|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,926.69
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,445.02 |
| Max. Negotiated Rate |
$1,926.69 |
| Rate for Payer: Aetna Commercial |
$1,734.02
|
| Rate for Payer: ASR ASR |
$1,868.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.20
|
| Rate for Payer: BCN Commercial |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Commercial |
$1,811.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Healthscope Commercial |
$1,868.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,926.69
|
| Rate for Payer: Mclaren Commercial |
$1,734.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,579.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,695.49
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,926.69
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$1,926.69 |
| Rate for Payer: Aetna Commercial |
$1,734.02
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$1,868.89
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.56
|
| Rate for Payer: BCN Commercial |
$1,588.56
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Commercial |
$1,811.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,868.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,926.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$1,734.02
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,579.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,688.17
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.61
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,695.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.40
|
| Rate for Payer: BCN Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: Aetna Medicare |
$4.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: ASR ASR |
$28.82
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$27.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Whirlpool |
$29.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.28
|
| Rate for Payer: Mclaren Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.03
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$20.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.28
|
| Rate for Payer: UHC Exchange |
$6.63
|
| Rate for Payer: UHC Medicaid |
$2.24
|
| Rate for Payer: UHCCP DNSP |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.24
|
| Rate for Payer: VA VA |
$4.28
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: BCBS Trust/PPO |
$54.68
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$64.59
|
| Rate for Payer: Healthscope Whirlpool |
$66.59
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$54.90
|
| Rate for Payer: BCN Commercial |
$54.90
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$64.59
|
| Rate for Payer: Healthscope Whirlpool |
$66.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.72
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$10.69
|
| Rate for Payer: PHP Medicaid |
$5.21
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79.89
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$63.92
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.72
|
| Rate for Payer: UHC Exchange |
$15.07
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHCCP DNSP |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$127.35
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$127.35 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: ASR ASR |
$123.53
|
| Rate for Payer: BCBS Trust/PPO |
$104.58
|
| Rate for Payer: BCN Commercial |
$104.58
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Healthscope Commercial |
$123.53
|
| Rate for Payer: Healthscope Whirlpool |
$127.35
|
| Rate for Payer: Mclaren Commercial |
$114.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$104.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.07
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$127.35
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$127.35 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$123.53
|
| Rate for Payer: BCBS Complete |
$13.68
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$105.00
|
| Rate for Payer: BCN Commercial |
$105.00
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$123.53
|
| Rate for Payer: Healthscope Whirlpool |
$127.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$114.61
|
| Rate for Payer: Mclaren Medicaid |
$24.91
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$104.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$111.58
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$89.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.91
|
| Rate for Payer: UHC Exchange |
$38.61
|
| Rate for Payer: UHC Medicaid |
$13.03
|
| Rate for Payer: UHCCP DNSP |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.03
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: ASR ASR |
$106.37
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$90.41
|
| Rate for Payer: BCN Commercial |
$90.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Healthscope Whirlpool |
$109.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$14.57
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicaid |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.14
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$85.71
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Aetna Commercial |
$98.69
|
| Rate for Payer: ASR ASR |
$106.37
|
| Rate for Payer: BCBS Trust/PPO |
$90.05
|
| Rate for Payer: BCN Commercial |
$90.05
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Healthscope Whirlpool |
$109.66
|
| Rate for Payer: Mclaren Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.50
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: Aetna Medicare |
$14.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$39.38
|
| Rate for Payer: BCN Commercial |
$39.38
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$47.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$14.57
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicaid |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.14
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$85.71
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$39.22
|
| Rate for Payer: BCN Commercial |
$39.22
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$47.76
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$13.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$91.58
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna Medicare |
$33.88
|
| Rate for Payer: ASR ASR |
$88.83
|
| Rate for Payer: BCBS Complete |
$36.63
|
| Rate for Payer: BCBS Trust/PPO |
$75.51
|
| Rate for Payer: BCN Commercial |
$75.51
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cofinity Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.26
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Healthscope Whirlpool |
$91.58
|
| Rate for Payer: Mclaren Commercial |
$82.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.84
|
| Rate for Payer: Nomi Health Commercial |
$75.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$80.24
|
| Rate for Payer: Priority Health Narrow Network |
$64.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.59
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$91.58
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: ASR ASR |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$75.21
|
| Rate for Payer: BCN Commercial |
$75.21
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cofinity Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.26
