|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$94.45
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$47.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.39
|
| Rate for Payer: BCBS Complete |
$37.78
|
| Rate for Payer: BCBS Trust/PPO |
$11.58
|
| Rate for Payer: BCN Commercial |
$11.58
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Advantage |
$66.11
|
| Rate for Payer: Cofinity Commercial |
$81.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: PHP Commercial |
$80.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.00
|
| Rate for Payer: Priority Health SBD |
$59.50
|
| Rate for Payer: Priority Health Tiered Network |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.39
|
| Rate for Payer: UHC Core |
$49.21
|
| Rate for Payer: UHC Exchange |
$37.12
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$94.45
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.39
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Advantage |
$66.11
|
| Rate for Payer: Cofinity Commercial |
$81.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: PHP Commercial |
$80.28
|
| Rate for Payer: Priority Health SBD |
$59.50
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$104.49
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$88.82
|
| Rate for Payer: Aetna Medicare |
$52.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.92
|
| Rate for Payer: BCBS Complete |
$41.80
|
| Rate for Payer: BCBS Trust/PPO |
$10.66
|
| Rate for Payer: BCN Commercial |
$10.66
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cofinity Advantage |
$73.14
|
| Rate for Payer: Cofinity Commercial |
$89.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.59
|
| Rate for Payer: Healthscope Commercial |
$94.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.82
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.37
|
| Rate for Payer: PHP Commercial |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.17
|
| Rate for Payer: Priority Health SBD |
$65.83
|
| Rate for Payer: Priority Health Tiered Network |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.92
|
| Rate for Payer: UHC Core |
$54.44
|
| Rate for Payer: UHC Exchange |
$41.06
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
IP
|
$104.49
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$94.04 |
| Rate for Payer: Aetna Commercial |
$88.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.92
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cofinity Advantage |
$73.14
|
| Rate for Payer: Cofinity Commercial |
$89.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.59
|
| Rate for Payer: Healthscope Commercial |
$94.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.37
|
| Rate for Payer: PHP Commercial |
$88.82
|
| Rate for Payer: Priority Health SBD |
$65.83
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
OP
|
$135.42
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$115.11
|
| Rate for Payer: Aetna Medicare |
$67.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.02
|
| Rate for Payer: BCBS Complete |
$54.17
|
| Rate for Payer: BCBS Trust/PPO |
$11.19
|
| Rate for Payer: BCN Commercial |
$11.19
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Advantage |
$94.79
|
| Rate for Payer: Cofinity Commercial |
$116.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$121.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: PHP Commercial |
$115.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.17
|
| Rate for Payer: Priority Health SBD |
$85.31
|
| Rate for Payer: Priority Health Tiered Network |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.02
|
| Rate for Payer: UHC Core |
$70.55
|
| Rate for Payer: UHC Exchange |
$53.22
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
IP
|
$135.42
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.31 |
| Max. Negotiated Rate |
$121.88 |
| Rate for Payer: Aetna Commercial |
$115.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.02
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Advantage |
$94.79
|
| Rate for Payer: Cofinity Commercial |
$116.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: PHP Commercial |
$115.11
|
| Rate for Payer: Priority Health SBD |
$85.31
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.48 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.07
|
| Rate for Payer: BCBS Complete |
$32.04
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Advantage |
$56.08
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.08
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: Priority Health SBD |
$50.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.07
|
| Rate for Payer: UHC Core |
$41.74
|
| Rate for Payer: UHC Exchange |
$31.48
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.07
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Advantage |
$56.08
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.08
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: Priority Health SBD |
$50.47
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Advantage |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.67
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health SBD |
$57.68
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Advantage |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.67
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health SBD |
$57.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: UHC Exchange |
$35.98
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
OP
|
$221.75
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$199.57 |
| Rate for Payer: Aetna Commercial |
$188.49
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| 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 |
$21.01
|
| Rate for Payer: BCN Commercial |
$21.01
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$177.40
|
| Rate for Payer: Cash Price |
$177.40
|
| Rate for Payer: Cofinity Advantage |
$155.22
|
| Rate for Payer: Cofinity Commercial |
$190.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$199.57
|
| 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 |
$188.49
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.31
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$188.49
|
| 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 |
$139.70
|
| 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) |
$144.14
|
| Rate for Payer: UHC Core |
$115.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$87.15
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
IP
|
$221.75
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$139.70 |
| Max. Negotiated Rate |
$199.57 |
| Rate for Payer: Aetna Commercial |
$188.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.14
|
| Rate for Payer: Cash Price |
$177.40
|
| Rate for Payer: Cofinity Advantage |
$155.22
|
| Rate for Payer: Cofinity Commercial |
$190.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.40
|
| Rate for Payer: Healthscope Commercial |
$199.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.31
|
| Rate for Payer: PHP Commercial |
$188.49
|
| Rate for Payer: Priority Health SBD |
$139.70
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$120.26 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$19.45
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$39.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$111.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.26
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health Tiered Network |
$96.21
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.36
|
| Rate for Payer: UHC Core |
$40.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$30.45
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: VA VA |
$37.19
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health SBD |
$48.81
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
OP
|
$28.65
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$24.35
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.76
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cofinity Advantage |
$20.05
|
| Rate for Payer: Cofinity Commercial |
$24.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$25.79
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicare |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.36
|
| Rate for Payer: Meridian Medicaid |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.35
