|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
OP
|
$40.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna Commercial |
$36.86
|
| Rate for Payer: ASR ASR |
$39.72
|
| Rate for Payer: BCBS Complete |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$31.75
|
| Rate for Payer: BCN Commercial |
$31.75
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cofinity Commercial |
$38.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$40.95
|
| Rate for Payer: Healthscope Whirlpool |
$39.72
|
| Rate for Payer: Mclaren Commercial |
$36.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.26
|
| Rate for Payer: Priority Health Narrow Network |
$29.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.04
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna Commercial |
$1,075.50
|
| Rate for Payer: ASR ASR |
$1,159.15
|
| Rate for Payer: BCBS Complete |
$478.00
|
| Rate for Payer: BCBS Trust/PPO |
$926.48
|
| Rate for Payer: BCN Commercial |
$926.48
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,123.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,195.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,159.15
|
| Rate for Payer: Mclaren Commercial |
$1,075.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.45
|
| Rate for Payer: Priority Health Narrow Network |
$848.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.60
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.50 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna Commercial |
$1,075.50
|
| Rate for Payer: ASR ASR |
$1,159.15
|
| Rate for Payer: BCBS Trust/PPO |
$926.48
|
| Rate for Payer: BCN Commercial |
$926.48
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,123.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,195.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,159.15
|
| Rate for Payer: Mclaren Commercial |
$1,075.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,051.60
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: ASR ASR |
$154.35
|
| Rate for Payer: BCBS Complete |
$63.65
|
| Rate for Payer: BCBS Trust/PPO |
$123.37
|
| Rate for Payer: BCN Commercial |
$123.37
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$159.12
|
| Rate for Payer: Healthscope Whirlpool |
$154.35
|
| Rate for Payer: Mclaren Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.80
|
| Rate for Payer: Priority Health Narrow Network |
$112.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.03
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: ASR ASR |
$154.35
|
| Rate for Payer: BCBS Trust/PPO |
$123.37
|
| Rate for Payer: BCN Commercial |
$123.37
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$159.12
|
| Rate for Payer: Healthscope Whirlpool |
$154.35
|
| Rate for Payer: Mclaren Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.03
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
IP
|
$330.88
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.62 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna Commercial |
$297.79
|
| Rate for Payer: ASR ASR |
$320.95
|
| Rate for Payer: BCBS Trust/PPO |
$256.53
|
| Rate for Payer: BCN Commercial |
$256.53
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$311.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Healthscope Whirlpool |
$320.95
|
| Rate for Payer: Mclaren Commercial |
$297.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.17
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
OP
|
$330.88
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna Commercial |
$297.79
|
| Rate for Payer: ASR ASR |
$320.95
|
| Rate for Payer: BCBS Complete |
$132.35
|
| Rate for Payer: BCBS Trust/PPO |
$256.53
|
| Rate for Payer: BCN Commercial |
$256.53
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$311.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Healthscope Whirlpool |
$320.95
|
| Rate for Payer: Mclaren Commercial |
$297.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.10
|
| Rate for Payer: Priority Health Narrow Network |
$234.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.17
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$475.65
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$475.65 |
| Rate for Payer: Aetna Commercial |
$428.08
|
| Rate for Payer: ASR ASR |
$461.38
|
| Rate for Payer: BCBS Complete |
$190.26
|
| Rate for Payer: BCBS Trust/PPO |
$368.77
|
| Rate for Payer: BCN Commercial |
$368.77
|
| Rate for Payer: Cash Price |
$380.52
|
| Rate for Payer: Cofinity Commercial |
$447.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.52
|
| Rate for Payer: Healthscope Commercial |
$475.65
|
| Rate for Payer: Healthscope Whirlpool |
$461.38
|
| Rate for Payer: Mclaren Commercial |
$428.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.84
|
| Rate for Payer: Priority Health Narrow Network |
$337.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.57
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$475.65
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.96 |
| Max. Negotiated Rate |
$475.65 |
| Rate for Payer: Aetna Commercial |
$428.08
|
| Rate for Payer: ASR ASR |
$461.38
|
| Rate for Payer: BCBS Trust/PPO |
$368.77
|
| Rate for Payer: BCN Commercial |
$368.77
|
| Rate for Payer: Cash Price |
$380.52
|
| Rate for Payer: Cofinity Commercial |
$447.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.52
|
| Rate for Payer: Healthscope Commercial |
$475.65
|
| Rate for Payer: Healthscope Whirlpool |
$461.38
|
| Rate for Payer: Mclaren Commercial |
$428.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.57
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$145.71 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$24.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$13.85
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.11
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$13.19
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$26.52
|
| Rate for Payer: PHP Medicaid |
$13.19
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.71
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$116.57
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$24.83
|
| Rate for Payer: VA VA |
$24.11
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,330.03
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,731.02 |
| Max. Negotiated Rate |
$5,330.03 |
| Rate for Payer: Aetna Commercial |
$4,797.03
|
| Rate for Payer: ASR ASR |
$5,170.13
|
| Rate for Payer: BCBS Trust/PPO |
$4,132.37
|
| Rate for Payer: BCN Commercial |
$4,132.37
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cofinity Commercial |
$5,010.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,264.02
|
| Rate for Payer: Healthscope Commercial |
$5,330.03
|
| Rate for Payer: Healthscope Whirlpool |
$5,170.13
|
| Rate for Payer: Mclaren Commercial |
$4,797.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,530.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,731.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,690.43
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,330.03
