|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,888.91
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,227.79 |
| Max. Negotiated Rate |
$1,888.91 |
| Rate for Payer: Aetna Commercial |
$1,700.02
|
| Rate for Payer: ASR ASR |
$1,832.24
|
| Rate for Payer: ASR Commercial |
$1,832.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,539.27
|
| Rate for Payer: BCN Commercial |
$1,464.47
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,775.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Healthscope Commercial |
$1,888.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,832.24
|
| Rate for Payer: Mclaren Commercial |
$1,700.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,548.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,662.24
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,888.91
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,888.91 |
| Rate for Payer: Aetna Commercial |
$1,700.02
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$1,832.24
|
| Rate for Payer: ASR Commercial |
$1,832.24
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.83
|
| Rate for Payer: BCN Commercial |
$1,464.47
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,775.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$1,888.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,832.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$1,700.02
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,548.91
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,655.06
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,324.13
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,662.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| 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 |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.85
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.28
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| 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 |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| 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 |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow Network |
$20.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Exchange |
$6.63
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP DNSP |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.28
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Aetna Commercial |
$26.22
|
| Rate for Payer: ASR ASR |
$28.26
|
| Rate for Payer: ASR Commercial |
$28.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.74
|
| Rate for Payer: BCN Commercial |
$22.58
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$29.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.26
|
| Rate for Payer: Mclaren Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.63
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| Rate for Payer: ASR ASR |
$63.32
|
| Rate for Payer: ASR Commercial |
$63.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.20
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$58.75
|
| 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 |
$63.32
|
| Rate for Payer: ASR Commercial |
$63.32
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$61.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Whirlpool |
$63.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.72
|
| Rate for Payer: Mclaren Commercial |
$58.75
|
| Rate for Payer: Mclaren Medicaid |
$5.21
|
| 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 |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| 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 |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$45.76
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$15.07
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP DNSP |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$5.21
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$124.85
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| Rate for Payer: ASR ASR |
$121.10
|
| Rate for Payer: ASR Commercial |
$121.10
|
| Rate for Payer: BCBS Trust/PPO |
$101.74
|
| Rate for Payer: BCN Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Healthscope Whirlpool |
$121.10
|
| Rate for Payer: Mclaren Commercial |
$112.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.12
|
| Rate for Payer: Nomi Health Commercial |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.87
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$124.85
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$112.36
|
| 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 |
$121.10
|
| Rate for Payer: ASR Commercial |
$121.10
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$102.24
|
| Rate for Payer: BCN Commercial |
$96.80
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Healthscope Whirlpool |
$121.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$112.36
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| 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 |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.12
|
| Rate for Payer: Nomi Health Commercial |
$102.38
|
| 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 |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.39
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$87.52
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP DNSP |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| 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 |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$88.04
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| 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 |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| 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 |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.20
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$75.36
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| 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 |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| 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 |
$8.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| 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 |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.02
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health Narrow Network |
$32.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicare Advantage |
$14.57
|
| Rate for Payer: UHCCP DNSP |
$14.57
|
| Rate for Payer: UHCCP Medicaid |
$7.81
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| 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 |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| 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 |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$89.78 |
| Rate for Payer: Aetna Commercial |
$80.80
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: ASR ASR |
$87.09
|
