|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$37.18 |
| Rate for Payer: Aetna Commercial |
$32.75
|
| Rate for Payer: Aetna Medicare |
$23.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: ASR ASR |
$35.30
|
| Rate for Payer: ASR Commercial |
$35.30
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$29.80
|
| Rate for Payer: BCN Commercial |
$28.21
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$36.39
|
| Rate for Payer: Healthscope Whirlpool |
$35.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.99
|
| Rate for Payer: Mclaren Commercial |
$32.75
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: Nomi Health Commercial |
$29.84
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicaid |
$12.86
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.88
|
| Rate for Payer: Priority Health Medicare |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$37.18
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP DNSP |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: VA VA |
$23.99
|
|
|
HC EKG TRACING FOR INITIAL PREV
|
Facility
|
IP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$36.39 |
| Rate for Payer: Aetna Commercial |
$32.75
|
| Rate for Payer: ASR ASR |
$35.30
|
| Rate for Payer: ASR Commercial |
$35.30
|
| Rate for Payer: BCBS Trust/PPO |
$29.65
|
| Rate for Payer: BCN Commercial |
$28.21
|
| Rate for Payer: Cash Price |
$29.11
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.11
|
| Rate for Payer: Healthscope Commercial |
$36.39
|
| Rate for Payer: Healthscope Whirlpool |
$35.30
|
| Rate for Payer: Mclaren Commercial |
$32.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: Nomi Health Commercial |
$29.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.02
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
OP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,078.43 |
| Max. Negotiated Rate |
$7,696.07 |
| Rate for Payer: Aetna Commercial |
$6,926.46
|
| Rate for Payer: Aetna Medicare |
$3,848.04
|
| Rate for Payer: ASR ASR |
$7,465.19
|
| Rate for Payer: ASR Commercial |
$7,465.19
|
| Rate for Payer: BCBS Complete |
$3,078.43
|
| Rate for Payer: BCBS Trust/PPO |
$6,302.31
|
| Rate for Payer: BCN Commercial |
$5,966.76
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$7,234.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$7,696.07
|
| Rate for Payer: Healthscope Whirlpool |
$7,465.19
|
| Rate for Payer: Mclaren Commercial |
$6,926.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: Nomi Health Commercial |
$6,310.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,743.30
|
| Rate for Payer: Priority Health Narrow Network |
$5,394.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,772.54
|
|
|
HC EKO INFUSION SYSTEM
|
Facility
|
IP
|
$7,696.07
|
|
| Hospital Charge Code |
27200279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,002.45 |
| Max. Negotiated Rate |
$7,696.07 |
| Rate for Payer: Aetna Commercial |
$6,926.46
|
| Rate for Payer: ASR ASR |
$7,465.19
|
| Rate for Payer: ASR Commercial |
$7,465.19
|
| Rate for Payer: BCBS Trust/PPO |
$6,271.53
|
| Rate for Payer: BCN Commercial |
$5,966.76
|
| Rate for Payer: Cash Price |
$6,156.86
|
| Rate for Payer: Cofinity Commercial |
$7,234.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,156.86
|
| Rate for Payer: Healthscope Commercial |
$7,696.07
|
| Rate for Payer: Healthscope Whirlpool |
$7,465.19
|
| Rate for Payer: Mclaren Commercial |
$6,926.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,541.66
|
| Rate for Payer: Nomi Health Commercial |
$6,310.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,002.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,772.54
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
OP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Aetna Commercial |
$175.10
|
| Rate for Payer: Aetna Medicare |
$89.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.41
|
| Rate for Payer: ASR ASR |
$188.71
|
| Rate for Payer: ASR Commercial |
$188.71
|
| Rate for Payer: BCBS Complete |
$50.61
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCBS Trust/PPO |
$159.32
|
| Rate for Payer: BCN Commercial |
$150.83
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$182.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.93
|
| Rate for Payer: Healthscope Commercial |
$194.55
|
| Rate for Payer: Healthscope Whirlpool |
$188.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$89.93
|
| Rate for Payer: Mclaren Commercial |
$175.10
|
| Rate for Payer: Mclaren Medicaid |
$48.20
|
| Rate for Payer: Mclaren Medicare |
$89.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Meridian Medicaid |
$50.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: Nomi Health Commercial |
$159.53
|
| Rate for Payer: PACE Medicare |
$85.43
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Commercial |
$98.92
|
| Rate for Payer: PHP Medicaid |
$48.20
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.46
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow Network |
$136.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Exchange |
$139.39
