|
HC SEMEN EXAM FERTILITY
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Trust/PPO |
$96.55
|
| Rate for Payer: BCN Commercial |
$96.55
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Trust/PPO |
$64.42
|
| Rate for Payer: BCN Commercial |
$64.42
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$78.45 |
| Rate for Payer: Aetna Commercial |
$70.61
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$76.10
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$64.68
|
| Rate for Payer: BCN Commercial |
$64.68
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$76.10
|
| Rate for Payer: Healthscope Whirlpool |
$78.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$390.15
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.61 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$351.13
|
| Rate for Payer: ASR ASR |
$378.45
|
| Rate for Payer: BCBS Trust/PPO |
$320.39
|
| Rate for Payer: BCN Commercial |
$320.39
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$378.45
|
| Rate for Payer: Healthscope Whirlpool |
$390.15
|
| Rate for Payer: Mclaren Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.33
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$390.15
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.36 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna Commercial |
$351.13
|
| Rate for Payer: Aetna Medicare |
$144.36
|
| Rate for Payer: ASR ASR |
$378.45
|
| Rate for Payer: BCBS Complete |
$156.06
|
| Rate for Payer: BCBS Trust/PPO |
$321.68
|
| Rate for Payer: BCN Commercial |
$321.68
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Commercial |
$366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$378.45
|
| Rate for Payer: Healthscope Whirlpool |
$390.15
|
| Rate for Payer: Mclaren Commercial |
$351.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$319.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$341.85
|
| Rate for Payer: Priority Health Narrow Network |
$273.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.33
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.95
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: ASR ASR |
$17.41
|
| Rate for Payer: BCBS Trust/PPO |
$14.74
|
| Rate for Payer: BCN Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$17.41
|
| Rate for Payer: Healthscope Whirlpool |
$17.95
|
| Rate for Payer: Mclaren Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Nomi Health Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.95
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$17.95 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: ASR ASR |
$17.41
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.80
|
| Rate for Payer: BCN Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cofinity Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Healthscope Commercial |
$17.41
|
| Rate for Payer: Healthscope Whirlpool |
$17.95
|
| Rate for Payer: Mclaren Commercial |
$16.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Nomi Health Commercial |
$14.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.73
|
| Rate for Payer: Priority Health Narrow Network |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.80
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$249.70
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.39 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna Commercial |
$224.73
|
| Rate for Payer: Aetna Medicare |
$92.39
|
| Rate for Payer: ASR ASR |
$242.21
|
| Rate for Payer: BCBS Complete |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$205.88
|
| Rate for Payer: BCN Commercial |
$205.88
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$234.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$242.21
|
| Rate for Payer: Healthscope Whirlpool |
$249.70
|
| Rate for Payer: Mclaren Commercial |
$224.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.79
|
| Rate for Payer: Priority Health Narrow Network |
$175.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.74
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$249.70
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$187.28 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna Commercial |
$224.73
|
| Rate for Payer: ASR ASR |
$242.21
|
| Rate for Payer: BCBS Trust/PPO |
$205.05
|
| Rate for Payer: BCN Commercial |
$205.05
|
| Rate for Payer: Cash Price |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$234.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.76
|
| Rate for Payer: Healthscope Commercial |
$242.21
|
| Rate for Payer: Healthscope Whirlpool |
$249.70
|
| Rate for Payer: Mclaren Commercial |
$224.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.25
|
| Rate for Payer: Nomi Health Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.74
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.45 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: BCBS Trust/PPO |
$76.04
|
| Rate for Payer: BCN Commercial |
$76.04
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$89.82
|
| Rate for Payer: Healthscope Whirlpool |
$92.60
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.26 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: Aetna Medicare |
$34.26
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: BCBS Complete |
$37.04
|
| Rate for Payer: BCBS Trust/PPO |
$76.35
|
| Rate for Payer: BCN Commercial |
$76.35
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$89.82
|
| Rate for Payer: Healthscope Whirlpool |
$92.60
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$1,011.19
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$758.39 |
| Max. Negotiated Rate |
$1,011.19 |
| Rate for Payer: Aetna Commercial |
$910.07
|
| Rate for Payer: ASR ASR |
$980.85
|
| Rate for Payer: BCBS Trust/PPO |
$830.39
|
| Rate for Payer: BCN Commercial |
$830.39
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Commercial |
$950.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$980.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.19
|
| Rate for Payer: Mclaren Commercial |
$910.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.85
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$1,011.19
