|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$190.74
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$190.74 |
| Rate for Payer: Aetna Commercial |
$171.67
|
| Rate for Payer: Aetna Medicare |
$86.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.55
|
| Rate for Payer: ASR ASR |
$185.02
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$86.04
|
| Rate for Payer: BCBS Trust/PPO |
$147.88
|
| Rate for Payer: BCN Commercial |
$147.88
|
| Rate for Payer: BCN Medicare Advantage |
$86.04
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cofinity Commercial |
$179.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.04
|
| Rate for Payer: Healthscope Commercial |
$190.74
|
| Rate for Payer: Healthscope Whirlpool |
$185.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.04
|
| Rate for Payer: Mclaren Commercial |
$171.67
|
| Rate for Payer: Mclaren Medicaid |
$47.06
|
| Rate for Payer: Mclaren Medicare |
$86.04
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.13
|
| Rate for Payer: PACE Medicare |
$81.74
|
| Rate for Payer: PACE SWMI |
$86.04
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: PHP Medicaid |
$47.06
|
| Rate for Payer: PHP Medicare Advantage |
$86.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.57
|
| Rate for Payer: Priority Health Medicare |
$86.04
|
| Rate for Payer: Priority Health Narrow Network |
$135.43
|
| Rate for Payer: Railroad Medicare Medicare |
$86.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.85
|
| Rate for Payer: UHC Medicare Advantage |
$88.62
|
| Rate for Payer: VA VA |
$86.04
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$166.80
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$166.80 |
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$161.80
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$129.32
|
| Rate for Payer: BCN Commercial |
$129.32
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$156.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$166.80
|
| Rate for Payer: Healthscope Whirlpool |
$161.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$150.12
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.78
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.79
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$118.43
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.78
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$166.80
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$166.80 |
| Rate for Payer: Aetna Commercial |
$150.12
|
| Rate for Payer: ASR ASR |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$129.32
|
| Rate for Payer: BCN Commercial |
$129.32
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Cofinity Commercial |
$156.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.44
|
| Rate for Payer: Healthscope Commercial |
$166.80
|
| Rate for Payer: Healthscope Whirlpool |
$161.80
|
| Rate for Payer: Mclaren Commercial |
$150.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.78
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$173.52
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$173.52 |
| Rate for Payer: Aetna Commercial |
$156.17
|
| Rate for Payer: Aetna Medicare |
$86.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.55
|
| Rate for Payer: ASR ASR |
$168.31
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$86.04
|
| Rate for Payer: BCBS Trust/PPO |
$134.53
|
| Rate for Payer: BCN Commercial |
$134.53
|
| Rate for Payer: BCN Medicare Advantage |
$86.04
|
| Rate for Payer: Cash Price |
$138.82
|
| Rate for Payer: Cash Price |
$138.82
|
| Rate for Payer: Cofinity Commercial |
$163.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.04
|
| Rate for Payer: Healthscope Commercial |
$173.52
|
| Rate for Payer: Healthscope Whirlpool |
$168.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.04
|
| Rate for Payer: Mclaren Commercial |
$156.17
|
| Rate for Payer: Mclaren Medicaid |
$47.06
|
| Rate for Payer: Mclaren Medicare |
$86.04
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.49
|
| Rate for Payer: PACE Medicare |
$81.74
|
| Rate for Payer: PACE SWMI |
$86.04
|
| Rate for Payer: PHP Commercial |
$94.64
|
| Rate for Payer: PHP Medicaid |
$47.06
|
| Rate for Payer: PHP Medicare Advantage |
$86.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.90
|
| Rate for Payer: Priority Health Medicare |
$86.04
|
| Rate for Payer: Priority Health Narrow Network |
$123.20
|
| Rate for Payer: Railroad Medicare Medicare |
$86.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.70
|
| Rate for Payer: UHC Medicare Advantage |
$88.62
|
| Rate for Payer: VA VA |
$86.04
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$173.52
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$121.46 |
| Max. Negotiated Rate |
$173.52 |
| Rate for Payer: Aetna Commercial |
$156.17
|
| Rate for Payer: ASR ASR |
$168.31
|
| Rate for Payer: BCBS Trust/PPO |
$134.53
|
| Rate for Payer: BCN Commercial |
$134.53
|
| Rate for Payer: Cash Price |
$138.82
|
| Rate for Payer: Cofinity Commercial |
$163.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.82
|
| Rate for Payer: Healthscope Commercial |
$173.52
|
| Rate for Payer: Healthscope Whirlpool |
$168.31
|
| Rate for Payer: Mclaren Commercial |
$156.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.70
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$202.50
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$182.25
