|
HC OXYCODONE LVL
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: BCBS Trust/PPO |
$65.15
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.71
|
| Rate for Payer: Priority Health Narrow Network |
$55.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$79.56 |
| Rate for Payer: Aetna Commercial |
$71.60
|
| Rate for Payer: ASR ASR |
$77.17
|
| Rate for Payer: ASR Commercial |
$77.17
|
| Rate for Payer: BCBS Trust/PPO |
$64.83
|
| Rate for Payer: BCN Commercial |
$61.68
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$79.56
|
| Rate for Payer: Healthscope Whirlpool |
$77.17
|
| Rate for Payer: Mclaren Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: Nomi Health Commercial |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.01
|
|
|
HC OXYCODONE URINE.
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Trust/PPO |
$82.84
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$98.61
|
| Rate for Payer: ASR Commercial |
$98.61
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$78.82
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$95.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$101.66
|
| Rate for Payer: Healthscope Whirlpool |
$98.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: ASR Commercial |
$53.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.88
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Aetna Medicare |
$27.54
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: ASR Commercial |
$53.43
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: BCBS Trust/PPO |
$45.11
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.26
|
| Rate for Payer: Priority Health Narrow Network |
$38.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$587.53 |
| Max. Negotiated Rate |
$1,468.83 |
| Rate for Payer: Aetna Commercial |
$1,321.95
|
| Rate for Payer: Aetna Medicare |
$734.41
|
| Rate for Payer: ASR ASR |
$1,424.77
|
| Rate for Payer: ASR Commercial |
$1,424.77
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.82
|
| Rate for Payer: BCN Commercial |
$1,138.78
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,468.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,424.77
|
| Rate for Payer: Mclaren Commercial |
$1,321.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: Nomi Health Commercial |
$1,204.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,286.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.57
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$954.74 |
| Max. Negotiated Rate |
$1,468.83 |
| Rate for Payer: Aetna Commercial |
$1,321.95
|
| Rate for Payer: ASR ASR |
$1,424.77
|
| Rate for Payer: ASR Commercial |
$1,424.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.95
|
| Rate for Payer: BCN Commercial |
$1,138.78
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,380.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,468.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,424.77
|
| Rate for Payer: Mclaren Commercial |
$1,321.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: Nomi Health Commercial |
$1,204.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.57
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$805.54 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,115.37
|
| Rate for Payer: ASR ASR |
$1,202.12
|
| Rate for Payer: ASR Commercial |
$1,202.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.91
|
| Rate for Payer: BCN Commercial |
$960.83
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,164.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.12
|
| Rate for Payer: Mclaren Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,090.58
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$495.72 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,115.37
|
| Rate for Payer: Aetna Medicare |
$619.65
|
| Rate for Payer: ASR ASR |
$1,202.12
|
| Rate for Payer: ASR Commercial |
$1,202.12
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.86
|
| Rate for Payer: BCN Commercial |
$960.83
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,164.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,202.12
|
| Rate for Payer: Mclaren Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: Nomi Health Commercial |
$1,016.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,085.87
|
| Rate for Payer: Priority Health Narrow Network |
$868.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,090.58
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Aetna Commercial |
$1,129.14
|
| Rate for Payer: Aetna Medicare |
$627.30
|
| Rate for Payer: ASR ASR |
$1,216.96
|
| Rate for Payer: ASR Commercial |
$1,216.96
|
| Rate for Payer: BCBS Complete |
$501.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,027.39
|
| Rate for Payer: BCN Commercial |
$972.69
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,179.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,254.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,216.96
|
| Rate for Payer: Mclaren Commercial |
$1,129.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: Nomi Health Commercial |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.28
|
| Rate for Payer: Priority Health Narrow Network |
$879.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.05
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$815.49 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Aetna Commercial |