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Healthscope Whirlpool |
$91.58
|
| Rate for Payer: Mclaren Commercial |
$82.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.84
|
| Rate for Payer: Nomi Health Commercial |
$75.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.59
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$116.73
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: ASR ASR |
$113.23
|
| Rate for Payer: BCBS Trust/PPO |
$95.86
|
| Rate for Payer: BCN Commercial |
$95.86
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$109.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Whirlpool |
$116.73
|
| Rate for Payer: Mclaren Commercial |
$105.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.72
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$116.73
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna Medicare |
$43.19
|
| Rate for Payer: ASR ASR |
$113.23
|
| Rate for Payer: BCBS Complete |
$46.69
|
| Rate for Payer: BCBS Trust/PPO |
$96.24
|
| Rate for Payer: BCN Commercial |
$96.24
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$109.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Whirlpool |
$116.73
|
| Rate for Payer: Mclaren Commercial |
$105.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.58
|
| Rate for Payer: Priority Health Narrow Network |
$53.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.72
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,859.96
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,144.97 |
| Max. Negotiated Rate |
$2,859.96 |
| Rate for Payer: Aetna Commercial |
$2,573.96
|
| Rate for Payer: ASR ASR |
$2,774.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,348.60
|
| Rate for Payer: BCN Commercial |
$2,348.60
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cofinity Commercial |
$2,688.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,287.97
|
| Rate for Payer: Healthscope Commercial |
$2,774.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,859.96
|
| Rate for Payer: Mclaren Commercial |
$2,573.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,430.97
|
| Rate for Payer: Nomi Health Commercial |
$2,345.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,144.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,516.76
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,859.96
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,004.83 |
| Max. Negotiated Rate |
$12,780.73 |
| Rate for Payer: Aetna Commercial |
$2,573.96
|
| 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 |
$2,774.16
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,358.04
|
| Rate for Payer: BCN Commercial |
$2,358.04
|
| Rate for Payer: BCN Medicare Advantage |
$8,245.63
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cofinity Commercial |
$2,688.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,287.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,245.63
|
| Rate for Payer: Healthscope Commercial |
$2,774.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,859.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,245.63
|
| Rate for Payer: Mclaren Commercial |
$2,573.96
|
| 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 |
$2,430.97
|
| Rate for Payer: Nomi Health Commercial |
$2,345.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,144.97
|
| 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 |
$2,505.90
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,004.83
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,516.76
|
| 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 TEMPORARY PACING WIRE
|
Facility
|
IP
|
$702.06
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.54 |
| Max. Negotiated Rate |
$702.06 |
| Rate for Payer: Aetna Commercial |
$631.85
|
| Rate for Payer: ASR ASR |
$681.00
|
| Rate for Payer: BCBS Trust/PPO |
$576.53
|
| Rate for Payer: BCN Commercial |
$576.53
|
| Rate for Payer: Cash Price |
$561.65
|
| Rate for Payer: Cofinity Commercial |
$659.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.65
|
| Rate for Payer: Healthscope Commercial |
$681.00
|
| Rate for Payer: Healthscope Whirlpool |
$702.06
|
| Rate for Payer: Mclaren Commercial |
$631.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.75
|
| Rate for Payer: Nomi Health Commercial |
$575.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.81
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$702.06
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.76 |
| Max. Negotiated Rate |
$702.06 |
| Rate for Payer: Aetna Commercial |
$631.85
|
| Rate for Payer: Aetna Medicare |
$259.76
|
| Rate for Payer: ASR ASR |
$681.00
|
| Rate for Payer: BCBS Complete |
$280.82
|
| Rate for Payer: BCBS Trust/PPO |
$578.85
|
| Rate for Payer: BCN Commercial |
$578.85
|
| Rate for Payer: Cash Price |
$561.65
|
| Rate for Payer: Cofinity Commercial |
$659.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.65
|
| Rate for Payer: Healthscope Commercial |
$681.00
|
| Rate for Payer: Healthscope Whirlpool |
$702.06
|
| Rate for Payer: Mclaren Commercial |
$631.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.75
|
| Rate for Payer: Nomi Health Commercial |
$575.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$615.14
|
| Rate for Payer: Priority Health Narrow Network |
$492.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.81
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$97.42
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: ASR ASR |
$104.99
|
| Rate for Payer: BCBS Complete |
$43.30
|
| Rate for Payer: BCBS Trust/PPO |
$89.24
|
| Rate for Payer: BCN Commercial |
$89.24
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$101.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$104.99
|
| Rate for Payer: Healthscope Whirlpool |
$108.24
|
| Rate for Payer: Mclaren Commercial |
$97.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$88.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.85
|
| Rate for Payer: Priority Health Narrow Network |
$59.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.25
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$108.24 |
| Rate for Payer: Aetna Commercial |
$97.42
|
| Rate for Payer: ASR ASR |
$104.99
|
| Rate for Payer: BCBS Trust/PPO |
$88.89
|
| Rate for Payer: BCN Commercial |
$88.89
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$101.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$104.99
|
| Rate for Payer: Healthscope Whirlpool |
$108.24
|
| Rate for Payer: Mclaren Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$88.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.25
|
|
|
HC TENOTOMY
|
Facility
|
IP
|
$2,950.53
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.90 |
| Max. Negotiated Rate |
$2,950.53 |
| Rate for Payer: Aetna Commercial |
$2,655.48
|
| Rate for Payer: ASR ASR |
$2,862.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,422.98
|
| Rate for Payer: BCN Commercial |
$2,422.98
|
| Rate for Payer: Cash Price |
$2,360.42
|
| Rate for Payer: Cofinity Commercial |
$2,773.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,360.42
|
| Rate for Payer: Healthscope Commercial |
$2,862.01
|
| Rate for Payer: Healthscope Whirlpool |
$2,950.53
|
| Rate for Payer: Mclaren Commercial |
$2,655.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,507.95
|
| Rate for Payer: Nomi Health Commercial |
$2,419.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,212.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,596.47
|
|