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.14 |
| Max. Negotiated Rate |
$1,011.19 |
| Rate for Payer: Aetna Commercial |
$910.07
|
| Rate for Payer: Aetna Medicare |
$374.14
|
| Rate for Payer: ASR ASR |
$980.85
|
| Rate for Payer: BCBS Complete |
$404.48
|
| Rate for Payer: BCBS Trust/PPO |
$833.73
|
| Rate for Payer: BCN Commercial |
$833.73
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Commercial |
$950.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$980.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.19
|
| Rate for Payer: Mclaren Commercial |
$910.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$886.00
|
| Rate for Payer: Priority Health Narrow Network |
$708.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.85
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| 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 |
$90.83
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Mclaren Medicaid |
$15.05
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.55
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicaid |
$7.87
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$7.87
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.90
|
| Rate for Payer: BCN Commercial |
$76.90
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$274.79 |
| Rate for Payer: Aetna Commercial |
$247.31
|
| 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 |
$266.55
|
| Rate for Payer: BCBS Complete |
$84.30
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$226.56
|
| Rate for Payer: BCN Commercial |
$226.56
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Commercial |
$258.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$266.55
|
| Rate for Payer: Healthscope Whirlpool |
$274.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.50
|
| Rate for Payer: Mclaren Commercial |
$247.31
|
| Rate for Payer: Mclaren Medicaid |
$153.50
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$84.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$225.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| 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 |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.28
|
| Rate for Payer: Priority Health Cigna 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 |
$241.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$153.50
|
| Rate for Payer: UHC Exchange |
$237.93
|
| Rate for Payer: UHC Medicaid |
$80.28
|
| Rate for Payer: UHCCP DNSP |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$80.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$206.09 |
| Max. Negotiated Rate |
$274.79 |
| Rate for Payer: Aetna Commercial |
$247.31
|
| Rate for Payer: ASR ASR |
$266.55
|
| Rate for Payer: BCBS Trust/PPO |
$225.66
|
| Rate for Payer: BCN Commercial |
$225.66
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Commercial |
$258.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Healthscope Commercial |
$266.55
|
| Rate for Payer: Healthscope Whirlpool |
$274.79
|
| Rate for Payer: Mclaren Commercial |
$247.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$225.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.82
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,225.16
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,668.87 |
| Max. Negotiated Rate |
$2,225.16 |
| Rate for Payer: Aetna Commercial |
$2,002.64
|
| Rate for Payer: ASR ASR |
$2,158.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.30
|
| Rate for Payer: BCN Commercial |
$1,827.30
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cofinity Commercial |
$2,091.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.13
|
| Rate for Payer: Healthscope Commercial |
$2,158.41
|
| Rate for Payer: Healthscope Whirlpool |
$2,225.16
|
| Rate for Payer: Mclaren Commercial |
$2,002.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.39
|
| Rate for Payer: Nomi Health Commercial |
$1,824.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,958.14
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,225.16
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,225.16 |
| Rate for Payer: Aetna Commercial |
$2,002.64
|
| Rate for Payer: Aetna Medicare |
$705.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: ASR ASR |
$2,158.41
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.64
|
| Rate for Payer: BCN Commercial |
$1,834.64
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cofinity Commercial |
$2,091.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$2,158.41
|
| Rate for Payer: Healthscope Whirlpool |
$2,225.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$705.59
|
| Rate for Payer: Mclaren Commercial |
$2,002.64
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$387.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.39
|
| Rate for Payer: Nomi Health Commercial |
$1,824.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.87
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$776.15
|
| Rate for Payer: PHP Medicaid |
$378.20
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$731.26
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Narrow Network |
$585.01
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,958.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Exchange |
$1,093.66
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP DNSP |
$705.59
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,495.59
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,371.69 |
| Max. Negotiated Rate |
$12,780.73 |
| Rate for Payer: Aetna Commercial |
$4,046.03
|
| Rate for Payer: Aetna Medicare |
$8,245.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,307.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,307.04
|
| Rate for Payer: ASR ASR |
$4,360.72
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,706.61
|
| Rate for Payer: BCN Commercial |
$3,706.61
|
| Rate for Payer: BCN Medicare Advantage |
$8,245.63
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cofinity Commercial |
$4,225.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,596.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,245.63
|
| Rate for Payer: Healthscope Commercial |
