|
HC TRACTION MECHANICAL
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$59.82
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: ASR Commercial |
$116.06
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$97.98
|
| Rate for Payer: BCN Commercial |
$92.76
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$119.65
|
| Rate for Payer: Healthscope Whirlpool |
$116.06
|
| Rate for Payer: Mclaren Commercial |
$107.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Narrow Network |
$26.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$126.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: ASR Commercial |
$116.06
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$97.98
|
| Rate for Payer: BCN Commercial |
$92.76
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$119.65
|
| Rate for Payer: Healthscope Whirlpool |
$116.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.26
|
| Rate for Payer: Mclaren Commercial |
$107.68
|
| Rate for Payer: Mclaren Medicaid |
$67.68
|
| Rate for Payer: Mclaren Medicare |
$126.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: PACE Medicare |
$119.95
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$138.89
|
| Rate for Payer: PHP Medicaid |
$67.68
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.36
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$67.49
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Exchange |
$195.70
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP DNSP |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$67.68
|
| Rate for Payer: VA VA |
$126.26
|
|
|
HC TRANS CARE MGMT 14 DAYS
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.77 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: ASR Commercial |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$97.50
|
| Rate for Payer: BCN Commercial |
$92.76
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$119.65
|
| Rate for Payer: Healthscope Whirlpool |
$116.06
|
| Rate for Payer: Mclaren Commercial |
$107.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$126.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: ASR Commercial |
$116.06
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$97.98
|
| Rate for Payer: BCN Commercial |
$92.76
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$119.65
|
| Rate for Payer: Healthscope Whirlpool |
$116.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.26
|
| Rate for Payer: Mclaren Commercial |
$107.68
|
| Rate for Payer: Mclaren Medicaid |
$67.68
|
| Rate for Payer: Mclaren Medicare |
$126.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: PACE Medicare |
$119.95
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$138.89
|
| Rate for Payer: PHP Medicaid |
$67.68
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.01
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$88.81
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Exchange |
$195.70
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP DNSP |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$67.68
|
| Rate for Payer: VA VA |
$126.26
|
|
|
HC TRANS CARE MGMT 7 DAYS
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.77 |
| Max. Negotiated Rate |
$119.65 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: ASR ASR |
$116.06
|
| Rate for Payer: ASR Commercial |
$116.06
|
| Rate for Payer: BCBS Trust/PPO |
$97.50
|
| Rate for Payer: BCN Commercial |
$92.76
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$119.65
|
| Rate for Payer: Healthscope Whirlpool |
$116.06
|
| Rate for Payer: Mclaren Commercial |
$107.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.29
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$24,969.60
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,230.24 |
| Max. Negotiated Rate |
$24,969.60 |
| Rate for Payer: Aetna Commercial |
$22,472.64
|
| Rate for Payer: ASR ASR |
$24,220.51
|
| Rate for Payer: ASR Commercial |
$24,220.51
|
| Rate for Payer: BCBS Trust/PPO |
$20,347.73
|
| Rate for Payer: BCN Commercial |
$19,358.93
|
| Rate for Payer: Cash Price |
$19,975.68
|
| Rate for Payer: Cofinity Commercial |
$23,471.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,975.68
|
| Rate for Payer: Healthscope Commercial |
$24,969.60
|
| Rate for Payer: Healthscope Whirlpool |
$24,220.51
|
| Rate for Payer: Mclaren Commercial |
$22,472.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,224.16
|
| Rate for Payer: Nomi Health Commercial |
$20,475.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,230.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,973.25
|
|
|
HC TRANSCATH INSERT/REPLACE PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$24,969.60
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
48100115
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,015.45 |
| Max. Negotiated Rate |
$28,962.59 |
| Rate for Payer: Aetna Commercial |
$22,472.64
|
| Rate for Payer: Aetna Medicare |
$18,685.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,356.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,356.92
|
| Rate for Payer: ASR ASR |
$24,220.51
|
| Rate for Payer: ASR Commercial |
$24,220.51
|
| Rate for Payer: BCBS Complete |
$10,516.22
|
| Rate for Payer: BCBS MAPPO |
$18,685.54
|
| Rate for Payer: BCBS Trust/PPO |
$20,447.61
|
| Rate for Payer: BCN Commercial |
$19,358.93
|
| Rate for Payer: BCN Medicare Advantage |
$18,685.54
|
| Rate for Payer: Cash Price |
$19,975.68
|
| Rate for Payer: Cash Price |
$19,975.68
|
| Rate for Payer: Cofinity Commercial |
$23,471.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,975.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,685.54
|
| Rate for Payer: Healthscope Commercial |
$24,969.60
|
| Rate for Payer: Healthscope Whirlpool |
$24,220.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,685.54
|
| Rate for Payer: Mclaren Commercial |
$22,472.64
|
| Rate for Payer: Mclaren Medicaid |
$10,015.45
|