$1,129.14
|
| Rate for Payer: ASR ASR |
$1,216.96
|
| Rate for Payer: ASR Commercial |
$1,216.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.37
|
| Rate for Payer: BCN Commercial |
$972.69
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,179.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,254.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,216.96
|
| Rate for Payer: Mclaren Commercial |
$1,129.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: Nomi Health Commercial |
$1,028.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.05
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,511.11 |
| Max. Negotiated Rate |
$3,863.25 |
| Rate for Payer: Aetna Commercial |
$3,476.93
|
| Rate for Payer: ASR ASR |
$3,747.35
|
| Rate for Payer: ASR Commercial |
$3,747.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,148.16
|
| Rate for Payer: BCN Commercial |
$2,995.18
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$3,631.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,863.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,747.35
|
| Rate for Payer: Mclaren Commercial |
$3,476.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: Nomi Health Commercial |
$3,167.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,399.66
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,545.30 |
| Max. Negotiated Rate |
$3,863.25 |
| Rate for Payer: Aetna Commercial |
$3,476.93
|
| Rate for Payer: Aetna Medicare |
$1,931.62
|
| Rate for Payer: ASR ASR |
$3,747.35
|
| Rate for Payer: ASR Commercial |
$3,747.35
|
| Rate for Payer: BCBS Complete |
$1,545.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,163.62
|
| Rate for Payer: BCN Commercial |
$2,995.18
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$3,631.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,863.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,747.35
|
| Rate for Payer: Mclaren Commercial |
$3,476.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: Nomi Health Commercial |
$3,167.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,384.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,708.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,399.66
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$521.44 |
| Max. Negotiated Rate |
$802.21 |
| Rate for Payer: Aetna Commercial |
$721.99
|
| Rate for Payer: ASR ASR |
$778.14
|
| Rate for Payer: ASR Commercial |
$778.14
|
| Rate for Payer: BCBS Trust/PPO |
$653.72
|
| Rate for Payer: BCN Commercial |
$621.95
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$754.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Healthscope Commercial |
$802.21
|
| Rate for Payer: Healthscope Whirlpool |
$778.14
|
| Rate for Payer: Mclaren Commercial |
$721.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: Nomi Health Commercial |
$657.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.94
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$802.21
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$802.21 |
| Rate for Payer: Aetna Commercial |
$721.99
|
| Rate for Payer: Aetna Medicare |
$196.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: ASR ASR |
$778.14
|
| Rate for Payer: ASR Commercial |
$778.14
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCBS Trust/PPO |
$656.93
|
| Rate for Payer: BCN Commercial |
$621.95
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cash Price |
$641.77
|
| Rate for Payer: Cofinity Commercial |
$754.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$802.21
|
| Rate for Payer: Healthscope Whirlpool |
$778.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$196.20
|
| Rate for Payer: Mclaren Commercial |
$721.99
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.88
|
| Rate for Payer: Nomi Health Commercial |
$657.81
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$215.82
|
| Rate for Payer: PHP Medicaid |
$105.16
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.90
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health Narrow Network |
$562.35
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$304.11
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP DNSP |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$55,791.45 |
| Max. Negotiated Rate |
$85,833.00 |
| Rate for Payer: Aetna Commercial |
$77,249.70
|
| Rate for Payer: ASR ASR |
$83,258.01
|
| Rate for Payer: ASR Commercial |
$83,258.01
|
| Rate for Payer: BCBS Trust/PPO |
$69,945.31
|
| Rate for Payer: BCN Commercial |
$66,546.32
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$80,683.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$85,833.00
|
| Rate for Payer: Healthscope Whirlpool |
$83,258.01
|
| Rate for Payer: Mclaren Commercial |
$77,249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: Nomi Health Commercial |
$70,383.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75,533.04
|
|
|
HC PACEMAKER AVIER LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$85,833.00
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$34,333.20 |
| Max. Negotiated Rate |
$85,833.00 |
| Rate for Payer: Aetna Commercial |
$77,249.70
|
| Rate for Payer: Aetna Medicare |
$42,916.50
|
| Rate for Payer: ASR ASR |
$83,258.01
|
| Rate for Payer: ASR Commercial |
$83,258.01
|
| Rate for Payer: BCBS Complete |
$34,333.20
|
| Rate for Payer: BCBS Trust/PPO |
