|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,909.09
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,163.64 |
| Max. Negotiated Rate |
$2,618.18 |
| Rate for Payer: Aetna Commercial |
$2,472.73
|
| Rate for Payer: Aetna Medicare |
$1,454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,890.91
|
| Rate for Payer: BCBS Complete |
$1,163.64
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Advantage |
$2,036.36
|
| Rate for Payer: Cofinity Commercial |
$2,501.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,618.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: PHP Commercial |
$2,472.73
|
| Rate for Payer: Priority Health SBD |
$1,832.73
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$3,038.67
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,215.47 |
| Max. Negotiated Rate |
$2,734.80 |
| Rate for Payer: Aetna Commercial |
$2,582.87
|
| Rate for Payer: Aetna Medicare |
$1,519.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,975.14
|
| Rate for Payer: BCBS Complete |
$1,215.47
|
| Rate for Payer: Cash Price |
$2,430.94
|
| Rate for Payer: Cofinity Advantage |
$2,127.07
|
| Rate for Payer: Cofinity Commercial |
$2,613.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.94
|
| Rate for Payer: Healthscope Commercial |
$2,734.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,430.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,279.00
|
| Rate for Payer: PHP Commercial |
$2,582.87
|
| Rate for Payer: Priority Health SBD |
$1,914.36
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$3,038.67
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,914.36 |
| Max. Negotiated Rate |
$2,734.80 |
| Rate for Payer: Aetna Commercial |
$2,582.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,975.14
|
| Rate for Payer: Cash Price |
$2,430.94
|
| Rate for Payer: Cofinity Advantage |
$2,127.07
|
| Rate for Payer: Cofinity Commercial |
$2,613.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.94
|
| Rate for Payer: Healthscope Commercial |
$2,734.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,582.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,279.00
|
| Rate for Payer: PHP Commercial |
$2,582.87
|
| Rate for Payer: Priority Health SBD |
$1,914.36
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$75.34
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$64.04
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$28.13
|
| Rate for Payer: BCN Commercial |
$28.13
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cofinity Advantage |
$52.74
|
| Rate for Payer: Cofinity Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.04
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.04
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$47.46
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.97
|
| Rate for Payer: UHC Core |
$39.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$29.61
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$75.34
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.97
|
| Rate for Payer: Cash Price |
$60.27
|
| Rate for Payer: Cofinity Advantage |
$52.74
|
| Rate for Payer: Cofinity Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.27
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PHP Commercial |
$64.04
|
| Rate for Payer: Priority Health SBD |
$47.46
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$37.12
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$33.41 |
| Rate for Payer: Aetna Commercial |
$31.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.13
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Advantage |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Healthscope Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.84
|
| Rate for Payer: PHP Commercial |
$31.55
|
| Rate for Payer: Priority Health SBD |
$23.39
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$37.12
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Aetna Commercial |
$31.55
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Advantage |
$25.98
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$33.41
|
| Rate for Payer: Mclaren Medicaid |
$15.07
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$30.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.55
|
| Rate for Payer: Nomi Health Commercial |
$86.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.84
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$31.55
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.19
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health SBD |
$23.39
|
| Rate for Payer: Priority Health Tiered Network |
$74.55
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.13
|
| Rate for Payer: UHC Core |
$19.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$14.59
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,849.99
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,945.49 |
| Max. Negotiated Rate |
$7,064.99 |
| Rate for Payer: Aetna Commercial |
$6,672.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,102.49
|
| Rate for Payer: Cash Price |
$6,279.99
|
| Rate for Payer: Cofinity Advantage |
$5,494.99
|
| Rate for Payer: Cofinity Commercial |
$6,750.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,279.99
|
| Rate for Payer: Healthscope Commercial |
$7,064.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,672.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,887.49
|
| Rate for Payer: PHP Commercial |
$6,672.49
|
| Rate for Payer: Priority Health SBD |
$4,945.49
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,849.99
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,085.05 |
| Max. Negotiated Rate |
$7,064.99 |
| Rate for Payer: Aetna Commercial |
$6,672.49
|
| Rate for Payer: Aetna Medicare |
$3,924.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,102.49
|
| Rate for Payer: BCBS Complete |
$3,140.00
|
| Rate for Payer: Cash Price |
$6,279.99
|
| Rate for Payer: Cofinity Advantage |
$5,494.99
|
| Rate for Payer: Cofinity Commercial |
$6,750.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,279.99
|
| Rate for Payer: Healthscope Commercial |
$7,064.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,279.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,672.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,887.49
|
| Rate for Payer: PHP Commercial |
$6,672.49
|
| Rate for Payer: Priority Health SBD |
$4,945.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,102.49
|
| Rate for Payer: UHC Core |
$4,089.84
|
| Rate for Payer: UHC Exchange |
$3,085.05
|
|
|
HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 95984
|
| Hospital Charge Code |
76100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.15
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Advantage |
$49.70
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: Priority Health SBD |
$44.73
|
|
|
HC ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 95984
|
| Hospital Charge Code |
76100548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.15
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Trust/PPO |
$62.18
|
| Rate for Payer: BCN Commercial |
$62.18
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Advantage |
$49.70
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: Priority Health SBD |
$44.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.15
|
| Rate for Payer: UHC Core |
$36.99
|
| Rate for Payer: UHC Exchange |
$27.90
|
|
|
HC ELEC ALYS IMPLT COMPLEX CN NPGT PRGRMG
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$306.34 |
| Rate for Payer: Aetna Commercial |
$230.35
|
| Rate for Payer: Aetna Medicare |
$98.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$68.10
