|
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 |
$40.90 |
| Max. Negotiated Rate |
$282.66 |
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna Medicare |
$93.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.41
|
| Rate for Payer: BCBS Complete |
$50.61
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCBS Trust/PPO |
$87.11
|
| Rate for Payer: BCN Commercial |
$87.11
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| 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 |
$89.93
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Mclaren Medicaid |
$48.20
|
| Rate for Payer: Mclaren Medicare |
$89.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Meridian Medicaid |
$50.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Nomi Health Commercial |
$269.79
|
| Rate for Payer: PACE Medicare |
$85.43
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.66
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow Network |
$226.13
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: Railroad Medicare Medicare |
$89.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Exchange |
$130.97
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: VA VA |
$89.93
|
|
|
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 |
$144.58
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.58
|
| 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
|
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 |
$144.58
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.58
|
| 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
|
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
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.16 |
| 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: BCBS Trust/PPO |
$10.16
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: Cash Price |
$74.08
|
| 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 HMO/PPO/Tiered Network |
$23.00
|
| Rate for Payer: Priority Health Narrow Network |
$18.40
|
| Rate for Payer: Priority Health SBD |
$58.34
|
| Rate for Payer: UHC Exchange |
$68.52
|
|
|
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 FOR PRESSURE
|
Facility
|
OP
|
$102.44
|
|
|
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 |
$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: BCBS Trust/PPO |
$9.62
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| 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: 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 HMO/PPO/Tiered Network |
$7.17
|
| Rate for Payer: Priority Health Narrow Network |
$5.74
|
| Rate for Payer: Priority Health SBD |
$64.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.16
|
| Rate for Payer: UHC Exchange |
$75.81
|
|
|
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 |
$5.74 |
| 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: BCBS Trust/PPO |
$9.62
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cash Price |
$106.21
|
| 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: 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 HMO/PPO/Tiered Network |
$7.17
|
| Rate for Payer: Priority Health Narrow Network |
$5.74
|
| Rate for Payer: Priority Health SBD |
$83.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.16
|
| Rate for Payer: UHC Exchange |
$98.24
|
|
|
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 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 Exchange |
$58.12
|
|
|
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 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 Exchange |
$66.42
|
|
|
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 ELECTROCARDIOGRAM
|
Facility
|
OP
|
$217.40
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$195.66 |
| Rate for Payer: Aetna Commercial |
$184.79
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$20.96
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| 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 |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$195.66
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.79
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$184.79
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$136.96
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$160.88
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$32.77
|
| Rate for Payer: VA VA |
$58.20
|
|
|
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
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$47.85 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health SBD |
$47.85
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$114.83 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$38.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.68
|
| Rate for Payer: BCBS Complete |
$20.56
|
| Rate for Payer: BCBS MAPPO |
$36.54
|
| Rate for Payer: BCN Medicare Advantage |
$36.54
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.54
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$19.59
|
| Rate for Payer: Mclaren Medicare |
$36.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.37
|
| Rate for Payer: Meridian Medicaid |
$20.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$109.62
|
| Rate for Payer: PACE Medicare |
$34.71
|
| Rate for Payer: PACE SWMI |
$36.54
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$36.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.83
|
| Rate for Payer: Priority Health Medicare |
$36.54
|
| Rate for Payer: Priority Health Narrow Network |
$91.86
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: Railroad Medicare Medicare |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.54
|
| Rate for Payer: UHC Exchange |
$56.20
|
| Rate for Payer: UHC Medicare Advantage |
$36.54
|
| Rate for Payer: UHCCP Medicaid |
$20.57
|
| Rate for Payer: VA VA |
$36.54
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
OP
|
$28.09
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| 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 |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| 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 |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.01
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow Network |
$5.61
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.01
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UHCCP Medicaid |
$3.95
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
OP
|
$87.82
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| 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 |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$5.12
|
| Rate for Payer: BCN Commercial |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$75.53
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$79.04
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| 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 |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$74.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.01
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow Network |
$5.61
|
| Rate for Payer: Priority Health SBD |
$55.33
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.01
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UHCCP Medicaid |
$3.95
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
IP
|
$87.82
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Healthscope Commercial |
$79.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: PHP Commercial |
$74.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health SBD |
$55.33
|
|
|
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 Commercial |
$2,205.00
|
| Rate for Payer: Cofinity Commercial |
$2,709.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,205.00
|
| 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: PHP Commercial |
$2,677.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.50
|
| Rate for Payer: Priority Health SBD |
$1,984.50
|
|
|
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 Commercial |
$2,205.00
|
| Rate for Payer: Cofinity Commercial |
$2,709.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,205.00
|
| 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: PHP Commercial |
$2,677.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.50
|
| Rate for Payer: Priority Health SBD |
$1,984.50
|
|
|
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 Commercial |
$2,791.60
|
| Rate for Payer: Cofinity Commercial |
$3,429.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,791.60
|
| 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: PHP Commercial |
$3,389.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,592.20
|
| Rate for Payer: Priority Health SBD |
$2,512.44
|
|
