|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$66.47 |
| Rate for Payer: Aetna Commercial |
$62.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.01
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Healthscope Commercial |
$66.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: PHP Commercial |
$62.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health SBD |
$46.53
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: PHP Commercial |
$30.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$22.93
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$30.93
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,078.43 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna Medicare |
$3,848.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,002.45
|
| Rate for Payer: BCBS Complete |
$3,078.43
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$5,387.25
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,387.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health SBD |
$4,848.52
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,848.52 |
| Max. Negotiated Rate |
$6,926.46 |
| Rate for Payer: Aetna Commercial |
$6,541.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,002.45
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$5,387.25
|
| Rate for Payer: Cofinity Commercial |
$6,618.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,387.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$6,926.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: PHP Commercial |
$6,541.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health SBD |
$4,848.52
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$122.57 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.46
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$136.19
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: PHP Commercial |
$165.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health SBD |
$122.57
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$251.99 |
| Rate for Payer: Aetna Commercial |
$165.37
|
| Rate for Payer: Aetna Medicare |
$93.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.90
|
| Rate for Payer: BCBS Complete |
$50.38
|
| Rate for Payer: BCBS MAPPO |
$89.52
|
| Rate for Payer: BCN Medicare Advantage |
$89.52
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$167.31
|
| Rate for Payer: Cofinity Commercial |
$136.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.52
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Mclaren Medicaid |
$47.98
|
| Rate for Payer: Mclaren Medicare |
$89.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.00
|
| Rate for Payer: Meridian Medicaid |
$50.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: PACE Medicare |
$85.04
|
| Rate for Payer: PACE SWMI |
$89.52
|
| Rate for Payer: PHP Commercial |
$165.37
|
| Rate for Payer: PHP Medicare Advantage |
$89.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health Medicare |
$89.52
|
| Rate for Payer: Priority Health SBD |
$122.57
|
| Rate for Payer: Railroad Medicare Medicare |
$89.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.99
|
| Rate for Payer: UHC Core |
$143.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.52
|
| Rate for Payer: UHC Exchange |
$143.97
|
| Rate for Payer: UHC Medicare Advantage |
$89.52
|
| Rate for Payer: UHCCP Medicaid |
$50.40
|
| Rate for Payer: VA VA |
$89.52
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$170.14
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$144.62
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cofinity Commercial |
$146.32
|
| Rate for Payer: Cofinity Commercial |
$119.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$153.13
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$144.62
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.59
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$107.19
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$125.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$125.90
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$170.14
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$107.19 |
| Max. Negotiated Rate |
$153.13 |
| Rate for Payer: Aetna Commercial |
$144.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.59
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cofinity Commercial |
$119.10
|
| Rate for Payer: Cofinity Commercial |
$146.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.11
|
| Rate for Payer: Healthscope Commercial |
$153.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: PHP Commercial |
$144.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.59
|
| Rate for Payer: Priority Health SBD |
$107.19
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$176.99
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health SBD |
$111.50
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$176.99
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$251.99 |
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna Medicare |
$93.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.90
|
| Rate for Payer: BCBS Complete |
$50.38
|
| Rate for Payer: BCBS MAPPO |
$89.52
|
| Rate for Payer: BCN Medicare Advantage |
$89.52
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Cofinity Commercial |
$123.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.52
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Mclaren Medicaid |
$47.98
|
| Rate for Payer: Mclaren Medicare |
$89.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.00
|
| Rate for Payer: Meridian Medicaid |
$50.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: PACE Medicare |
$85.04
|
| Rate for Payer: PACE SWMI |
$89.52
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: PHP Medicare Advantage |
$89.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health Medicare |
$89.52
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: Railroad Medicare Medicare |
$89.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.99
|
| Rate for Payer: UHC Core |
$130.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.52
|
| Rate for Payer: UHC Exchange |
$130.97
|
| Rate for Payer: UHC Medicare Advantage |
$89.52
|
| Rate for Payer: UHCCP Medicaid |
$50.40
|
| Rate for Payer: VA VA |
$89.52
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$206.55
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.62 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$175.57
|
| Rate for Payer: Aetna Medicare |
$103.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.26
|
| Rate for Payer: BCBS Complete |
$82.62
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$144.59
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$185.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.57
|
| Rate for Payer: PHP Commercial |
