payer: Nomi Health Commercial |
$1,106.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.26
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
OP
|
$1,276.51
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$1,148.86
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$1,238.21
|
| Rate for Payer: ASR Commercial |
$1,238.21
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,045.33
|
| Rate for Payer: BCN Commercial |
$989.68
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$1,021.21
|
| Rate for Payer: Cash Price |
$1,021.21
|
| Rate for Payer: Cofinity Commercial |
$1,199.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,276.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,238.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$1,148.86
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.03
|
| Rate for Payer: Nomi Health Commercial |
$1,046.74
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.48
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$894.83
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,123.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
IP
|
$1,276.51
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$829.73 |
| Max. Negotiated Rate |
$1,276.51 |
| Rate for Payer: Aetna Commercial |
$1,148.86
|
| Rate for Payer: ASR ASR |
$1,238.21
|
| Rate for Payer: ASR Commercial |
$1,238.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.23
|
| Rate for Payer: BCN Commercial |
$989.68
|
| Rate for Payer: Cash Price |
$1,021.21
|
| Rate for Payer: Cofinity Commercial |
$1,199.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.21
|
| Rate for Payer: Healthscope Commercial |
$1,276.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,238.21
|
| Rate for Payer: Mclaren Commercial |
$1,148.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.03
|
| Rate for Payer: Nomi Health Commercial |
$1,046.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,123.33
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna Commercial |
$798.62
|
| Rate for Payer: ASR ASR |
$860.74
|
| Rate for Payer: ASR Commercial |
$860.74
|
| Rate for Payer: BCBS Trust/PPO |
$723.11
|
| Rate for Payer: BCN Commercial |
$687.97
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$834.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$860.74
|
| Rate for Payer: Mclaren Commercial |
$798.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.88
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$798.62
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$860.74
|
| Rate for Payer: ASR Commercial |
$860.74
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$726.66
|
| Rate for Payer: BCN Commercial |
$687.97
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$834.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$860.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$798.62
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.50
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$622.04
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$718.71
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$467.16 |
| Max. Negotiated Rate |
$718.71 |
| Rate for Payer: Aetna Commercial |
$646.84
|
| Rate for Payer: ASR ASR |
$697.15
|
| Rate for Payer: ASR Commercial |
$697.15
|
| Rate for Payer: BCBS Trust/PPO |
$585.68
|
| Rate for Payer: BCN Commercial |
$557.22
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cofinity Commercial |
$675.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.97
|
| Rate for Payer: Healthscope Commercial |
$718.71
|
| Rate for Payer: Healthscope Whirlpool |
$697.15
|
| Rate for Payer: Mclaren Commercial |
$646.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.90
|
| Rate for Payer: Nomi Health Commercial |
$589.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.46
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$718.71
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$718.71 |
| Rate for Payer: Aetna Commercial |
$646.84
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$697.15
|
| Rate for Payer: ASR Commercial |
$697.15
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$588.55
|
| Rate for Payer: BCN Commercial |
$557.22
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cofinity Commercial |
$675.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$718.71
|
| Rate for Payer: Healthscope Whirlpool |
$697.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$646.84
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.90
|
| Rate for Payer: Nomi Health Commercial |
$589.34
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$223.39
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$629.73
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$503.82
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$632.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$646.01
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP DNSP |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$223.39
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna Commercial |
$798.62
|
| Rate for Payer: ASR ASR |
$860.74
|
| Rate for Payer: ASR Commercial |
$860.74
|
| Rate for Payer: BCBS Trust/PPO |
$723.11
|
| Rate for Payer: BCN Commercial |
$687.97
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$834.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$860.74
|
| Rate for Payer: Mclaren Commercial |
$798.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.88
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$798.62
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$860.74
|
| Rate for Payer: ASR Commercial |
$860.74
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$726.66
|
| Rate for Payer: BCN Commercial |
$687.97
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$834.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$860.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$798.62
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.50
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$622.04
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna Commercial |
$798.62
|
| Rate for Payer: ASR ASR |
$860.74
|
| Rate for Payer: ASR Commercial |
$860.74
|
| Rate for Payer: BCBS Trust/PPO |
$723.11
|
| Rate for Payer: BCN Commercial |
$687.97
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$834.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$860.74
|
| Rate for Payer: Mclaren Commercial |
$798.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.88
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$798.62
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$860.74
|
| Rate for Payer: ASR Commercial |
$860.74
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$726.66
|
| Rate for Payer: BCN Commercial |
$687.97
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$834.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$887.36
|
| Rate for Payer: Healthscope Whirlpool |
$860.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$798.62
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.50
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$622.04
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$913.46
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$822.11
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$886.06
|
| Rate for Payer: ASR Commercial |
$886.06
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$748.03
|
| Rate for Payer: BCN Commercial |
$708.21
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cofinity Commercial |
$858.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$913.46
|
| Rate for Payer: Healthscope Whirlpool |
$886.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$822.11
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.44
|
| Rate for Payer: Nomi Health Commercial |
$749.04
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$800.37
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$640.34
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$803.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$913.46
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$593.75 |
| Max. Negotiated Rate |
$913.46 |
| Rate for Payer: Aetna Commercial |
$822.11
|
| Rate for Payer: ASR ASR |
$886.06
|
| Rate for Payer: ASR Commercial |
$886.06
|
| Rate for Payer: BCBS Trust/PPO |
$744.38
|
| Rate for Payer: BCN Commercial |
$708.21
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cofinity Commercial |
$858.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.77
|
| Rate for Payer: Healthscope Commercial |
$913.46
|
| Rate for Payer: Healthscope Whirlpool |
$886.06
|
| Rate for Payer: Mclaren Commercial |
$822.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.44
|
| Rate for Payer: Nomi Health Commercial |
$749.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$803.84
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,226.51
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$797.23 |
| Max. Negotiated Rate |
$1,226.51 |
| Rate for Payer: Aetna Commercial |
$1,103.86
|
| Rate for Payer: ASR ASR |
$1,189.71
|
| Rate for Payer: ASR Commercial |
$1,189.71
|
| Rate for Payer: BCBS Trust/PPO |
$999.48
|
| Rate for Payer: BCN Commercial |
$950.91
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,152.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Healthscope Commercial |
$1,226.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.71
|
| Rate for Payer: Mclaren Commercial |
$1,103.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,079.33
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
OP
|
$1,226.51
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$1,417.29 |
| Rate for Payer: Aetna Commercial |
$1,103.86
|
| Rate for Payer: Aetna Medicare |
$914.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: ASR ASR |
$1,189.71
|
| Rate for Payer: ASR Commercial |
$1,189.71
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.39
|
| Rate for Payer: BCN Commercial |
$950.91
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,152.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,226.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$914.38
|
| Rate for Payer: Mclaren Commercial |
$1,103.86
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,005.82
|
| Rate for Payer: PHP Medicaid |
$490.11
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,074.67
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health Narrow Network |
$859.78
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,079.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,417.29
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP DNSP |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.90
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$25.52
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