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,132.01 |
| Max. Negotiated Rate |
$5,330.03 |
| Rate for Payer: Aetna Commercial |
$4,797.03
|
| Rate for Payer: ASR ASR |
$5,170.13
|
| Rate for Payer: BCBS Complete |
$2,132.01
|
| Rate for Payer: BCBS Trust/PPO |
$4,132.37
|
| Rate for Payer: BCN Commercial |
$4,132.37
|
| Rate for Payer: Cash Price |
$4,264.02
|
| Rate for Payer: Cofinity Commercial |
$5,010.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,264.02
|
| Rate for Payer: Healthscope Commercial |
$5,330.03
|
| Rate for Payer: Healthscope Whirlpool |
$5,170.13
|
| Rate for Payer: Mclaren Commercial |
$4,797.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,530.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,731.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,850.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,784.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,690.43
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
OP
|
$1,272.44
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$508.98 |
| Max. Negotiated Rate |
$1,272.44 |
| Rate for Payer: Aetna Commercial |
$1,145.20
|
| Rate for Payer: ASR ASR |
$1,234.27
|
| Rate for Payer: BCBS Complete |
$508.98
|
| Rate for Payer: BCBS Trust/PPO |
$986.52
|
| Rate for Payer: BCN Commercial |
$986.52
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cofinity Commercial |
$1,196.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.95
|
| Rate for Payer: Healthscope Commercial |
$1,272.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,234.27
|
| Rate for Payer: Mclaren Commercial |
$1,145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,081.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,157.92
|
| Rate for Payer: Priority Health Narrow Network |
$903.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,119.75
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,272.44
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$890.71 |
| Max. Negotiated Rate |
$1,272.44 |
| Rate for Payer: Aetna Commercial |
$1,145.20
|
| Rate for Payer: ASR ASR |
$1,234.27
|
| Rate for Payer: BCBS Trust/PPO |
$986.52
|
| Rate for Payer: BCN Commercial |
$986.52
|
| Rate for Payer: Cash Price |
$1,017.95
|
| Rate for Payer: Cofinity Commercial |
$1,196.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.95
|
| Rate for Payer: Healthscope Commercial |
$1,272.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,234.27
|
| Rate for Payer: Mclaren Commercial |
$1,145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,081.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,119.75
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
IP
|
$183.40
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: ASR ASR |
$177.90
|
| Rate for Payer: BCBS Trust/PPO |
$142.19
|
| Rate for Payer: BCN Commercial |
$142.19
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cofinity Commercial |
$172.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.72
|
| Rate for Payer: Healthscope Commercial |
$183.40
|
| Rate for Payer: Healthscope Whirlpool |
$177.90
|
| Rate for Payer: Mclaren Commercial |
$165.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.39
|
|
|
HC IOM INTRAOPERATIVE MONITOR/15 MINUTES
|
Facility
|
OP
|
$183.40
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
74000017
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: ASR ASR |
$177.90
|
| Rate for Payer: BCBS Complete |
$73.36
|
| Rate for Payer: BCBS Trust/PPO |
$142.19
|
| Rate for Payer: BCN Commercial |
$142.19
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cash Price |
$146.72
|
| Rate for Payer: Cofinity Commercial |
$172.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.72
|
| Rate for Payer: Healthscope Commercial |
$183.40
|
| Rate for Payer: Healthscope Whirlpool |
$177.90
|
| Rate for Payer: Mclaren Commercial |
$165.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.39
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
IP
|
$350.37
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.26 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
|
|
HC IOM STD PRASS PROBE
|
Facility
|
OP
|
$350.37
|
|
| Hospital Charge Code |
62200008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.15 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Complete |
$140.15
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.84
|
| Rate for Payer: Priority Health Narrow Network |
$248.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
OP
|
$15.06
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$15.06 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: ASR ASR |
$14.61
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$11.68
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Healthscope Whirlpool |
$14.61
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.70
|
| Rate for Payer: Priority Health Narrow Network |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
HC IOM SUBDERMAL RECORDING ELECTR
|
Facility
|
IP
|
$15.06
|
|
| Hospital Charge Code |
62200009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$15.06 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: ASR ASR |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.68
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$15.06
|
| Rate for Payer: Healthscope Whirlpool |
$14.61
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
HC IONIZED CALCIUM
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.78 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: ASR ASR |
$102.24
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$105.40
|
| Rate for Payer: Healthscope Whirlpool |
$102.24
|
| Rate for Payer: Mclaren Commercial |
$94.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.75
|
|
|
HC IONIZED CALCIUM
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna Medicare |
$13.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.10
|
| Rate for Payer: ASR ASR |
$102.24
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$105.40
|
| Rate for Payer: Healthscope Whirlpool |
$102.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.68
|
| Rate for Payer: Mclaren Commercial |
$94.86
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Medicare |
$13.00
|
| Rate for Payer: PACE SWMI |
$13.68
|
| Rate for Payer: PHP Commercial |
$15.05
|
| Rate for Payer: PHP Medicaid |
$7.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.18
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$36.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.75
|
| Rate for Payer: UHC Medicare Advantage |
$14.09
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.83 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$80.66
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC IONTOPHORESIS EACH 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
42000016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$80.66
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.33
|
| Rate for Payer: Priority Health Narrow Network |
$41.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