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
| Rate for Payer: UHCCP DNSP |
$89.93
|
| Rate for Payer: UHCCP Medicaid |
$48.20
|
| Rate for Payer: VA VA |
$89.93
|
|
|
HC ELEC ALYS IMPLT NPGT CPLX SP/PN PRGM
|
Facility
|
IP
|
$194.55
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
92000029
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.46 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Aetna Commercial |
$175.10
|
| Rate for Payer: ASR ASR |
$188.71
|
| Rate for Payer: ASR Commercial |
$188.71
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$150.83
|
| Rate for Payer: Cash Price |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$182.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.64
|
| Rate for Payer: Healthscope Commercial |
$194.55
|
| Rate for Payer: Healthscope Whirlpool |
$188.71
|
| Rate for Payer: Mclaren Commercial |
$175.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: Nomi Health Commercial |
$159.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
IP
|
$170.14
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$170.14 |
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: ASR ASR |
$165.04
|
| Rate for Payer: ASR Commercial |
$165.04
|
| Rate for Payer: BCBS Trust/PPO |
$138.65
|
| Rate for Payer: BCN Commercial |
$131.91
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cofinity Commercial |
$159.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.11
|
| Rate for Payer: Healthscope Commercial |
$170.14
|
| Rate for Payer: Healthscope Whirlpool |
$165.04
|
| Rate for Payer: Mclaren Commercial |
$153.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: Nomi Health Commercial |
$139.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.72
|
|
|
HC ELEC ALYS IMPLT NPGT PHYS/QHP W/O PRGM
|
Facility
|
OP
|
$170.14
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
92000030
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$165.04
|
| Rate for Payer: ASR Commercial |
$165.04
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$139.33
|
| Rate for Payer: BCN Commercial |
$131.91
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cash Price |
$136.11
|
| Rate for Payer: Cofinity Commercial |
$159.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$170.14
|
| Rate for Payer: Healthscope Whirlpool |
$165.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$153.13
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: Nomi Health Commercial |
$139.51
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.08
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$119.27
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
IP
|
$176.99
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$115.04 |
| Max. Negotiated Rate |
$176.99 |
| Rate for Payer: Aetna Commercial |
$159.29
|
| Rate for Payer: ASR ASR |
$171.68
|
| Rate for Payer: ASR Commercial |
$171.68
|
| Rate for Payer: BCBS Trust/PPO |
$144.23
|
| Rate for Payer: BCN Commercial |
$137.22
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$166.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$176.99
|
| Rate for Payer: Healthscope Whirlpool |
$171.68
|
| Rate for Payer: Mclaren Commercial |
$159.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Nomi Health Commercial |
$145.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.75
|
|
|
HC ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGM
|
Facility
|
OP
|
$176.99
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
92000031
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$176.99 |
| Rate for Payer: Aetna Commercial |
$159.29
|
| Rate for Payer: Aetna Medicare |
$89.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.41
|
| Rate for Payer: ASR ASR |
$171.68
|
| Rate for Payer: ASR Commercial |
$171.68
|
| Rate for Payer: BCBS Complete |
$50.61
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCBS Trust/PPO |
$144.94
|
| Rate for Payer: BCN Commercial |
$137.22
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$166.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.93
|
| Rate for Payer: Healthscope Commercial |
$176.99
|
| Rate for Payer: Healthscope Whirlpool |
$171.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$89.93
|
| Rate for Payer: Mclaren Commercial |
$159.29
|
| Rate for Payer: Mclaren Medicaid |
$48.20
|
| Rate for Payer: Mclaren Medicare |
$89.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Meridian Medicaid |
$50.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Nomi Health Commercial |
$145.13
|
| Rate for Payer: PACE Medicare |
$85.43
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Commercial |
$98.92
|
| Rate for Payer: PHP Medicaid |
$48.20
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.08
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow Network |
$124.07
|
| Rate for Payer: Railroad Medicare Medicare |
$89.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Exchange |
$139.39
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
| Rate for Payer: UHCCP DNSP |
$89.93
|
| Rate for Payer: UHCCP Medicaid |
$48.20
|
| Rate for Payer: VA VA |
$89.93
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
