|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$382.50
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.97 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.62
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health SBD |
$240.97
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.60
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.44
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$12.32
|
| Rate for Payer: Cofinity Commercial |
$15.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.08
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.96
|
| Rate for Payer: PHP Commercial |
$14.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.44
|
| Rate for Payer: Priority Health SBD |
$11.09
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.60
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.96
|
| Rate for Payer: Aetna Medicare |
$8.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.44
|
| Rate for Payer: BCBS Complete |
$7.04
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$12.32
|
| Rate for Payer: Cofinity Commercial |
$15.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.08
|
| Rate for Payer: Healthscope Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.96
|
| Rate for Payer: PHP Commercial |
$14.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.44
|
| Rate for Payer: Priority Health SBD |
$11.09
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$244.80
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna Medicare |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: BCBS Complete |
$97.92
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health SBD |
$154.22
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$244.80
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health SBD |
$154.22
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna Medicare |
$45.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.16
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.01
|
| Rate for Payer: Priority Health SBD |
$57.19
|
| Rate for Payer: UHC Core |
$67.18
|
| Rate for Payer: UHC Exchange |
$67.18
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.16
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.01
|
| Rate for Payer: Priority Health SBD |
$57.19
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$991.36
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$624.56 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.38
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$693.95
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health SBD |
$624.56
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$991.36
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.54 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: Aetna Medicare |
$495.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.38
|
| Rate for Payer: BCBS Complete |
$396.54
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$693.95
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health SBD |
$624.56
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.47
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$432.09 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$86.39
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Cofinity Commercial |
$175.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Mclaren Medicaid |
$82.28
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$86.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health SBD |
$158.19
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Medicare Advantage |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$86.42
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$158.19 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.22
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$175.77
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health SBD |
$158.19
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,181.53
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,374.36 |
| Max. Negotiated Rate |
$1,963.38 |
| Rate for Payer: Aetna Commercial |
$1,854.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,417.99
|
| Rate for Payer: Cash Price |
$1,745.22
|
| Rate for Payer: Cofinity Commercial |
$1,527.07
|
| Rate for Payer: Cofinity Commercial |
$1,876.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,527.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,745.22
|
| Rate for Payer: Healthscope Commercial |
$1,963.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,854.30
|
| Rate for Payer: PHP Commercial |
$1,854.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.99
|
| Rate for Payer: Priority Health SBD |
$1,374.36
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,181.53
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,963.38 |
| Rate for Payer: Aetna Commercial |
$1,854.30
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,417.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$1,745.22
|
| Rate for Payer: Cash Price |
$1,745.22
|
| Rate for Payer: Cofinity Commercial |
$1,876.12
|
| Rate for Payer: Cofinity Commercial |
$1,527.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,527.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,745.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,963.38
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,854.30
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$1,854.30
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.99
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$1,374.36
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,281.51
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,697.35 |
| Max. Negotiated Rate |
$3,853.36 |
| Rate for Payer: Aetna Commercial |
$3,639.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,782.98
|
| Rate for Payer: Cash Price |
$3,425.21
|
| Rate for Payer: Cofinity Commercial |
$2,997.06
|
| Rate for Payer: Cofinity Commercial |
$3,682.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,997.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,425.21
|
| Rate for Payer: Healthscope Commercial |
$3,853.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,639.28
|
| Rate for Payer: PHP Commercial |
$3,639.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,782.98
|
| Rate for Payer: Priority Health SBD |
$2,697.35
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,281.51
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,697.35 |
| Max. Negotiated Rate |
$22,720.18 |
| Rate for Payer: Aetna Commercial |
$3,639.28
|
| Rate for Payer: Aetna Medicare |
$8,394.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,782.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$3,425.21
|
| Rate for Payer: Cash Price |
$3,425.21
|
| Rate for Payer: Cofinity Commercial |
$3,682.10
|
| Rate for Payer: Cofinity Commercial |
$2,997.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,997.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,425.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$3,853.36
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,639.28
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$3,639.28
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,782.98
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health SBD |
$2,697.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,720.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,544.20
|
| Rate for Payer: VA VA |
$8,071.40
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,450.82
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,584.02 |
| Max. Negotiated Rate |
$9,405.74 |
| Rate for Payer: Aetna Commercial |
$8,883.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,793.03
|
| Rate for Payer: Cash Price |
$8,360.66
|
| Rate for Payer: Cofinity Commercial |
$7,315.57
|
| Rate for Payer: Cofinity Commercial |
$8,987.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,315.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,360.66
|
| Rate for Payer: Healthscope Commercial |
$9,405.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,883.20
|
| Rate for Payer: PHP Commercial |
$8,883.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,793.03
|
| Rate for Payer: Priority Health SBD |
$6,584.02
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,450.82
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,180.33 |
| Max. Negotiated Rate |
$9,405.74 |
| Rate for Payer: Aetna Commercial |
$8,883.20
|
| Rate for Payer: Aetna Medicare |
$5,225.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,793.03
|
| Rate for Payer: BCBS Complete |
$4,180.33
|
| Rate for Payer: Cash Price |
$8,360.66
|
| Rate for Payer: Cofinity Commercial |
$7,315.57
|
| Rate for Payer: Cofinity Commercial |
$8,987.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,315.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,360.66
|
| Rate for Payer: Healthscope Commercial |
$9,405.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,883.20
|
| Rate for Payer: PHP Commercial |
$8,883.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,793.03
|
| Rate for Payer: Priority Health SBD |
$6,584.02
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.73
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS MAPPO |
$30.98
|
| Rate for Payer: BCN Medicare Advantage |
$30.98
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$16.61
|
| Rate for Payer: Mclaren Medicare |
$30.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.53
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PACE Medicare |
$29.43
|
| Rate for Payer: PACE SWMI |
$30.98
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$30.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health Medicare |
$30.98
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: Railroad Medicare Medicare |
$30.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.98
|
| Rate for Payer: UHC Medicare Advantage |
$30.98
|
| Rate for Payer: UHCCP Medicaid |
$17.44
|
| Rate for Payer: VA VA |
$30.98
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health SBD |
$41.95
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$345.41
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$217.61 |
| Max. Negotiated Rate |
$310.87 |
| Rate for Payer: Aetna Commercial |
$293.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.52
|
| Rate for Payer: Cash Price |
$276.33
|
| Rate for Payer: Cofinity Commercial |
$241.79
|
| Rate for Payer: Cofinity Commercial |
$297.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.33
|
| Rate for Payer: Healthscope Commercial |
$310.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.60
|
| Rate for Payer: PHP Commercial |
$293.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.52
|
| Rate for Payer: Priority Health SBD |
$217.61
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$345.41
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$310.87 |
| Rate for Payer: Aetna Commercial |
$293.60
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$276.33
|
| Rate for Payer: Cash Price |
$276.33
|
| Rate for Payer: Cofinity Commercial |
$297.05
|
| Rate for Payer: Cofinity Commercial |
$241.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$310.87
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.60
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$293.60
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.52
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$217.61
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$10.34
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$66.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$10.34
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.30
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health SBD |
$66.20
|
|