$70,288.64
|
| Rate for Payer: BCN Commercial |
$66,546.32
|
| Rate for Payer: Cash Price |
$68,666.40
|
| Rate for Payer: Cofinity Commercial |
$80,683.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68,666.40
|
| Rate for Payer: Healthscope Commercial |
$85,833.00
|
| Rate for Payer: Healthscope Whirlpool |
$83,258.01
|
| Rate for Payer: Mclaren Commercial |
$77,249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,958.05
|
| Rate for Payer: Nomi Health Commercial |
$70,383.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55,791.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,206.87
|
| Rate for Payer: Priority Health Narrow Network |
$60,168.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75,533.04
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,168.80 |
| Max. Negotiated Rate |
$7,952.00 |
| Rate for Payer: Aetna Commercial |
$7,156.80
|
| Rate for Payer: ASR ASR |
$7,713.44
|
| Rate for Payer: ASR Commercial |
$7,713.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,480.08
|
| Rate for Payer: BCN Commercial |
$6,165.19
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$7,474.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,952.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,713.44
|
| Rate for Payer: Mclaren Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Nomi Health Commercial |
$6,520.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,997.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,180.80 |
| Max. Negotiated Rate |
$7,952.00 |
| Rate for Payer: Aetna Commercial |
$7,156.80
|
| Rate for Payer: Aetna Medicare |
$3,976.00
|
| Rate for Payer: ASR ASR |
$7,713.44
|
| Rate for Payer: ASR Commercial |
$7,713.44
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: BCBS Trust/PPO |
$6,511.89
|
| Rate for Payer: BCN Commercial |
$6,165.19
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Commercial |
$7,474.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,952.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,713.44
|
| Rate for Payer: Mclaren Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Nomi Health Commercial |
$6,520.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,168.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,967.54
|
| Rate for Payer: Priority Health Narrow Network |
$5,574.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,997.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
OP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,693.22 |
| Max. Negotiated Rate |
$9,233.04 |
| Rate for Payer: Aetna Commercial |
$8,309.74
|
| Rate for Payer: Aetna Medicare |
$4,616.52
|
| Rate for Payer: ASR ASR |
$8,956.05
|
| Rate for Payer: ASR Commercial |
$8,956.05
|
| Rate for Payer: BCBS Complete |
$3,693.22
|
| Rate for Payer: BCBS Trust/PPO |
$7,560.94
|
| Rate for Payer: BCN Commercial |
$7,158.38
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$8,679.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$9,233.04
|
| Rate for Payer: Healthscope Whirlpool |
$8,956.05
|
| Rate for Payer: Mclaren Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: Nomi Health Commercial |
$7,571.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,089.99
|
| Rate for Payer: Priority Health Narrow Network |
$6,472.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,125.08
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 9
|
Facility
|
IP
|
$9,233.04
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500349
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,001.48 |
| Max. Negotiated Rate |
$9,233.04 |
| Rate for Payer: Aetna Commercial |
$8,309.74
|
| Rate for Payer: ASR ASR |
$8,956.05
|
| Rate for Payer: ASR Commercial |
$8,956.05
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.00
|
| Rate for Payer: BCN Commercial |
$7,158.38
|
| Rate for Payer: Cash Price |
$7,386.43
|
| Rate for Payer: Cofinity Commercial |
$8,679.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,386.43
|
| Rate for Payer: Healthscope Commercial |
$9,233.04
|
| Rate for Payer: Healthscope Whirlpool |
$8,956.05
|
| Rate for Payer: Mclaren Commercial |
$8,309.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,848.08
|
| Rate for Payer: Nomi Health Commercial |
$7,571.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,001.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,125.08
|
|
|
HC PACEMAKER IMPLANT, DUAL
|
Facility
|
IP
|
$19,347.05
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
36100059
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,575.58 |
| Max. Negotiated Rate |
$19,347.05 |
| Rate for Payer: Aetna Commercial |
$17,412.35
|
| Rate for Payer: ASR ASR |
$18,766.64
|
| Rate for Payer: ASR Commercial |
$18,766.64
|
| Rate for Payer: BCBS Trust/PPO |
$15,765.91
|
| Rate for Payer: BCN Commercial |
$14,999.77
|
| Rate for Payer: Cash Price |
$15,477.64
|
| Rate for Payer: Cofinity Commercial |
$18,186.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,477.64
|
| Rate for Payer: Healthscope Commercial |
$19,347.05
|
| Rate for Payer: Healthscope Whirlpool |
$18,766.64
|
| Rate for Payer: Mclaren Commercial |
$17,412.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,444.99
|
| Rate for Payer: Nomi Health Commercial |
$15,864.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,575.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17,025.40
|
|