| Rate for Payer: ASR Commercial |
$87.09
|
| Rate for Payer: BCBS Complete |
$35.91
|
| Rate for Payer: BCBS Trust/PPO |
$73.52
|
| Rate for Payer: BCN Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Healthscope Commercial |
$89.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.09
|
| Rate for Payer: Mclaren Commercial |
$80.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.67
|
| Rate for Payer: Priority Health Narrow Network |
$62.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.01
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$89.78 |
| Rate for Payer: Aetna Commercial |
$80.80
|
| Rate for Payer: ASR ASR |
$87.09
|
| Rate for Payer: ASR Commercial |
$87.09
|
| Rate for Payer: BCBS Trust/PPO |
$73.16
|
| Rate for Payer: BCN Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Healthscope Commercial |
$89.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.09
|
| Rate for Payer: Mclaren Commercial |
$80.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.01
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: ASR Commercial |
$111.01
|
| Rate for Payer: BCBS Trust/PPO |
$93.26
|
| Rate for Payer: BCN Commercial |
$88.73
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$114.44
|
| Rate for Payer: Healthscope Whirlpool |
$111.01
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna Medicare |
$57.22
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: ASR Commercial |
$111.01
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$93.71
|
| Rate for Payer: BCN Commercial |
$88.73
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$114.44
|
| Rate for Payer: Healthscope Whirlpool |
$111.01
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.27
|
| Rate for Payer: Priority Health Narrow Network |
$80.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,822.52 |
| Max. Negotiated Rate |
$12,510.67 |
| Rate for Payer: Aetna Commercial |
$2,523.49
|
| Rate for Payer: Aetna Medicare |
$8,071.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: ASR ASR |
$2,719.76
|
| Rate for Payer: ASR Commercial |
$2,719.76
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,296.10
|
| Rate for Payer: BCN Commercial |
$2,173.85
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,635.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$2,803.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,719.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,071.40
|
| Rate for Payer: Mclaren Commercial |
$2,523.49
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$2,299.18
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$8,878.54
|
| Rate for Payer: PHP Medicaid |
$4,326.27
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,456.76
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,965.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,467.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Exchange |
$12,510.67
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP DNSP |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,326.27
|
| Rate for Payer: VA VA |
$8,071.40
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,822.52 |
| Max. Negotiated Rate |
$2,803.88 |
| Rate for Payer: Aetna Commercial |
$2,523.49
|
| Rate for Payer: ASR ASR |
$2,719.76
|
| Rate for Payer: ASR Commercial |
$2,719.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,284.88
|
| Rate for Payer: BCN Commercial |
$2,173.85
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,635.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Healthscope Commercial |
$2,803.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,719.76
|
| Rate for Payer: Mclaren Commercial |
$2,523.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$2,299.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,467.41
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$688.29
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.32 |
| Max. Negotiated Rate |
$688.29 |
| Rate for Payer: Aetna Commercial |
$619.46
|
| Rate for Payer: Aetna Medicare |
$344.14
|
| Rate for Payer: ASR ASR |
$667.64
|
| Rate for Payer: ASR Commercial |
$667.64
|
| Rate for Payer: BCBS Complete |
$275.32
|
| Rate for Payer: BCBS Trust/PPO |
$563.64
|
| Rate for Payer: BCN Commercial |
$533.63
|
| Rate for Payer: Cash Price |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$646.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.63
|
| Rate for Payer: Healthscope Commercial |
$688.29
|
| Rate for Payer: Healthscope Whirlpool |
$667.64
|
| Rate for Payer: Mclaren Commercial |
$619.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.05
|
| Rate for Payer: Nomi Health Commercial |
$564.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$603.08
|
| Rate for Payer: Priority Health Narrow Network |
$482.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.70
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
IP
|
$688.29
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.39 |
| Max. Negotiated Rate |
$688.29 |
| Rate for Payer: Aetna Commercial |
$619.46
|
| Rate for Payer: ASR ASR |
$667.64
|
| Rate for Payer: ASR Commercial |
$667.64
|
| Rate for Payer: BCBS Trust/PPO |
$560.89
|
| Rate for Payer: BCN Commercial |
$533.63
|
| Rate for Payer: Cash Price |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$646.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.63
|
| Rate for Payer: Healthscope Commercial |
$688.29
|
| Rate for Payer: Healthscope Whirlpool |
$667.64
|
| Rate for Payer: Mclaren Commercial |
$619.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.05
|
| Rate for Payer: Nomi Health Commercial |
$564.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.70
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$86.90
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.98
|
| Rate for Payer: Priority Health Narrow Network |
$74.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$86.48
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC TENOTOMY
|
Facility
|
IP
|
$2,892.68
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,880.24 |
| Max. Negotiated Rate |
$2,892.68 |
| Rate for Payer: Aetna Commercial |
$2,603.41
|
| Rate for Payer: ASR ASR |
$2,805.90
|
| Rate for Payer: ASR Commercial |
$2,805.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,357.24
|
| Rate for Payer: BCN Commercial |
$2,242.69
|
| Rate for Payer: Cash Price |
$2,314.14
|
| Rate for Payer: Cofinity Commercial |
$2,719.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.14
|
| Rate for Payer: Healthscope Commercial |
$2,892.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,805.90
|
| Rate for Payer: Mclaren Commercial |
$2,603.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,458.78
|
| Rate for Payer: Nomi Health Commercial |
$2,372.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,880.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,545.56
|
|