OP
|
$206.55
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.62 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$185.90
|
| Rate for Payer: Aetna Medicare |
$103.28
|
| Rate for Payer: ASR ASR |
$200.35
|
| Rate for Payer: ASR Commercial |
$200.35
|
| Rate for Payer: BCBS Complete |
$82.62
|
| Rate for Payer: BCBS Trust/PPO |
$169.14
|
| Rate for Payer: BCN Commercial |
$160.14
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$194.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Healthscope Whirlpool |
$200.35
|
| Rate for Payer: Mclaren Commercial |
$185.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.57
|
| Rate for Payer: Nomi Health Commercial |
$169.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.98
|
| Rate for Payer: Priority Health Narrow Network |
$144.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.76
|
|
|
HC ELEC BREAST PUMP KI (OB)
|
Facility
|
IP
|
$206.55
|
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$185.90
|
| Rate for Payer: ASR ASR |
$200.35
|
| Rate for Payer: ASR Commercial |
$200.35
|
| Rate for Payer: BCBS Trust/PPO |
$168.32
|
| Rate for Payer: BCN Commercial |
$160.14
|
| Rate for Payer: Cash Price |
$165.24
|
| Rate for Payer: Cofinity Commercial |
$194.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Healthscope Whirlpool |
$200.35
|
| Rate for Payer: Mclaren Commercial |
$185.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.57
|
| Rate for Payer: Nomi Health Commercial |
$169.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.76
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: ASR Commercial |
$89.82
|
| Rate for Payer: BCBS Trust/PPO |
$75.46
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$92.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.82
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
|
|
HC ELECTRICAL STIM UNATTENDED
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
42000010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: Aetna Medicare |
$46.30
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: ASR Commercial |
$89.82
|
| Rate for Payer: BCBS Complete |
$37.04
|
| Rate for Payer: BCBS Trust/PPO |
$75.83
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$92.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.82
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.14
|
| Rate for Payer: Priority Health Narrow Network |
$64.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
IP
|
$102.44
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.59 |
| Max. Negotiated Rate |
$102.44 |
| Rate for Payer: Aetna Commercial |
$92.20
|
| Rate for Payer: ASR ASR |
$99.37
|
| Rate for Payer: ASR Commercial |
$99.37
|
| Rate for Payer: BCBS Trust/PPO |
$83.48
|
| Rate for Payer: BCN Commercial |
$79.42
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$96.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Healthscope Commercial |
$102.44
|
| Rate for Payer: Healthscope Whirlpool |
$99.37
|
| Rate for Payer: Mclaren Commercial |
$92.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: Nomi Health Commercial |
$84.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.15
|
|
|
HC ELECTRICAL STIM UNATTENDED FOR PRESSURE
|
Facility
|
OP
|
$102.44
|
|
|
Service Code
|
HCPCS G0281
|
| Hospital Charge Code |
42000057
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$102.44 |
| Rate for Payer: Aetna Commercial |
$92.20
|
| Rate for Payer: Aetna Medicare |
$51.22
|
| Rate for Payer: ASR ASR |
$99.37
|
| Rate for Payer: ASR Commercial |
$99.37
|
| Rate for Payer: BCBS Complete |
$40.98
|
| Rate for Payer: BCBS Trust/PPO |
$83.89
|
| Rate for Payer: BCN Commercial |
$79.42
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$96.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Healthscope Commercial |
$102.44
|
| Rate for Payer: Healthscope Whirlpool |
$99.37
|
| Rate for Payer: Mclaren Commercial |
$92.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: Nomi Health Commercial |
$84.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.46
|
| Rate for Payer: Priority Health Narrow Network |
$21.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.15
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
IP
|
$132.76
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.29 |
| Max. Negotiated Rate |
$132.76 |
| Rate for Payer: Aetna Commercial |
$119.48
|
| Rate for Payer: ASR ASR |
$128.78
|
| Rate for Payer: ASR Commercial |
$128.78
|
| Rate for Payer: BCBS Trust/PPO |
$108.19
|
| Rate for Payer: BCN Commercial |
$102.93
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.21
|
| Rate for Payer: Healthscope Commercial |
$132.76
|
| Rate for Payer: Healthscope Whirlpool |
$128.78
|
| Rate for Payer: Mclaren Commercial |
$119.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.85
|
| Rate for Payer: Nomi Health Commercial |
$108.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.83
|
|
|
HC ELECTRICAL STIM UNATTENDED NOT PRESSURE
|
Facility
|
OP
|
$132.76
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$132.76 |
| Rate for Payer: Aetna Commercial |
$119.48
|
