|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: ASR ASR |
$363.75
|
| Rate for Payer: BCBS Trust/PPO |
$290.74
|
| Rate for Payer: BCN Commercial |
$290.74
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$352.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$375.00
|
| Rate for Payer: Healthscope Whirlpool |
$363.75
|
| Rate for Payer: Mclaren Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.25
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.37
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Whirlpool |
$16.73
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.18
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.25
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: ASR ASR |
$16.73
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS Trust/PPO |
$13.37
|
| Rate for Payer: BCN Commercial |
$13.37
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Whirlpool |
$16.73
|
| Rate for Payer: Mclaren Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.70
|
| Rate for Payer: Priority Health Narrow Network |
$12.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.18
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: ASR ASR |
$232.80
|
| Rate for Payer: BCBS Trust/PPO |
$186.07
|
| Rate for Payer: BCN Commercial |
$186.07
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$225.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.00
|
| Rate for Payer: Healthscope Commercial |
$240.00
|
| Rate for Payer: Healthscope Whirlpool |
$232.80
|
| Rate for Payer: Mclaren Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.20
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: ASR ASR |
$232.80
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS Trust/PPO |
$186.07
|
| Rate for Payer: BCN Commercial |
$186.07
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$225.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.00
|
| Rate for Payer: Healthscope Commercial |
$240.00
|
| Rate for Payer: Healthscope Whirlpool |
$232.80
|
| Rate for Payer: Mclaren Commercial |
$216.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.40
|
| Rate for Payer: Priority Health Narrow Network |
$170.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.20
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: ASR ASR |
$86.33
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS Trust/PPO |
$69.00
|
| Rate for Payer: BCN Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$89.00
|
| Rate for Payer: Healthscope Whirlpool |
$86.33
|
| Rate for Payer: Mclaren Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.32
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: ASR ASR |
$86.33
|
| Rate for Payer: BCBS Trust/PPO |
$69.00
|
| Rate for Payer: BCN Commercial |
$69.00
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$89.00
|
| Rate for Payer: Healthscope Whirlpool |
$86.33
|
| Rate for Payer: Mclaren Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.32
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$971.92
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$680.34 |
| Max. Negotiated Rate |
$971.92 |
| Rate for Payer: Aetna Commercial |
$874.73
|
| Rate for Payer: ASR ASR |
$942.76
|
| Rate for Payer: BCBS Trust/PPO |
$753.53
|
| Rate for Payer: BCN Commercial |
$753.53
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$913.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.54
|
| Rate for Payer: Healthscope Commercial |
$971.92
|
| Rate for Payer: Healthscope Whirlpool |
$942.76
|
| Rate for Payer: Mclaren Commercial |
$874.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.29
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$971.92
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.77 |
| Max. Negotiated Rate |
$971.92 |
| Rate for Payer: Aetna Commercial |
$874.73
|
| Rate for Payer: ASR ASR |
$942.76
|
| Rate for Payer: BCBS Complete |
$388.77
|
| Rate for Payer: BCBS Trust/PPO |
$753.53
|
| Rate for Payer: BCN Commercial |
$753.53
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$913.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.54
|
| Rate for Payer: Healthscope Commercial |
$971.92
|
| Rate for Payer: Healthscope Whirlpool |
$942.76
|
| Rate for Payer: Mclaren Commercial |
$874.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$884.45
|
| Rate for Payer: Priority Health Narrow Network |
$690.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.29
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.56
|
| Rate for Payer: PHP Medicaid |
$8.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$63.90
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: ASR ASR |
$87.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Whirlpool |
$87.30
|
| Rate for Payer: Mclaren Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.20
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$213.84
|
| Rate for Payer: ASR ASR |
$230.47
|
| Rate for Payer: BCBS Trust/PPO |
$184.21
|
| Rate for Payer: BCN Commercial |
$184.21
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Healthscope Whirlpool |
$230.47
|
| Rate for Payer: Mclaren Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.09
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Aetna Commercial |
$213.84
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: ASR ASR |
$230.47
|
| Rate for Payer: BCBS Complete |
$88.17
