|
HC EEG W/O VID 2-12 HRS INTMT MNTR
|
Facility
|
IP
|
$1,646.29
|
|
|
Service Code
|
CPT 95706
|
| Hospital Charge Code |
74000028
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,070.09 |
| Max. Negotiated Rate |
$1,646.29 |
| Rate for Payer: Aetna Commercial |
$1,481.66
|
| Rate for Payer: ASR ASR |
$1,596.90
|
| Rate for Payer: ASR Commercial |
$1,596.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.56
|
| Rate for Payer: BCN Commercial |
$1,276.37
|
| Rate for Payer: Cash Price |
$1,317.03
|
| Rate for Payer: Cofinity Commercial |
$1,547.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.03
|
| Rate for Payer: Healthscope Commercial |
$1,646.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,596.90
|
| Rate for Payer: Mclaren Commercial |
$1,481.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.35
|
| Rate for Payer: Nomi Health Commercial |
$1,349.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,448.74
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
OP
|
$1,021.26
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$836.31
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$959.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.83
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$715.90
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC EEG W/O VID 2-12 HR UNMNTR
|
Facility
|
IP
|
$1,021.26
|
|
|
Service Code
|
CPT 95705
|
| Hospital Charge Code |
74000020
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$663.82 |
| Max. Negotiated Rate |
$1,021.26 |
| Rate for Payer: Aetna Commercial |
$919.13
|
| Rate for Payer: ASR ASR |
$990.62
|
| Rate for Payer: ASR Commercial |
$990.62
|
| Rate for Payer: BCBS Trust/PPO |
$832.22
|
| Rate for Payer: BCN Commercial |
$791.78
|
| Rate for Payer: Cash Price |
$817.01
|
| Rate for Payer: Cofinity Commercial |
$959.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.01
|
| Rate for Payer: Healthscope Commercial |
$1,021.26
|
| Rate for Payer: Healthscope Whirlpool |
$990.62
|
| Rate for Payer: Mclaren Commercial |
$919.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.07
|
| Rate for Payer: Nomi Health Commercial |
$837.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.71
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
OP
|
$1,959.46
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$1,900.68
|
| Rate for Payer: ASR Commercial |
$1,900.68
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.60
|
| Rate for Payer: BCN Commercial |
$1,519.17
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,841.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,959.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$1,763.51
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,716.88
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.58
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC EEG W/O VID EA 12-26 HR UNMNTR
|
Facility
|
IP
|
$1,959.46
|
|
|
Service Code
|
CPT 95708
|
| Hospital Charge Code |
74000021
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,273.65 |
| Max. Negotiated Rate |
$1,959.46 |
| Rate for Payer: Aetna Commercial |
$1,763.51
|
| Rate for Payer: ASR ASR |
$1,900.68
|
| Rate for Payer: ASR Commercial |
$1,900.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.76
|
| Rate for Payer: BCN Commercial |
$1,519.17
|
| Rate for Payer: Cash Price |
$1,567.57
|
| Rate for Payer: Cofinity Commercial |
$1,841.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.57
|
| Rate for Payer: Healthscope Commercial |
$1,959.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.68
|
| Rate for Payer: Mclaren Commercial |
$1,763.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.54
|
| Rate for Payer: Nomi Health Commercial |
$1,606.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.32
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.82 |
| Max. Negotiated Rate |
$2,852.05 |
| Rate for Payer: Aetna Commercial |
$2,566.84
|
| Rate for Payer: Aetna Medicare |
$1,426.03
|
| Rate for Payer: ASR ASR |
$2,766.49
|
| Rate for Payer: ASR Commercial |
$2,766.49
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,335.54
|
| Rate for Payer: BCN Commercial |
$2,211.19
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,680.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,852.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,766.49
|
| Rate for Payer: Mclaren Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,498.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,999.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.80
|
|
|
HC EGD W EUS EXAM ESOPH ONLY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,853.83 |
| Max. Negotiated Rate |
$2,852.05 |
| Rate for Payer: Aetna Commercial |
$2,566.84
|
| Rate for Payer: ASR ASR |
$2,766.49
|
| Rate for Payer: ASR Commercial |
$2,766.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.14
|
| Rate for Payer: BCN Commercial |
$2,211.19
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,680.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,852.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,766.49
|
