|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$12,901.46
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$12,901.46 |
| Rate for Payer: Aetna Commercial |
$11,611.31
|
| Rate for Payer: Aetna Medicare |
$5,272.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: ASR ASR |
$12,514.42
|
| Rate for Payer: ASR Commercial |
$12,514.42
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCBS Trust/PPO |
$10,565.01
|
| Rate for Payer: BCN Commercial |
$10,002.50
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Cash Price |
$10,321.17
|
| Rate for Payer: Cash Price |
$10,321.17
|
| Rate for Payer: Cofinity Commercial |
$12,127.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,321.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Healthscope Commercial |
$12,901.46
|
| Rate for Payer: Healthscope Whirlpool |
$12,514.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,272.07
|
| Rate for Payer: Mclaren Commercial |
$11,611.31
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,966.24
|
| Rate for Payer: Nomi Health Commercial |
$10,579.20
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Commercial |
$5,799.28
|
| Rate for Payer: PHP Medicaid |
$2,825.83
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,385.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,304.26
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Priority Health Narrow Network |
$9,043.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,353.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$8,171.71
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP DNSP |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
OP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$674.53 |
| Max. Negotiated Rate |
$1,686.32 |
| Rate for Payer: Aetna Commercial |
$1,517.69
|
| Rate for Payer: Aetna Medicare |
$843.16
|
| Rate for Payer: ASR ASR |
$1,635.73
|
| Rate for Payer: ASR Commercial |
$1,635.73
|
| Rate for Payer: BCBS Complete |
$674.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,380.93
|
| Rate for Payer: BCN Commercial |
$1,307.40
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,585.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,686.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,635.73
|
| Rate for Payer: Mclaren Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Nomi Health Commercial |
$1,382.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,477.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,182.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.96
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,096.11 |
| Max. Negotiated Rate |
$1,686.32 |
| Rate for Payer: Aetna Commercial |
$1,517.69
|
| Rate for Payer: ASR ASR |
$1,635.73
|
| Rate for Payer: ASR Commercial |
$1,635.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,374.18
|
| Rate for Payer: BCN Commercial |
$1,307.40
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,585.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.06
|
| Rate for Payer: Healthscope Commercial |
$1,686.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,635.73
|
| Rate for Payer: Mclaren Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.37
|
| Rate for Payer: Nomi Health Commercial |
$1,382.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,483.96
|
|
|
HC SELENIUM LEVEL
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$25.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$14.37
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.53
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$13.68
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$28.08
|
| Rate for Payer: PHP Medicaid |
$13.68
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.53
|
| Rate for Payer: UHC Exchange |
$39.57
|
| Rate for Payer: UHC Medicare Advantage |
$25.53
|
| Rate for Payer: UHCCP DNSP |
$25.53
|
| Rate for Payer: UHCCP Medicaid |
$13.68
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SELENIUM LEVEL
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
30100420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
IP
|
$0.52
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: ASR ASR |
$0.50
|
| Rate for Payer: ASR Commercial |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.42
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.52
|
| Rate for Payer: Healthscope Whirlpool |
$0.50
|
| Rate for Payer: Mclaren Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.44
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.46
|
|
|
HC SELF-ADMINISTRABLE DRUG
|
Facility
|
OP
|
$0.52
|
|
| Hospital Charge Code |
63700003
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: ASR ASR |
$0.50
|
| Rate for Payer: ASR Commercial |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.43
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.52
|
| Rate for Payer: Healthscope Whirlpool |
$0.50
|
| Rate for Payer: Mclaren Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.44
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.46
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.46
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.01
|
| Rate for Payer: Priority Health Narrow Network |
$33.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC SELF-MGMT EDUC & TRAIN 1 PT PER 30 MIN
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
94200039
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$12.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.39
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$94.39
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.31
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Mclaren Medicare |
$12.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: PACE Medicare |
$11.69
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$13.54
|
| Rate for Payer: PHP Medicaid |
$6.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.99
|
| Rate for Payer: Priority Health Medicare |
$12.31
|
| Rate for Payer: Priority Health Narrow Network |
$80.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.31
|
| Rate for Payer: UHC Exchange |
$19.08
|
| Rate for Payer: UHC Medicare Advantage |
$12.31
|
| Rate for Payer: UHCCP DNSP |
$12.31
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
| Rate for Payer: VA VA |
$12.31
|
|
|
HC SEMEN EXAM FERTILITY
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Trust/PPO |
$93.93
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.67
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
HC SEMEN EXAM VASECTOMY
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| 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 |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$62.98
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.39
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$53.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$382.50
