|
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 |
$40.98 |
| 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: 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 |
$89.76
|
| Rate for Payer: Priority Health Narrow Network |
$71.81
|
| 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 |
$53.10 |
| 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: 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 |
$116.32
|
| Rate for Payer: Priority Health Narrow Network |
$93.06
|
| 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
|
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 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 ELECTROCARDIOGRAM
|
Facility
|
OP
|
$217.40
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
73000001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$217.40 |
| Rate for Payer: Aetna Commercial |
$195.66
|
| 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 |
$210.88
|
| Rate for Payer: ASR Commercial |
$210.88
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$178.03
|
| Rate for Payer: BCN Commercial |
$168.55
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| 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 |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$217.40
|
| Rate for Payer: Healthscope Whirlpool |
$210.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$195.66
|
| 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 |
$184.79
|
| Rate for Payer: Nomi Health Commercial |
$178.27
|
| 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 |
$141.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.49
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$152.40
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.31
|
| 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 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
|
|
|
HC ELECTROCORTICOGRAM IMPLTD BRN NPGT <30 D
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
74000033
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: Aetna Medicare |
$36.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.46
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Complete |
$20.47
|
| Rate for Payer: BCBS MAPPO |
$36.37
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: BCN Medicare Advantage |
$36.37
|
| Rate for Payer: Cash Price |
$60.76
|
| 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: Health Alliance Plan Medicare Advantage |
$36.37
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$36.37
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$19.49
|
| Rate for Payer: Mclaren Medicare |
$36.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.19
|
| Rate for Payer: Meridian Medicaid |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PACE Medicare |
$34.55
|
| Rate for Payer: PACE SWMI |
$36.37
|
| Rate for Payer: PHP Commercial |
$40.01
|
| Rate for Payer: PHP Medicaid |
$19.49
|
| Rate for Payer: PHP Medicare Advantage |
$36.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.55
|
| Rate for Payer: Priority Health Medicare |
$36.37
|
| Rate for Payer: Priority Health Narrow Network |
$53.24
|
| Rate for Payer: Railroad Medicare Medicare |
$36.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.37
|
| Rate for Payer: UHC Exchange |
$56.37
|
| Rate for Payer: UHC Medicare Advantage |
$36.37
|
| Rate for Payer: UHCCP DNSP |
$36.37
|
| Rate for Payer: UHCCP Medicaid |
$19.49
|
| Rate for Payer: VA VA |
$36.37
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
OP
|
$28.09
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$25.28
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.76
|
| Rate for Payer: ASR ASR |
$27.25
|
| Rate for Payer: ASR Commercial |
$27.25
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.00
|
| Rate for Payer: BCN Commercial |
$21.78
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Healthscope Whirlpool |
$27.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.01
|
| Rate for Payer: Mclaren Commercial |
$25.28
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| Rate for Payer: Mclaren Medicare |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.36
|
| Rate for Payer: Meridian Medicaid |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Nomi Health Commercial |
$23.03
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$7.71
|
| Rate for Payer: PHP Medicaid |
$3.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.61
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow Network |
$19.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.01
|
| Rate for Payer: UHC Exchange |
$10.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UHCCP DNSP |
$7.01
|
| Rate for Payer: UHCCP Medicaid |
$3.76
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100012
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$25.28
|
| Rate for Payer: ASR ASR |
$27.25
|
| Rate for Payer: ASR Commercial |
$27.25
|
| Rate for Payer: BCBS Trust/PPO |
$22.89
|
| Rate for Payer: BCN Commercial |
$21.78
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Healthscope Whirlpool |
$27.25
|
| Rate for Payer: Mclaren Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Nomi Health Commercial |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.72
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
OP
|
$87.82
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.76
|
| Rate for Payer: ASR ASR |
$85.19
|
| Rate for Payer: ASR Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$7.01
|
| Rate for Payer: BCBS Trust/PPO |
$71.92
|
| Rate for Payer: BCN Commercial |
$68.09
|
| Rate for Payer: BCN Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$82.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Whirlpool |
$85.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.01
|
| Rate for Payer: Mclaren Commercial |
$79.04
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| Rate for Payer: Mclaren Medicare |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.36
|
| Rate for Payer: Meridian Medicaid |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: Nomi Health Commercial |
$72.01
|
| Rate for Payer: PACE Medicare |
$6.66
|
| Rate for Payer: PACE SWMI |
$7.01
|
| Rate for Payer: PHP Commercial |
$7.71
|
| Rate for Payer: PHP Medicaid |