| Rate for Payer: Mclaren Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.80
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
IP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,936.41 |
| Max. Negotiated Rate |
$2,979.09 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: ASR ASR |
$2,889.72
|
| Rate for Payer: ASR Commercial |
$2,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.66
|
| Rate for Payer: BCN Commercial |
$2,309.69
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,800.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,979.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.72
|
| Rate for Payer: Mclaren Commercial |
$2,681.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: Nomi Health Commercial |
$2,442.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,621.60
|
|
|
HC EGD W EUS EXAM ESOPH,STOM,DUO,
|
Facility
|
OP
|
$2,979.09
|
|
| Hospital Charge Code |
36000036
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,191.64 |
| Max. Negotiated Rate |
$2,979.09 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: Aetna Medicare |
$1,489.55
|
| Rate for Payer: ASR ASR |
$2,889.72
|
| Rate for Payer: ASR Commercial |
$2,889.72
|
| Rate for Payer: BCBS Complete |
$1,191.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,439.58
|
| Rate for Payer: BCN Commercial |
$2,309.69
|
| Rate for Payer: Cash Price |
$2,383.27
|
| Rate for Payer: Cofinity Commercial |
$2,800.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.27
|
| Rate for Payer: Healthscope Commercial |
$2,979.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.72
|
| Rate for Payer: Mclaren Commercial |
$2,681.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,532.23
|
| Rate for Payer: Nomi Health Commercial |
$2,442.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,936.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,610.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,088.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,621.60
|
|
|
HC EGG WHITE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC EGG WHITE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EGG YOLK, IGE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.43
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC EGG YOLK, IGE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200482
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: ASR Commercial |
$30.27
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$25.56
|
| Rate for Payer: BCN Commercial |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Healthscope Whirlpool |
$30.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.35
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$21.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
OP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$71.64
|
| Rate for Payer: ASR Commercial |
$71.64
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$60.48
|
| Rate for Payer: BCN Commercial |
$57.26
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$69.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$73.86
|
| Rate for Payer: Healthscope Whirlpool |
$71.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$66.47
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.72
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$51.78
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC EKG RHYTHM STRIP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$73.86 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: ASR ASR |
$71.64
|
| Rate for Payer: ASR Commercial |
$71.64
|
| Rate for Payer: BCBS Trust/PPO |
$60.19
|
| Rate for Payer: BCN Commercial |
$57.26
|
| Rate for Payer: Cash Price |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$69.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.09
|
| Rate for Payer: Healthscope Commercial |
$73.86
|
| Rate for Payer: Healthscope Whirlpool |
$71.64
|
| Rate for Payer: Mclaren Commercial |
$66.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.78
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
|
|
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 EKG TRACING FOR INITIAL PREV
|
Facility
|
OP
|
$36.39
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000004
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Aetna Commercial |
$32.75
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: ASR ASR |
$35.30
|
| Rate for Payer: ASR Commercial |
$35.30
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$29.80
|
| Rate for Payer: BCN Commercial |
$28.21
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| 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 |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$36.39
|
| Rate for Payer: Healthscope Whirlpool |
$35.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.88
|
| Rate for Payer: Mclaren Commercial |
$32.75
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.93
|
| Rate for Payer: Nomi Health Commercial |
$29.84
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: PHP Medicaid |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| 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 |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP DNSP |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