$175.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.26
|
| Rate for Payer: Priority Health SBD |
$130.13
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$206.55
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.13 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Commercial |
$175.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.26
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$144.59
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$185.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.57
|
| Rate for Payer: PHP Commercial |
$175.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.26
|
| Rate for Payer: Priority Health SBD |
$130.13
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$46.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.19
|
| Rate for Payer: BCBS Complete |
$37.04
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Cofinity Commercial |
$64.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health SBD |
$58.34
|
| Rate for Payer: UHC Core |
$68.52
|
| Rate for Payer: UHC Exchange |
$68.52
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.19
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health SBD |
$58.34
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$102.44
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$87.07
|
| Rate for Payer: Aetna Medicare |
$51.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.59
|
| Rate for Payer: BCBS Complete |
$40.98
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Cofinity Commercial |
$71.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$87.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: Priority Health SBD |
$64.54
|
| Rate for Payer: UHC Core |
$75.81
|
| Rate for Payer: UHC Exchange |
$75.81
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
IP
|
$102.44
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna Commercial |
$87.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.59
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$71.71
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: PHP Commercial |
$87.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: Priority Health SBD |
$64.54
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
IP
|
$132.76
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.64 |
| Max. Negotiated Rate |
$119.48 |
| Rate for Payer: Aetna Commercial |
$112.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.29
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$114.17
|
| Rate for Payer: Cofinity Commercial |
$92.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.21
|
| Rate for Payer: Healthscope Commercial |
$119.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.85
|
| Rate for Payer: PHP Commercial |
$112.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.29
|
| Rate for Payer: Priority Health SBD |
$83.64
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
OP
|
$132.76
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$112.85
|
| Rate for Payer: Aetna Medicare |
$66.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.29
|
| Rate for Payer: BCBS Complete |
$53.10
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$92.93
|
| Rate for Payer: Cofinity Commercial |
$114.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.21
|
| Rate for Payer: Healthscope Commercial |
$119.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.85
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$112.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.29
|
| Rate for Payer: Priority Health SBD |
$83.64
|
| Rate for Payer: UHC Core |
$98.24
|
| Rate for Payer: UHC Exchange |
$98.24
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
IP
|
$78.54
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$70.69 |
| Rate for Payer: Aetna Commercial |
$66.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.05
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$54.98
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.83
|
| Rate for Payer: Healthscope Commercial |
$70.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.76
|
| Rate for Payer: PHP Commercial |
$66.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.05
|
| Rate for Payer: Priority Health SBD |
$49.48
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
OP
|
$78.54
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$70.69 |
| Rate for Payer: Aetna Commercial |
$66.76
|
| Rate for Payer: Aetna Medicare |
$39.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.05
|
| Rate for Payer: BCBS Complete |
$31.42
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$54.98
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.83
|
| Rate for Payer: Healthscope Commercial |
$70.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.76
|
| Rate for Payer: PHP Commercial |
$66.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.05
|
| Rate for Payer: Priority Health SBD |
$49.48
|
| Rate for Payer: UHC Core |
$58.12
|
| Rate for Payer: UHC Exchange |
$58.12
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health SBD |
$56.55
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$44.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health SBD |
$56.55
|
| Rate for Payer: UHC Core |
$66.42
|
| Rate for Payer: UHC Exchange |
$66.42
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
OP
|
$217.40
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$195.66 |
| Rate for Payer: Aetna Commercial |
$184.79
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$173.92
|
| Rate for Payer: Cash Price |
$173.92
|
| Rate for Payer: Cofinity Commercial |
$186.96
|
| Rate for Payer: Cofinity Commercial |
$152.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$195.66
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.79
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$184.79
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.31
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$136.96
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$160.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$160.88
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
IP
|
$217.40
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$195.66 |
| Rate for Payer: Aetna Commercial |
$184.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.31
|
| Rate for Payer: Cash Price |
$173.92
|
| Rate for Payer: Cofinity Commercial |
$152.18
|
| Rate for Payer: Cofinity Commercial |
$186.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.92
|
| Rate for Payer: Healthscope Commercial |
$195.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.79
|
| Rate for Payer: PHP Commercial |
$184.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.31
|
| Rate for Payer: Priority Health SBD |
$136.96
|
|