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$184.21
|
| Rate for Payer: BCN Commercial |
$184.21
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$223.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$237.60
|
| Rate for Payer: Healthscope Whirlpool |
$230.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$213.84
|
| Rate for Payer: Mclaren Medicaid |
$83.96
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Medicaid |
$88.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicaid |
$83.96
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.09
|
| Rate for Payer: UHC Medicare Advantage |
$158.10
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,138.75
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,497.12 |
| Max. Negotiated Rate |
$2,138.75 |
| Rate for Payer: Aetna Commercial |
$1,924.88
|
| Rate for Payer: ASR ASR |
$2,074.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.17
|
| Rate for Payer: BCN Commercial |
$1,658.17
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cofinity Commercial |
$2,010.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.00
|
| Rate for Payer: Healthscope Commercial |
$2,138.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,074.59
|
| Rate for Payer: Mclaren Commercial |
$1,924.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,817.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,882.10
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,138.75
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.09 |
| Max. Negotiated Rate |
$2,138.75 |
| Rate for Payer: Aetna Commercial |
$1,924.88
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$2,074.59
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.17
|
| Rate for Payer: BCN Commercial |
$1,658.17
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cofinity Commercial |
$2,010.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$2,138.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,074.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$1,924.88
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,817.94
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.89
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$495.91
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,882.10
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,077.63
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,854.34 |
| Max. Negotiated Rate |
$9,439.52 |
| Rate for Payer: Aetna Commercial |
$3,669.87
|
| Rate for Payer: Aetna Medicare |
$7,551.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,439.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,439.52
|
| Rate for Payer: ASR ASR |
$3,955.30
|
| Rate for Payer: BCBS Complete |
$4,337.65
|
| Rate for Payer: BCBS MAPPO |
$7,551.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,161.39
|
| Rate for Payer: BCN Commercial |
$3,161.39
|
| Rate for Payer: BCN Medicare Advantage |
$7,551.62
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cofinity Commercial |
$3,832.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,551.62
|
| Rate for Payer: Healthscope Commercial |
$4,077.63
|
| Rate for Payer: Healthscope Whirlpool |
$3,955.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,551.62
|
| Rate for Payer: Mclaren Commercial |
$3,669.87
|
| Rate for Payer: Mclaren Medicaid |
$4,130.74
|
| Rate for Payer: Mclaren Medicare |
$7,551.62
|
| Rate for Payer: Meridian Medicaid |
$4,337.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,929.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,684.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,465.99
|
| Rate for Payer: PACE Medicare |
$7,174.04
|
| Rate for Payer: PACE SWMI |
$7,551.62
|
| Rate for Payer: PHP Commercial |
$8,306.78
|
| Rate for Payer: PHP Medicaid |
$4,130.74
|
| Rate for Payer: PHP Medicare Advantage |
$7,551.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,130.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,922.40
|
| Rate for Payer: Priority Health Medicare |
$7,551.62
|
| Rate for Payer: Priority Health Narrow Network |
$6,337.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7,551.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,588.31
|
| Rate for Payer: UHC Medicare Advantage |
$7,778.17
|
| Rate for Payer: VA VA |
$7,551.62
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,077.63
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,854.34 |
| Max. Negotiated Rate |
$4,077.63 |
| Rate for Payer: Aetna Commercial |
$3,669.87
|
| Rate for Payer: ASR ASR |
$3,955.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,161.39
|
| Rate for Payer: BCN Commercial |
$3,161.39
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cofinity Commercial |
$3,832.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.10
|
| Rate for Payer: Healthscope Commercial |
$4,077.63
|
| Rate for Payer: Healthscope Whirlpool |
$3,955.30
|
| Rate for Payer: Mclaren Commercial |
$3,669.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,465.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,588.31
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,245.90
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,098.36 |
| Max. Negotiated Rate |
$10,245.90 |
| Rate for Payer: Aetna Commercial |
$9,221.31
|
| Rate for Payer: ASR ASR |
$9,938.52
|
| Rate for Payer: BCBS Complete |