| Rate for Payer: Aetna Medicare |
$66.38
|
| Rate for Payer: ASR ASR |
$128.78
|
| Rate for Payer: ASR Commercial |
$128.78
|
| Rate for Payer: BCBS Complete |
$53.10
|
| Rate for Payer: BCBS Trust/PPO |
$108.72
|
| Rate for Payer: BCN Commercial |
$102.93
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cash Price |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$124.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.21
|
| Rate for Payer: Healthscope Commercial |
$132.76
|
| Rate for Payer: Healthscope Whirlpool |
$128.78
|
| Rate for Payer: Mclaren Commercial |
$119.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.85
|
| Rate for Payer: Nomi Health Commercial |
$108.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.84
|
| Rate for Payer: Priority Health Narrow Network |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.83
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
OP
|
$78.54
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Aetna Commercial |
$70.69
|
| Rate for Payer: Aetna Medicare |
$39.27
|
| Rate for Payer: ASR ASR |
$76.18
|
| Rate for Payer: ASR Commercial |
$76.18
|
| Rate for Payer: BCBS Complete |
$31.42
|
| Rate for Payer: BCBS Trust/PPO |
$64.32
|
| Rate for Payer: BCN Commercial |
$60.89
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.83
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Healthscope Whirlpool |
$76.18
|
| Rate for Payer: Mclaren Commercial |
$70.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.76
|
| Rate for Payer: Nomi Health Commercial |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.82
|
| Rate for Payer: Priority Health Narrow Network |
$55.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.12
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST BINAURAL
|
Facility
|
IP
|
$78.54
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
76100494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$78.54 |
| Rate for Payer: Aetna Commercial |
$70.69
|
| Rate for Payer: ASR ASR |
$76.18
|
| Rate for Payer: ASR Commercial |
$76.18
|
| Rate for Payer: BCBS Trust/PPO |
$64.00
|
| Rate for Payer: BCN Commercial |
$60.89
|
| Rate for Payer: Cash Price |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.83
|
| Rate for Payer: Healthscope Commercial |
$78.54
|
| Rate for Payer: Healthscope Whirlpool |
$76.18
|
| Rate for Payer: Mclaren Commercial |
$70.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.76
|
| Rate for Payer: Nomi Health Commercial |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.12
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: Aetna Medicare |
$44.88
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: ASR Commercial |
$87.07
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$73.50
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: Nomi Health Commercial |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.65
|
| Rate for Payer: Priority Health Narrow Network |
$62.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC ELECTROACOUSTIC HEARNG AID TEST MONAURAL
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: ASR Commercial |
$87.07
|
| Rate for Payer: BCBS Trust/PPO |
$73.15
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: Nomi Health Commercial |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
OP
|
$217.40
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$217.40 |
| Rate for Payer: Aetna Commercial |
$195.66
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$210.88
|
| Rate for Payer: ASR Commercial |
$210.88
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$178.03
|
| Rate for Payer: BCN Commercial |
$168.55
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$173.92
|
| Rate for Payer: Cash Price |
$173.92
|
| Rate for Payer: Cofinity Commercial |
$204.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$217.40
|
| Rate for Payer: Healthscope Whirlpool |
$210.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$195.66
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.79
|
| Rate for Payer: Nomi Health Commercial |
$178.27
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.64
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$158.11
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC ELECTROCARDIOGRAM
|
Facility
|
IP
|
$217.40
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$141.31 |
| Max. Negotiated Rate |
$217.40 |
| Rate for Payer: Aetna Commercial |
$195.66
|
| Rate for Payer: ASR ASR |
$210.88
|
| Rate for Payer: ASR Commercial |
$210.88
|
| Rate for Payer: BCBS Trust/PPO |
$177.16
|
| Rate for Payer: BCN Commercial |
$168.55
|
| Rate for Payer: Cash Price |
$173.92
|
| Rate for Payer: Cofinity Commercial |
$204.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.92
|
| Rate for Payer: Healthscope Commercial |
$217.40
|
| Rate for Payer: Healthscope Whirlpool |
$210.88
|
| Rate for Payer: Mclaren Commercial |
$195.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.79
|
| Rate for Payer: Nomi Health Commercial |
$178.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.31
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