$4,360.72
|
| Rate for Payer: Healthscope Whirlpool |
$4,495.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,245.63
|
| Rate for Payer: Mclaren Commercial |
$4,046.03
|
| Rate for Payer: Mclaren Medicaid |
$8,245.63
|
| Rate for Payer: Mclaren Medicare |
$8,245.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,657.91
|
| Rate for Payer: Meridian Medicaid |
$4,528.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,482.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,070.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,821.25
|
| Rate for Payer: Nomi Health Commercial |
$3,686.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,371.69
|
| Rate for Payer: PACE Medicare |
$7,833.35
|
| Rate for Payer: PACE SWMI |
$8,245.63
|
| Rate for Payer: PHP Commercial |
$9,070.19
|
| Rate for Payer: PHP Medicaid |
$4,419.66
|
| Rate for Payer: PHP Medicare Advantage |
$8,245.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,312.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,345.86
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health Narrow Network |
$7,476.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,956.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,245.63
|
| Rate for Payer: UHC Exchange |
$12,780.73
|
| Rate for Payer: UHC Medicaid |
$4,312.46
|
| Rate for Payer: UHCCP DNSP |
$8,245.63
|
| Rate for Payer: UHCCP Medicaid |
$4,312.46
|
| Rate for Payer: VA VA |
$8,245.63
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,495.59
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,371.69 |
| Max. Negotiated Rate |
$4,495.59 |
| Rate for Payer: Aetna Commercial |
$4,046.03
|
| Rate for Payer: ASR ASR |
$4,360.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,691.78
|
| Rate for Payer: BCN Commercial |
$3,691.78
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cofinity Commercial |
$4,225.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,596.47
|
| Rate for Payer: Healthscope Commercial |
$4,360.72
|
| Rate for Payer: Healthscope Whirlpool |
$4,495.59
|
| Rate for Payer: Mclaren Commercial |
$4,046.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,821.25
|
| Rate for Payer: Nomi Health Commercial |
$3,686.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,371.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,956.12
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,659.84
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,994.88 |
| Max. Negotiated Rate |
$10,659.84 |
| Rate for Payer: Aetna Commercial |
$9,593.86
|
| Rate for Payer: ASR ASR |
$10,340.04
|
| Rate for Payer: BCBS Trust/PPO |
$8,753.86
|
| Rate for Payer: BCN Commercial |
$8,753.86
|
| Rate for Payer: Cash Price |
$8,527.87
|
| Rate for Payer: Cofinity Commercial |
$10,020.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,527.87
|
| Rate for Payer: Healthscope Commercial |
$10,340.04
|
| Rate for Payer: Healthscope Whirlpool |
$10,659.84
|
| Rate for Payer: Mclaren Commercial |
$9,593.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,060.86
|
| Rate for Payer: Nomi Health Commercial |
$8,741.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,994.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,380.66
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,659.84
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,944.14 |
| Max. Negotiated Rate |
$10,659.84 |
| Rate for Payer: Aetna Commercial |
$9,593.86
|
| Rate for Payer: Aetna Medicare |
$3,944.14
|
| Rate for Payer: ASR ASR |
$10,340.04
|
| Rate for Payer: BCBS Complete |
$4,263.94
|
| Rate for Payer: BCBS Trust/PPO |
$8,789.04
|
| Rate for Payer: BCN Commercial |
$8,789.04
|
| Rate for Payer: Cash Price |
$8,527.87
|
| Rate for Payer: Cofinity Commercial |
$10,020.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,527.87
|
| Rate for Payer: Healthscope Commercial |
$10,340.04
|
| Rate for Payer: Healthscope Whirlpool |
$10,659.84
|
| Rate for Payer: Mclaren Commercial |
$9,593.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,527.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,060.86
|
| Rate for Payer: Nomi Health Commercial |
$8,741.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,994.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,340.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,472.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,380.66
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$157.38 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Aetna Medicare |
$30.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.73
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Complete |
$17.01
|
| Rate for Payer: BCBS MAPPO |
$30.98
|
| Rate for Payer: BCBS Trust/PPO |
$56.00
|
| Rate for Payer: BCN Commercial |
$56.00
|
| Rate for Payer: BCN Medicare Advantage |
$30.98
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$65.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.98
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Mclaren Medicaid |
$30.98
|
| Rate for Payer: Mclaren Medicare |
$30.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.53
|
| Rate for Payer: Meridian Medicaid |
$17.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| 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 |
$16.61
|
| Rate for Payer: PHP Medicare Advantage |
$30.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.38
|
| Rate for Payer: Priority Health Medicare |
$30.98
|
| Rate for Payer: Priority Health Narrow Network |
$125.91
|
| Rate for Payer: Railroad Medicare Medicare |
$30.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.98
|
| Rate for Payer: UHC Exchange |
$48.02
|
| Rate for Payer: UHC Medicaid |
$16.20
|
| Rate for Payer: UHCCP DNSP |
$30.98
|
| Rate for Payer: UHCCP Medicaid |
$16.20
|
| Rate for Payer: VA VA |
$30.98
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: ASR ASR |
$65.88
|
| Rate for Payer: BCBS Trust/PPO |
$55.78
|
| Rate for Payer: BCN Commercial |
$55.78
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$65.88
|
| Rate for Payer: Healthscope Whirlpool |
$67.92
|
| Rate for Payer: Mclaren Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.77
|
|