$3.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.95
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow Network |
$61.56
|
| Rate for Payer: Railroad Medicare Medicare |
$7.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.01
|
| Rate for Payer: UHC Exchange |
$10.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.01
|
| Rate for Payer: UHCCP DNSP |
$7.01
|
| Rate for Payer: UHCCP Medicaid |
$3.76
|
| Rate for Payer: VA VA |
$7.01
|
|
|
HC ELECTROLYTES WHOLE BLOOD
|
Facility
|
IP
|
$87.82
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
30100490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: ASR ASR |
$85.19
|
| Rate for Payer: ASR Commercial |
$85.19
|
| Rate for Payer: BCBS Trust/PPO |
$71.56
|
| Rate for Payer: BCN Commercial |
$68.09
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$82.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Whirlpool |
$85.19
|
| Rate for Payer: Mclaren Commercial |
$79.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: Nomi Health Commercial |
$72.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.28
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPINGLEVEL 31
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna Commercial |
$2,835.00
|
| Rate for Payer: Aetna Medicare |
$1,575.00
|
| Rate for Payer: ASR ASR |
$3,055.50
|
| Rate for Payer: ASR Commercial |
$3,055.50
|
| Rate for Payer: BCBS Complete |
$1,260.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,579.53
|
| Rate for Payer: BCN Commercial |
$2,442.20
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cofinity Commercial |
$2,961.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$3,150.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,055.50
|
| Rate for Payer: Mclaren Commercial |
$2,835.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,677.50
|
| Rate for Payer: Nomi Health Commercial |
$2,583.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,760.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,208.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,772.00
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPINGLEVEL 31
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200369
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,047.50 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: Aetna Commercial |
$2,835.00
|
| Rate for Payer: ASR ASR |
$3,055.50
|
| Rate for Payer: ASR Commercial |
$3,055.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,566.93
|
| Rate for Payer: BCN Commercial |
$2,442.20
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cofinity Commercial |
$2,961.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.00
|
| Rate for Payer: Healthscope Commercial |
$3,150.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,055.50
|
| Rate for Payer: Mclaren Commercial |
$2,835.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,677.50
|
| Rate for Payer: Nomi Health Commercial |
$2,583.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,047.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,772.00
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 39
|
Facility
|
IP
|
$3,988.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,592.20 |
| Max. Negotiated Rate |
$3,988.00 |
| Rate for Payer: Aetna Commercial |
$3,589.20
|
| Rate for Payer: ASR ASR |
$3,868.36
|
| Rate for Payer: ASR Commercial |
$3,868.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,249.82
|
| Rate for Payer: BCN Commercial |
$3,091.90
|
| Rate for Payer: Cash Price |
$3,190.40
|
| Rate for Payer: Cofinity Commercial |
$3,748.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,190.40
|
| Rate for Payer: Healthscope Commercial |
$3,988.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,868.36
|
| Rate for Payer: Mclaren Commercial |
$3,589.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,389.80
|
| Rate for Payer: Nomi Health Commercial |
$3,270.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,592.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,509.44
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 39
|
Facility
|
OP
|
$3,988.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,595.20 |
| Max. Negotiated Rate |
$3,988.00 |
| Rate for Payer: Aetna Commercial |
$3,589.20
|
| Rate for Payer: Aetna Medicare |
$1,994.00
|
| Rate for Payer: ASR ASR |
$3,868.36
|
| Rate for Payer: ASR Commercial |
$3,868.36
|
| Rate for Payer: BCBS Complete |
$1,595.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.77
|
| Rate for Payer: BCN Commercial |
$3,091.90
|
| Rate for Payer: Cash Price |
$3,190.40
|
| Rate for Payer: Cofinity Commercial |
$3,748.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,190.40
|
| Rate for Payer: Healthscope Commercial |
$3,988.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,868.36
|
| Rate for Payer: Mclaren Commercial |
$3,589.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,389.80
|
| Rate for Payer: Nomi Health Commercial |
$3,270.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,592.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,494.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,795.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,509.44
|
|
|
HC ELECTROPHYSIOLOGY CATH 3D OR VECTOR MAPPING LEVEL 46
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,848.00 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Aetna Medicare |
$2,310.00
|
| Rate for Payer: ASR ASR |
$4,481.40
|
| Rate for Payer: ASR Commercial |
$4,481.40
|
| Rate for Payer: BCBS Complete |
$1,848.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,783.32
|
| Rate for Payer: BCN Commercial |
$3,581.89
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Cofinity Commercial |
$4,342.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,696.00
|
| Rate for Payer: Healthscope Commercial |
$4,620.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,481.40
|
| Rate for Payer: Mclaren Commercial |
$4,158.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,927.00
|
| Rate for Payer: Nomi Health Commercial |
$3,788.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,003.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,048.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,238.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,065.60
|
|