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$344.25
|
| Rate for Payer: Aetna Medicare |
$191.25
|
| Rate for Payer: ASR ASR |
$371.02
|
| Rate for Payer: ASR Commercial |
$371.02
|
| Rate for Payer: BCBS Complete |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.23
|
| Rate for Payer: BCN Commercial |
$296.55
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$359.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Healthscope Whirlpool |
$371.02
|
| Rate for Payer: Mclaren Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: Nomi Health Commercial |
$313.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.15
|
| Rate for Payer: Priority Health Narrow Network |
$268.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.60
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$382.50
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$248.62 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna Commercial |
$344.25
|
| Rate for Payer: ASR ASR |
$371.02
|
| Rate for Payer: ASR Commercial |
$371.02
|
| Rate for Payer: BCBS Trust/PPO |
$311.70
|
| Rate for Payer: BCN Commercial |
$296.55
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$359.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Healthscope Whirlpool |
$371.02
|
| Rate for Payer: Mclaren Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: Nomi Health Commercial |
$313.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.60
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.60
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: ASR ASR |
$17.07
|
| Rate for Payer: ASR Commercial |
$17.07
|
| Rate for Payer: BCBS Trust/PPO |
$14.34
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.08
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Whirlpool |
$17.07
|
| Rate for Payer: Mclaren Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.49
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.60
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Medicare |
$8.80
|
| Rate for Payer: ASR ASR |
$17.07
|
| Rate for Payer: ASR Commercial |
$17.07
|
| Rate for Payer: BCBS Complete |
$7.04
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.08
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Whirlpool |
$17.07
|
| Rate for Payer: Mclaren Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.96
|
| Rate for Payer: Nomi Health Commercial |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow Network |
$12.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.49
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$244.80
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: ASR ASR |
$237.46
|
| Rate for Payer: ASR Commercial |
$237.46
|
| Rate for Payer: BCBS Trust/PPO |
$199.49
|
| Rate for Payer: BCN Commercial |
$189.79
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$230.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$244.80
|
| Rate for Payer: Healthscope Whirlpool |
$237.46
|
| Rate for Payer: Mclaren Commercial |
$220.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Nomi Health Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.42
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$244.80
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Medicare |
$122.40
|
| Rate for Payer: ASR ASR |
$237.46
|
| Rate for Payer: ASR Commercial |
$237.46
|
| Rate for Payer: BCBS Complete |
$97.92
|
| Rate for Payer: BCBS Trust/PPO |
$200.47
|
| Rate for Payer: BCN Commercial |
$189.79
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$230.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$244.80
|
| Rate for Payer: Healthscope Whirlpool |
$237.46
|
| Rate for Payer: Mclaren Commercial |
$220.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Nomi Health Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.49
|
| Rate for Payer: Priority Health Narrow Network |
$171.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.42
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Medicare |
$45.39
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: ASR Commercial |
$88.06
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: BCBS Trust/PPO |
$74.34
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.16
|
| Rate for Payer: Nomi Health Commercial |
$74.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.54
|
| Rate for Payer: Priority Health Narrow Network |
$63.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: ASR ASR |
$88.06
|
| Rate for Payer: ASR Commercial |
$88.06
|
| Rate for Payer: BCBS Trust/PPO |
$73.98
|
| Rate for Payer: BCN Commercial |
$70.38
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$85.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Healthscope Whirlpool |
$88.06
|
| Rate for Payer: Mclaren Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.16
|
| Rate for Payer: Nomi Health Commercial |
$74.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.89
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$991.36
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.54 |
| Max. Negotiated Rate |
$991.36 |
| Rate for Payer: Aetna Commercial |
$892.22
|
| Rate for Payer: Aetna Medicare |
$495.68
|
| Rate for Payer: ASR ASR |
$961.62
|
| Rate for Payer: ASR Commercial |
$961.62
|
| Rate for Payer: BCBS Complete |
$396.54
|
| Rate for Payer: BCBS Trust/PPO |
$811.82
|
| Rate for Payer: BCN Commercial |
$768.60
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$931.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$991.36
|
| Rate for Payer: Healthscope Whirlpool |
$961.62
|
| Rate for Payer: Mclaren Commercial |
$892.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$868.63
|
| Rate for Payer: Priority Health Narrow Network |
$694.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.40
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$991.36
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.38 |
| Max. Negotiated Rate |
$991.36 |
| Rate for Payer: Aetna Commercial |
$892.22
|
| Rate for Payer: ASR ASR |
$961.62
|
| Rate for Payer: ASR Commercial |
$961.62
|
| Rate for Payer: BCBS Trust/PPO |
$807.86
|
| Rate for Payer: BCN Commercial |
$768.60
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$931.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$991.36
|
| Rate for Payer: Healthscope Whirlpool |
$961.62
|
| Rate for Payer: Mclaren Commercial |
$892.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.40
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| 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 |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| 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 |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| 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 |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: VA VA |
$15.05
|
|
