|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.39
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$96.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$463.88
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$185.55 |
| Max. Negotiated Rate |
$463.88 |
| Rate for Payer: Aetna Commercial |
$417.49
|
| Rate for Payer: ASR ASR |
$449.96
|
| Rate for Payer: BCBS Complete |
$185.55
|
| Rate for Payer: BCBS Trust/PPO |
$359.65
|
| Rate for Payer: BCN Commercial |
$359.65
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cofinity Commercial |
$436.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.10
|
| Rate for Payer: Healthscope Commercial |
$463.88
|
| Rate for Payer: Healthscope Whirlpool |
$449.96
|
| Rate for Payer: Mclaren Commercial |
$417.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.13
|
| Rate for Payer: Priority Health Narrow Network |
$329.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.21
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$463.88
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$463.88 |
| Rate for Payer: Aetna Commercial |
$417.49
|
| Rate for Payer: ASR ASR |
$449.96
|
| Rate for Payer: BCBS Trust/PPO |
$359.65
|
| Rate for Payer: BCN Commercial |
$359.65
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cofinity Commercial |
$436.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.10
|
| Rate for Payer: Healthscope Commercial |
$463.88
|
| Rate for Payer: Healthscope Whirlpool |
$449.96
|
| Rate for Payer: Mclaren Commercial |
$417.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$408.21
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$673.54
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$471.48 |
| Max. Negotiated Rate |
$673.54 |
| Rate for Payer: Aetna Commercial |
$606.19
|
| Rate for Payer: ASR ASR |
$653.33
|
| Rate for Payer: BCBS Trust/PPO |
$522.20
|
| Rate for Payer: BCN Commercial |
$522.20
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$633.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Healthscope Commercial |
$673.54
|
| Rate for Payer: Healthscope Whirlpool |
$653.33
|
| Rate for Payer: Mclaren Commercial |
$606.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.72
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$673.54
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.69 |
| Max. Negotiated Rate |
$673.54 |
| Rate for Payer: Aetna Commercial |
$606.19
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$653.33
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$522.20
|
| Rate for Payer: BCCCP Commercial |
$43.69
|
| Rate for Payer: BCN Commercial |
$522.20
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$633.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$673.54
|
| Rate for Payer: Healthscope Whirlpool |
$653.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$606.19
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.83
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$214.26
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.72
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$673.54
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$673.54 |
| Rate for Payer: Aetna Commercial |
$606.19
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$653.33
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$522.20
|
| Rate for Payer: BCN Commercial |
$522.20
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$633.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$673.54
|
| Rate for Payer: Healthscope Whirlpool |
$653.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$606.19
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.92
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$478.21
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.72
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$673.54
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$471.48 |
| Max. Negotiated Rate |
$673.54 |
| Rate for Payer: Aetna Commercial |
$606.19
|
| Rate for Payer: ASR ASR |
$653.33
|
| Rate for Payer: BCBS Trust/PPO |
$522.20
|
| Rate for Payer: BCN Commercial |
$522.20
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$633.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Healthscope Commercial |
$673.54
|
| Rate for Payer: Healthscope Whirlpool |
$653.33
|
| Rate for Payer: Mclaren Commercial |
$606.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.72
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,188.71
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$1,188.71 |
| Rate for Payer: Aetna Commercial |
$1,069.84
|
| Rate for Payer: ASR ASR |
$1,153.05
|
| Rate for Payer: BCBS Trust/PPO |
$921.61
|
| Rate for Payer: BCN Commercial |
$921.61
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cofinity Commercial |
$1,117.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.97
|
| Rate for Payer: Healthscope Commercial |
$1,188.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,153.05
|
| Rate for Payer: Mclaren Commercial |
$1,069.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.06
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,188.71
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,188.71 |
| Rate for Payer: Aetna Commercial |
$1,069.84
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,153.05
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$921.61
|
| Rate for Payer: BCN Commercial |
$921.61
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cofinity Commercial |
$1,117.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,188.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,153.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,069.84
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.40
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.15
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$224.12
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.06
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,377.54
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$2,377.54 |
| Rate for Payer: Aetna Commercial |
$2,139.79
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$2,306.21
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,843.31
|
| Rate for Payer: BCN Commercial |
$1,843.31
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cofinity Commercial |
$2,234.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,902.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$2,377.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,306.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$2,139.79
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,020.91
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.15
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$224.12
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,092.24
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,377.54
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,664.28 |
| Max. Negotiated Rate |
$2,377.54 |
| Rate for Payer: Aetna Commercial |
$2,139.79
|
| Rate for Payer: ASR ASR |
$2,306.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,843.31
|
| Rate for Payer: BCN Commercial |
$1,843.31
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cofinity Commercial |
$2,234.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,902.03
|
| Rate for Payer: Healthscope Commercial |
$2,377.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,306.21
|
| Rate for Payer: Mclaren Commercial |
$2,139.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,020.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,092.24