$4,098.36
|
| Rate for Payer: BCBS Trust/PPO |
$7,943.65
|
| Rate for Payer: BCN Commercial |
$7,943.65
|
| Rate for Payer: Cash Price |
$8,196.72
|
| Rate for Payer: Cofinity Commercial |
$9,631.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,196.72
|
| Rate for Payer: Healthscope Commercial |
$10,245.90
|
| Rate for Payer: Healthscope Whirlpool |
$9,938.52
|
| Rate for Payer: Mclaren Commercial |
$9,221.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,709.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,172.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,323.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,274.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,016.39
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,245.90
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,172.13 |
| Max. Negotiated Rate |
$10,245.90 |
| Rate for Payer: Aetna Commercial |
$9,221.31
|
| Rate for Payer: ASR ASR |
$9,938.52
|
| Rate for Payer: BCBS Trust/PPO |
$7,943.65
|
| Rate for Payer: BCN Commercial |
$7,943.65
|
| Rate for Payer: Cash Price |
$8,196.72
|
| Rate for Payer: Cofinity Commercial |
$9,631.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,196.72
|
| Rate for Payer: Healthscope Commercial |
$10,245.90
|
| Rate for Payer: Healthscope Whirlpool |
$9,938.52
|
| Rate for Payer: Mclaren Commercial |
$9,221.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,709.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,172.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,016.39
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$133.41 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: Aetna Medicare |
$30.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.72
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: BCBS Complete |
$17.79
|
| Rate for Payer: BCBS MAPPO |
$30.98
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: BCN Medicare Advantage |
$30.98
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.98
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Mclaren Medicaid |
$16.95
|
| Rate for Payer: Mclaren Medicare |
$30.98
|
| Rate for Payer: Meridian Medicaid |
$17.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Medicare |
$29.43
|
| Rate for Payer: PACE SWMI |
$30.98
|
| Rate for Payer: PHP Commercial |
$34.08
|
| Rate for Payer: PHP Medicaid |
$16.95
|
| Rate for Payer: PHP Medicare Advantage |
$30.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.41
|
| Rate for Payer: Priority Health Medicare |
$30.98
|
| Rate for Payer: Priority Health Narrow Network |
$106.73
|
| Rate for Payer: Railroad Medicare Medicare |
$30.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
| Rate for Payer: UHC Medicare Advantage |
$31.91
|
| Rate for Payer: VA VA |
$30.98
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$328.48
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$262.55
|
| Rate for Payer: BCN Commercial |
$262.55
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$318.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$338.64
|
| Rate for Payer: Healthscope Whirlpool |
$328.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$304.78
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.84
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$10.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.48
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$187.58
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.00
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$237.05 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: ASR ASR |
$328.48
|
| Rate for Payer: BCBS Trust/PPO |
$262.55
|
| Rate for Payer: BCN Commercial |
$262.55
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$318.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$338.64
|
| Rate for Payer: Healthscope Whirlpool |
$328.48
|
| Rate for Payer: Mclaren Commercial |
$304.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.00
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
IP
|
$103.02
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$103.02 |
| Rate for Payer: Aetna Commercial |
$92.72
|
| Rate for Payer: ASR ASR |
$99.93
|
| Rate for Payer: BCBS Trust/PPO |
$79.87
|
| Rate for Payer: BCN Commercial |
$79.87
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$96.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Healthscope Commercial |
$103.02
|
| Rate for Payer: Healthscope Whirlpool |
$99.93
|
| Rate for Payer: Mclaren Commercial |
$92.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.66
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$234.48 |
| Rate for Payer: Aetna Commercial |
$92.72
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$99.93
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$79.87
|
| Rate for Payer: BCN Commercial |
$79.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$96.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$103.02
|
| Rate for Payer: Healthscope Whirlpool |
$99.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$92.72
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$10.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.48
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$187.58
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.66
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