|
| Rate for Payer: ASR ASR |
$196.42
|
| Rate for Payer: BCBS Complete |
$81.00
|
| Rate for Payer: BCBS Trust/PPO |
$157.00
|
| Rate for Payer: BCN Commercial |
$157.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cofinity Commercial |
$190.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Healthscope Whirlpool |
$196.42
|
| Rate for Payer: Mclaren Commercial |
$182.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.28
|
| Rate for Payer: Priority Health Narrow Network |
$143.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.20
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$202.50
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$182.25
|
| Rate for Payer: ASR ASR |
$196.42
|
| Rate for Payer: BCBS Trust/PPO |
$157.00
|
| Rate for Payer: BCN Commercial |
$157.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cofinity Commercial |
$190.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Healthscope Whirlpool |
$196.42
|
| Rate for Payer: Mclaren Commercial |
$182.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.20
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: BCBS Trust/PPO |
$70.38
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.61
|
| Rate for Payer: Priority Health Narrow Network |
$64.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$100.43
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Aetna Commercial |
$90.39
|
| Rate for Payer: ASR ASR |
$97.42
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Trust/PPO |
$77.86
|
| Rate for Payer: BCN Commercial |
$77.86
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$94.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Healthscope Whirlpool |
$97.42
|
| Rate for Payer: Mclaren Commercial |
$90.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.66
|
| Rate for Payer: Priority Health Narrow Network |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.38
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
IP
|
$100.43
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Aetna Commercial |
$90.39
|
| Rate for Payer: ASR ASR |
$97.42
|
| Rate for Payer: BCBS Trust/PPO |
$77.86
|
| Rate for Payer: BCN Commercial |
$77.86
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$94.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Healthscope Whirlpool |
$97.42
|
| Rate for Payer: Mclaren Commercial |
$90.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.38
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
OP
|
$130.16
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$130.16 |
| Rate for Payer: Aetna Commercial |
$117.14
|
| Rate for Payer: ASR ASR |
$126.26
|
| Rate for Payer: BCBS Complete |
$52.06
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCN Commercial |
$100.91
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cofinity Commercial |
$122.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.13
|
| Rate for Payer: Healthscope Commercial |
$130.16
|
| Rate for Payer: Healthscope Whirlpool |
$126.26
|
| Rate for Payer: Mclaren Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.76
|
| Rate for Payer: Priority Health Narrow Network |
$23.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.54
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
IP
|
$130.16
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.11 |
| Max. Negotiated Rate |
$130.16 |
| Rate for Payer: Aetna Commercial |
$117.14
|
| Rate for Payer: ASR ASR |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCN Commercial |
$100.91
|
| Rate for Payer: Cash Price |
$104.13
|
| Rate for Payer: Cofinity Commercial |
$122.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.13
|
| Rate for Payer: Healthscope Commercial |
$130.16
|
| Rate for Payer: Healthscope Whirlpool |
$126.26
|
| Rate for Payer: Mclaren Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.54
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: ASR ASR |
$74.69
|
| Rate for Payer: BCBS Trust/PPO |
$59.70
|
| Rate for Payer: BCN Commercial |
$59.70
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$77.00
|
| Rate for Payer: Healthscope Whirlpool |
$74.69
|
| Rate for Payer: Mclaren Commercial |
$69.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.76
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: ASR ASR |
$74.69
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$59.70
|
| Rate for Payer: BCN Commercial |
$59.70
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$77.00
|
| Rate for Payer: Healthscope Whirlpool |
$74.69
|
| Rate for Payer: Mclaren Commercial |
$69.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.07
|
| Rate for Payer: Priority Health Narrow Network |
$54.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.76
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: ASR ASR |
$85.36
|
| Rate for Payer: BCBS Trust/PPO |
$68.23
|
| Rate for Payer: BCN Commercial |
$68.23
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$82.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.40
|
| Rate for Payer: Healthscope Commercial |
$88.00
|
| Rate for Payer: Healthscope Whirlpool |
$85.36
|
| Rate for Payer: Mclaren Commercial |
$79.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.44
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: ASR ASR |
$85.36
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS Trust/PPO |
$68.23
|
| Rate for Payer: BCN Commercial |