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$845.57
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$591.90 |
| Max. Negotiated Rate |
$845.57 |
| Rate for Payer: Aetna Commercial |
$761.01
|
| Rate for Payer: ASR ASR |
$820.20
|
| Rate for Payer: BCBS Trust/PPO |
$655.57
|
| Rate for Payer: BCN Commercial |
$655.57
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cofinity Commercial |
$794.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.46
|
| Rate for Payer: Healthscope Commercial |
$845.57
|
| Rate for Payer: Healthscope Whirlpool |
$820.20
|
| Rate for Payer: Mclaren Commercial |
$761.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.10
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
OP
|
$845.57
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.98 |
| Max. Negotiated Rate |
$845.57 |
| Rate for Payer: Aetna Commercial |
$761.01
|
| Rate for Payer: Aetna Medicare |
$285.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: ASR ASR |
$820.20
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$655.57
|
| Rate for Payer: BCN Commercial |
$655.57
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cofinity Commercial |
$794.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Healthscope Commercial |
$845.57
|
| Rate for Payer: Healthscope Whirlpool |
$820.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$285.16
|
| Rate for Payer: Mclaren Commercial |
$761.01
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.73
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Commercial |
$313.68
|
| Rate for Payer: PHP Medicaid |
$155.98
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.47
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$600.35
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.10
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: VA VA |
$285.16
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$257.51
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$277.54
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$221.83
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$268.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$286.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$257.51
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.37
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$203.15
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.79
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.28 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$257.51
|
| Rate for Payer: ASR ASR |
$277.54
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$221.83
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$268.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$286.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.54
|
| Rate for Payer: Mclaren Commercial |
$257.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.79
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$257.51
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$277.54
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$221.83
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$268.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$286.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$257.51
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.42
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$107.54
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.79
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.28 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$257.51
|
| Rate for Payer: ASR ASR |
$277.54
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$221.83
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$268.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$286.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.54
|
| Rate for Payer: Mclaren Commercial |
$257.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.79
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
OP
|
$405.25
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$162.10 |
| Max. Negotiated Rate |
$405.25 |
| Rate for Payer: Aetna Commercial |
$364.72
|
| Rate for Payer: ASR ASR |
$393.09
|
| Rate for Payer: BCBS Complete |
$162.10
|
| Rate for Payer: BCBS Trust/PPO |
$314.19
|
| Rate for Payer: BCN Commercial |
$314.19
|
| Rate for Payer: Cash Price |
$324.20
|
| Rate for Payer: Cofinity Commercial |
$380.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.20
|
| Rate for Payer: Healthscope Commercial |
$405.25
|
| Rate for Payer: Healthscope Whirlpool |
$393.09
|
| Rate for Payer: Mclaren Commercial |
$364.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$344.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.78
|
| Rate for Payer: Priority Health Narrow Network |
$287.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.62
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
IP
|
$405.25
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.68 |
| Max. Negotiated Rate |
$405.25 |
| Rate for Payer: Aetna Commercial |
$364.72
|
| Rate for Payer: ASR ASR |
$393.09
|
| Rate for Payer: BCBS Trust/PPO |
$314.19
|
| Rate for Payer: BCN Commercial |
$314.19
|
| Rate for Payer: Cash Price |
$324.20
|
| Rate for Payer: Cofinity Commercial |
$380.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.20
|
| Rate for Payer: Healthscope Commercial |
$405.25
|
| Rate for Payer: Healthscope Whirlpool |
$393.09
|
| Rate for Payer: Mclaren Commercial |
$364.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$344.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.62
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$631.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.92 |
| Max. Negotiated Rate |
$631.32 |
| Rate for Payer: Aetna Commercial |
$568.19
|
| Rate for Payer: ASR ASR |
$612.38
|
| Rate for Payer: BCBS Trust/PPO |
$489.46
|
| Rate for Payer: BCN Commercial |
$489.46
|
| Rate for Payer: Cash Price |
$505.06
|
| Rate for Payer: Cofinity Commercial |
$593.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.06
|
| Rate for Payer: Healthscope Commercial |
$631.32
|
| Rate for Payer: Healthscope Whirlpool |
$612.38
|
| Rate for Payer: Mclaren Commercial |
$568.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.56
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$631.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$631.32 |
| Rate for Payer: Aetna Commercial |
$568.19
|
| Rate for Payer: ASR ASR |
$612.38
|
| Rate for Payer: BCBS Complete |
$252.53
|
| Rate for Payer: BCBS Trust/PPO |
$489.46
|
| Rate for Payer: BCCCP Commercial |
$59.82
|
| Rate for Payer: BCN Commercial |
$489.46
|
| Rate for Payer: Cash Price |
$505.06
|
| Rate for Payer: Cash Price |
$505.06
|
| Rate for Payer: Cofinity Commercial |
$593.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.06
|
| Rate for Payer: Healthscope Commercial |
$631.32
|
| Rate for Payer: Healthscope Whirlpool |
$612.38
|
| Rate for Payer: Mclaren Commercial |
$568.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.44
|
| Rate for Payer: Priority Health Narrow Network |
$311.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.56
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.26 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.89
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$263.11
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
|
HC US INFANT HIPS W MANIPULATION
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
40200040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