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.49
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$24.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.01
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health SBD |
$18.05
|
| Rate for Payer: Priority Health Tiered Network |
$5.61
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.52
|
| Rate for Payer: UHC Core |
$10.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.01
|
| Rate for Payer: UHC Exchange |
$10.52
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
IP
|
$28.65
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$24.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.62
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cofinity Advantage |
$20.05
|
| Rate for Payer: Cofinity Commercial |
$24.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.49
|
| Rate for Payer: PHP Commercial |
$24.35
|
| Rate for Payer: Priority Health SBD |
$18.05
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
OP
|
$89.58
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$80.62 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.76
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Advantage |
$62.71
|
| Rate for Payer: Cofinity Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$80.62
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicare |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.36
|
| Rate for Payer: Meridian Medicaid |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.14
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.19
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$76.14
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.01
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health SBD |
$56.44
|
| Rate for Payer: Priority Health Tiered Network |
$5.61
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.52
|
| Rate for Payer: UHC Core |
$10.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.01
|
| Rate for Payer: UHC Exchange |
$10.52
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
IP
|
$89.58
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$80.62 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.23
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Advantage |
$62.71
|
| Rate for Payer: Cofinity Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Healthscope Commercial |
$80.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.19
|
| Rate for Payer: PHP Commercial |
$76.14
|
| Rate for Payer: Priority Health SBD |
$56.44
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 100
|
Facility
|
IP
|
$10,050.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,331.50 |
| Max. Negotiated Rate |
$9,045.00 |
| Rate for Payer: Aetna Commercial |
$8,542.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,532.50
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cofinity Advantage |
$7,035.00
|
| Rate for Payer: Cofinity Commercial |
$8,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,040.00
|
| Rate for Payer: Healthscope Commercial |
$9,045.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,542.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,537.50
|
| Rate for Payer: PHP Commercial |
$8,542.50
|
| Rate for Payer: Priority Health SBD |
$6,331.50
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 100
|
Facility
|
OP
|
$10,050.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$9,045.00 |
| Rate for Payer: Aetna Commercial |
$8,542.50
|
| Rate for Payer: Aetna Medicare |
$5,025.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,532.50
|
| Rate for Payer: BCBS Complete |
$4,020.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cash Price |
$8,040.00
|
| Rate for Payer: Cofinity Advantage |
$7,035.00
|
| Rate for Payer: Cofinity Commercial |
$8,643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,040.00
|
| Rate for Payer: Healthscope Commercial |
$9,045.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,040.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,542.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,537.50
|
| Rate for Payer: PHP Commercial |
$8,542.50
|
| Rate for Payer: Priority Health SBD |
$6,331.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,532.50
|
| Rate for Payer: UHC Core |
$5,236.05
|
| Rate for Payer: UHC Exchange |
$3,949.65
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPINGLEVEL 31
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna Commercial |
$2,677.50
|
| Rate for Payer: Aetna Medicare |
$1,575.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.50
|
| Rate for Payer: BCBS Complete |
$1,260.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cofinity Advantage |
$2,205.00
|
| Rate for Payer: Cofinity Commercial |
$2,709.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$2,835.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,520.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,677.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,362.50
|
| Rate for Payer: PHP Commercial |
$2,677.50
|
| Rate for Payer: Priority Health SBD |
$1,984.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,047.50
|
| Rate for Payer: UHC Core |
$1,641.15
|
| Rate for Payer: UHC Exchange |
$1,237.95
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPINGLEVEL 31
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna Commercial |
$2,677.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,047.50
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cofinity Advantage |
$2,205.00
|
| Rate for Payer: Cofinity Commercial |
$2,709.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$2,835.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,677.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,362.50
|
| Rate for Payer: PHP Commercial |
$2,677.50
|
| Rate for Payer: Priority Health SBD |
$1,984.50
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 39
|
Facility
|
OP
|
$3,988.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,589.20 |
| Rate for Payer: Aetna Commercial |
$3,389.80
|
| Rate for Payer: Aetna Medicare |
$1,994.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,592.20
|
| Rate for Payer: BCBS Complete |
$1,595.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$3,190.40
|
| Rate for Payer: Cash Price |
$3,190.40
|
| Rate for Payer: Cofinity Advantage |
$2,791.60
|
| Rate for Payer: Cofinity Commercial |
$3,429.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,190.40
|
| Rate for Payer: Healthscope Commercial |
$3,589.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,190.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,389.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,991.00
|
| Rate for Payer: PHP Commercial |
$3,389.80
|
| Rate for Payer: Priority Health SBD |
$2,512.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,592.20
|
| Rate for Payer: UHC Core |
$2,077.75
|
| Rate for Payer: UHC Exchange |
$1,567.28
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 39
|
Facility
|
IP
|
$3,988.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,512.44 |
| Max. Negotiated Rate |
$3,589.20 |
| Rate for Payer: Aetna Commercial |
$3,389.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,592.20
|
| Rate for Payer: Cash Price |
$3,190.40
|
| Rate for Payer: Cofinity Advantage |
$2,791.60
|
| Rate for Payer: Cofinity Commercial |
$3,429.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,190.40
|
| Rate for Payer: Healthscope Commercial |
$3,589.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,389.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,991.00
|
| Rate for Payer: PHP Commercial |
$3,389.80
|
| Rate for Payer: Priority Health SBD |
$2,512.44
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 46
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,910.60 |
| Max. Negotiated Rate |
$4,158.00 |
| Rate for Payer: Aetna Commercial |
$3,927.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,003.00
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Cofinity Advantage |
$3,234.00
|
| Rate for Payer: Cofinity Commercial |
$3,973.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,696.00
|
| Rate for Payer: Healthscope Commercial |
$4,158.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,927.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,465.00
|
| Rate for Payer: PHP Commercial |
$3,927.00
|
| Rate for Payer: Priority Health SBD |
$2,910.60
|
|