$68.23
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$82.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.40
|
| Rate for Payer: Healthscope Commercial |
$88.00
|
| Rate for Payer: Healthscope Whirlpool |
$85.36
|
| Rate for Payer: Mclaren Commercial |
$79.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.08
|
| Rate for Payer: Priority Health Narrow Network |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.44
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
IP
|
$213.14
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$213.14 |
| Rate for Payer: Aetna Commercial |
$191.83
|
| Rate for Payer: ASR ASR |
$206.75
|
| Rate for Payer: BCBS Trust/PPO |
$165.25
|
| Rate for Payer: BCN Commercial |
$165.25
|
| Rate for Payer: Cash Price |
$170.51
|
| Rate for Payer: Cofinity Commercial |
$200.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.51
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Whirlpool |
$206.75
|
| Rate for Payer: Mclaren Commercial |
$191.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.56
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
OP
|
$213.14
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$213.14 |
| Rate for Payer: Aetna Commercial |
$191.83
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$206.75
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$165.25
|
| Rate for Payer: BCN Commercial |
$165.25
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$170.51
|
| Rate for Payer: Cash Price |
$170.51
|
| Rate for Payer: Cofinity Commercial |
$200.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Whirlpool |
$206.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$191.83
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.17
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.71
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$147.77
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.56
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: Aetna Medicare |
$33.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.90
|
| Rate for Payer: ASR ASR |
$72.23
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.52
|
| Rate for Payer: Mclaren Commercial |
$67.01
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Mclaren Medicare |
$33.52
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PACE Medicare |
$31.84
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Commercial |
$36.87
|
| Rate for Payer: PHP Medicaid |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.76
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$31.81
|
| Rate for Payer: Railroad Medicare Medicare |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.52
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
| Rate for Payer: VA VA |
$33.52
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: ASR ASR |
$72.23
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.23
|
| Rate for Payer: Mclaren Commercial |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.52
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: ASR ASR |
$26.71
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Healthscope Whirlpool |
$26.71
|
| Rate for Payer: Mclaren Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.24
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
OP
|
$27.54
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.76
|
| Rate for Payer: ASR ASR |
$26.71
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Healthscope Whirlpool |
$26.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.01
|
| Rate for Payer: Mclaren Commercial |
$24.79
|
| Rate for Payer: Mclaren Medicaid |
$3.83
|
| Rate for Payer: Mclaren Medicare |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$4.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$7.71
|
| Rate for Payer: PHP Medicaid |
$3.83
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.91
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow Network |
$59.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.22
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: ASR ASR |
$83.52
|
| Rate for Payer: BCBS Trust/PPO |
$66.75
|
| Rate for Payer: BCN Commercial |
$66.75
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.88
|
| Rate for Payer: Healthscope Commercial |
$86.10
|
| Rate for Payer: Healthscope Whirlpool |
$83.52
|
| Rate for Payer: Mclaren Commercial |
$77.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.77
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.76
|
| Rate for Payer: ASR ASR |
$83.52
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$66.75
|
| Rate for Payer: BCN Commercial |
$66.75
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$80.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$86.10
|
| Rate for Payer: Healthscope Whirlpool |
$83.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.01
|
| Rate for Payer: Mclaren Commercial |
$77.49
|
| Rate for Payer: Mclaren Medicaid |
$3.83
|
| Rate for Payer: Mclaren Medicare |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$4.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$7.71
|
| Rate for Payer: PHP Medicaid |
$3.83
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.91
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow Network |
$59.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.77
|
| Rate for Payer: UHC Medicare Advantage |
$7.22
|
| Rate for Payer: VA VA |
$7.01
|
|