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 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 |
$3,848.03
|
| 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 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 |
$47.98 |
| Max. Negotiated Rate |
$194.55 |
| Rate for Payer: Aetna Commercial |
$175.09
|
| Rate for Payer: Aetna Medicare |
$89.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.90
|
| Rate for Payer: ASR ASR |
$188.71
|
| Rate for Payer: ASR Commercial |
$188.71
|
| Rate for Payer: BCBS Complete |
$50.38
|
| Rate for Payer: BCBS MAPPO |
$89.52
|
| Rate for Payer: BCBS Trust/PPO |
$159.32
|
| Rate for Payer: BCN Commercial |
$150.83
|
| Rate for Payer: BCN Medicare Advantage |
$89.52
|
| 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 |
$89.52
|
| Rate for Payer: Healthscope Commercial |
$194.55
|
| Rate for Payer: Healthscope Whirlpool |
$188.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$89.52
|
| Rate for Payer: Mclaren Commercial |
$175.09
|
| Rate for Payer: Mclaren Medicaid |
$47.98
|
| Rate for Payer: Mclaren Medicare |
$89.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.00
|
| Rate for Payer: Meridian Medicaid |
$50.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.37
|
| Rate for Payer: Nomi Health Commercial |
$159.53
|
| Rate for Payer: PACE Medicare |
$85.04
|
| Rate for Payer: PACE SWMI |
$89.52
|
| Rate for Payer: PHP Commercial |
$98.47
|
| Rate for Payer: PHP Medicaid |
$47.98
|
| Rate for Payer: PHP Medicare Advantage |
$89.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.98
|
| 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 |
$89.52
|
| Rate for Payer: Priority Health Narrow Network |
$136.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.52
|
| Rate for Payer: UHC Exchange |
$138.76
|
| Rate for Payer: UHC Medicare Advantage |
$89.52
|
| Rate for Payer: UHCCP DNSP |
$89.52
|
| Rate for Payer: UHCCP Medicaid |
$47.98
|
| Rate for Payer: VA VA |
$89.52
|
|
|
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 |
$175.09
|
| 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 |
$175.09
|
| 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 |
$67.38 |
| Max. Negotiated Rate |
$194.85 |
| Rate for Payer: Aetna Commercial |
$153.13
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$165.04
|
| Rate for Payer: ASR Commercial |
$165.04
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$139.33
|
| Rate for Payer: BCN Commercial |
$131.91
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| 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 |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$170.14
|
| Rate for Payer: Healthscope Whirlpool |
$165.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$153.13
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.62
|
| Rate for Payer: Nomi Health Commercial |
$139.51
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| 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 |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$119.27
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
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 |
$47.98 |
| Max. Negotiated Rate |
$176.99 |
| Rate for Payer: Aetna Commercial |
$159.29
|
| Rate for Payer: Aetna Medicare |
$89.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.90
|
| Rate for Payer: ASR ASR |
$171.68
|
| Rate for Payer: ASR Commercial |
$171.68
|
| Rate for Payer: BCBS Complete |
$50.38
|
| Rate for Payer: BCBS MAPPO |
$89.52
|
| Rate for Payer: BCBS Trust/PPO |
$144.94
|
| Rate for Payer: BCN Commercial |
$137.22
|
| Rate for Payer: BCN Medicare Advantage |
$89.52
|
| 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 |
$89.52
|
| Rate for Payer: Healthscope Commercial |
$176.99
|
| Rate for Payer: Healthscope Whirlpool |
$171.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$89.52
|
| Rate for Payer: Mclaren Commercial |
$159.29
|
| Rate for Payer: Mclaren Medicaid |
$47.98
|
| Rate for Payer: Mclaren Medicare |
$89.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.00
|
| Rate for Payer: Meridian Medicaid |
$50.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Nomi Health Commercial |
$145.13
|
| Rate for Payer: PACE Medicare |
$85.04
|
| Rate for Payer: PACE SWMI |
$89.52
|
| Rate for Payer: PHP Commercial |
$98.47
|
| Rate for Payer: PHP Medicaid |
$47.98
|
| Rate for Payer: PHP Medicare Advantage |
$89.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.98
|
| 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 |
$89.52
|
| Rate for Payer: Priority Health Narrow Network |
$124.07
|
| Rate for Payer: Railroad Medicare Medicare |
$89.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.52
|
| Rate for Payer: UHC Exchange |
$138.76
|
| Rate for Payer: UHC Medicare Advantage |
$89.52
|
| Rate for Payer: UHCCP DNSP |
$89.52
|
| Rate for Payer: UHCCP Medicaid |
$47.98
|
| Rate for Payer: VA VA |
$89.52
|
|
|
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
|
|