|
| Rate for Payer: BCN Commercial |
$68.10
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Advantage |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$233.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$243.90
|
| Rate for Payer: Mclaren Medicaid |
$49.54
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$99.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$284.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$230.35
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.34
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health SBD |
$170.73
|
| Rate for Payer: Priority Health Tiered Network |
$245.07
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.15
|
| Rate for Payer: UHC Core |
$141.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$106.50
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ELEC ALYS IMPLT COMPLEX CN NPGT PRGRMG
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Aetna Commercial |
$230.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.15
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Advantage |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$233.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.80
|
| Rate for Payer: Healthscope Commercial |
$243.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: PHP Commercial |
$230.35
|
| Rate for Payer: Priority Health SBD |
$170.73
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$198.44
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$306.34 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna Medicare |
$98.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$122.89
|
| Rate for Payer: BCN Commercial |
$122.89
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Advantage |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Mclaren Medicaid |
$49.54
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$99.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$284.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.83
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.34
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health SBD |
$125.02
|
| Rate for Payer: Priority Health Tiered Network |
$245.07
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.99
|
| Rate for Payer: UHC Core |
$103.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$77.99
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$198.44
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$125.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.99
|
| Rate for Payer: Cash Price |
$158.75
|
| Rate for Payer: Cofinity Advantage |
$138.91
|
| Rate for Payer: Cofinity Commercial |
$170.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.75
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.83
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health SBD |
$125.02
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$173.54
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$147.51
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$26.66
|
| Rate for Payer: BCN Commercial |
$26.66
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cofinity Advantage |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.51
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.16
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$147.51
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$109.33
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.80
|
| Rate for Payer: UHC Core |
$90.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$68.20
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$173.54
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$109.33 |
| Max. Negotiated Rate |
$156.19 |
| Rate for Payer: Aetna Commercial |
$147.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.80
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cofinity Advantage |
$121.48
|
| Rate for Payer: Cofinity Commercial |
$149.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.83
|
| Rate for Payer: Healthscope Commercial |
$156.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.16
|
| Rate for Payer: PHP Commercial |
$147.51
|
| Rate for Payer: Priority Health SBD |
$109.33
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$180.53
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$306.34 |
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: Aetna Medicare |
$98.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.41
|
| Rate for Payer: BCBS Complete |
$52.03
|
| Rate for Payer: BCBS MAPPO |
$94.73
|
| Rate for Payer: BCBS Trust/PPO |
$87.34
|
| Rate for Payer: BCN Commercial |
$87.34
|
| Rate for Payer: BCN Medicare Advantage |
$94.73
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Advantage |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.73
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Mclaren Medicaid |
$49.54
|
| Rate for Payer: Mclaren Medicare |
$94.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.47
|
| Rate for Payer: Meridian Medicaid |
$99.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Nomi Health Commercial |
$284.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.40
|
| Rate for Payer: PACE Medicare |
$89.99
|
| Rate for Payer: PACE SWMI |
$94.73
|
| Rate for Payer: PHP Commercial |
$153.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$306.34
|
| Rate for Payer: Priority Health Medicare |
$94.73
|
| Rate for Payer: Priority Health SBD |
$113.73
|
| Rate for Payer: Priority Health Tiered Network |
$245.07
|
| Rate for Payer: Railroad Medicare Medicare |
$94.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.34
|
| Rate for Payer: UHC Core |
$94.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.73
|
| Rate for Payer: UHC Exchange |
$70.95
|
| Rate for Payer: UHC Medicaid |
$49.54
|
| Rate for Payer: UHCCP Medicaid |
$49.54
|
| Rate for Payer: VA VA |
$94.73
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$180.53
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$113.73 |
| Max. Negotiated Rate |
$162.48 |
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Advantage |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.40
|
| Rate for Payer: PHP Commercial |
$153.45
|
| Rate for Payer: Priority Health SBD |
$113.73
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$210.68
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.73 |
| Max. Negotiated Rate |
$189.61 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.94
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cofinity Advantage |
$147.48
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.54
|
| Rate for Payer: Healthscope Commercial |
$189.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.01
|
| Rate for Payer: PHP Commercial |
$179.08
|
| Rate for Payer: Priority Health SBD |
$132.73
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$210.68
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$189.61 |
| Rate for Payer: Aetna Commercial |
$179.08
|
| Rate for Payer: Aetna Medicare |
$105.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.94
|
| Rate for Payer: BCBS Complete |
$84.27
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cofinity Advantage |
$147.48
|
| Rate for Payer: Cofinity Commercial |
$181.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.54
|
| Rate for Payer: Healthscope Commercial |
$189.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.01
|
| Rate for Payer: PHP Commercial |
$179.08
|
| Rate for Payer: Priority Health SBD |
$132.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.94
|
| Rate for Payer: UHC Core |
$109.76
|
| Rate for Payer: UHC Exchange |
$82.80
|
|