| Rate for Payer: Mclaren Medicare |
$18,685.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,619.82
|
| Rate for Payer: Meridian Medicaid |
$10,516.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,488.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,224.16
|
| Rate for Payer: Nomi Health Commercial |
$20,475.07
|
| Rate for Payer: PACE Medicare |
$17,751.26
|
| Rate for Payer: PACE SWMI |
$18,685.54
|
| Rate for Payer: PHP Commercial |
$20,554.09
|
| Rate for Payer: PHP Medicaid |
$10,015.45
|
| Rate for Payer: PHP Medicare Advantage |
$18,685.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,015.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,230.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,579.37
|
| Rate for Payer: Priority Health Medicare |
$18,685.54
|
| Rate for Payer: Priority Health Narrow Network |
$14,063.50
|
| Rate for Payer: Railroad Medicare Medicare |
$18,685.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,973.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,685.54
|
| Rate for Payer: UHC Exchange |
$28,962.59
|
| Rate for Payer: UHC Medicare Advantage |
$18,685.54
|
| Rate for Payer: UHCCP DNSP |
$18,685.54
|
| Rate for Payer: UHCCP Medicaid |
$10,015.45
|
| Rate for Payer: VA VA |
$18,685.54
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
IP
|
$43,221.34
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$28,093.87 |
| Max. Negotiated Rate |
$43,221.34 |
| Rate for Payer: Aetna Commercial |
$38,899.21
|
| Rate for Payer: ASR ASR |
$41,924.70
|
| Rate for Payer: ASR Commercial |
$41,924.70
|
| Rate for Payer: BCBS Trust/PPO |
$35,221.07
|
| Rate for Payer: BCN Commercial |
$33,509.50
|
| Rate for Payer: Cash Price |
$34,577.07
|
| Rate for Payer: Cofinity Commercial |
$40,628.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,577.07
|
| Rate for Payer: Healthscope Commercial |
$43,221.34
|
| Rate for Payer: Healthscope Whirlpool |
$41,924.70
|
| Rate for Payer: Mclaren Commercial |
$38,899.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,738.14
|
| Rate for Payer: Nomi Health Commercial |
$35,441.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,093.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38,034.78
|
|
|
HC TRANS CATH MITRAL VALVE IMPLNT/REPLACE
|
Facility
|
OP
|
$43,221.34
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
48100121
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,288.54 |
| Max. Negotiated Rate |
$43,221.34 |
| Rate for Payer: Aetna Commercial |
$38,899.21
|
| Rate for Payer: Aetna Medicare |
$21,610.67
|
| Rate for Payer: ASR ASR |
$41,924.70
|
| Rate for Payer: ASR Commercial |
$41,924.70
|
| Rate for Payer: BCBS Complete |
$17,288.54
|
| Rate for Payer: BCBS Trust/PPO |
$35,393.96
|
| Rate for Payer: BCN Commercial |
$33,509.50
|
| Rate for Payer: Cash Price |
$34,577.07
|
| Rate for Payer: Cofinity Commercial |
$40,628.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,577.07
|
| Rate for Payer: Healthscope Commercial |
$43,221.34
|
| Rate for Payer: Healthscope Whirlpool |
$41,924.70
|
| Rate for Payer: Mclaren Commercial |
$38,899.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,738.14
|
| Rate for Payer: Nomi Health Commercial |
$35,441.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,093.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,870.54
|
| Rate for Payer: Priority Health Narrow Network |
$30,298.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38,034.78
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
IP
|
$3,891.10
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,529.22 |
| Max. Negotiated Rate |
$3,891.10 |
| Rate for Payer: Aetna Commercial |
$3,501.99
|
| Rate for Payer: ASR ASR |
$3,774.37
|
| Rate for Payer: ASR Commercial |
$3,774.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,170.86
|
| Rate for Payer: BCN Commercial |
$3,016.77
|
| Rate for Payer: Cash Price |
$3,112.88
|
| Rate for Payer: Cofinity Commercial |
$3,657.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,112.88
|
| Rate for Payer: Healthscope Commercial |
$3,891.10
|
| Rate for Payer: Healthscope Whirlpool |
$3,774.37
|
| Rate for Payer: Mclaren Commercial |
$3,501.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,307.44
|
| Rate for Payer: Nomi Health Commercial |
$3,190.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,529.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,424.17
|
|
|
HC TRANSCATH REMOVAL PERM LEADLESS PACEMAKER
|
Facility
|
OP
|
$3,891.10
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
48100116
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,501.99
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$3,774.37
|
| Rate for Payer: ASR Commercial |
$3,774.37
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,186.42
|
| Rate for Payer: BCN Commercial |
$3,016.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,112.88
|
| Rate for Payer: Cash Price |
$3,112.88
|
| Rate for Payer: Cofinity Commercial |
$3,657.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,112.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,891.10
|
| Rate for Payer: Healthscope Whirlpool |
$3,774.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,501.99
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,307.44
|
| Rate for Payer: Nomi Health Commercial |
$3,190.70
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,529.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,024.28
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,419.42
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,424.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC TRANS CATH RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ
|
Facility
|
OP
|
$16,004.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
36000125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,994.22 |
| Max. Negotiated Rate |
$16,004.00 |
| Rate for Payer: Aetna Commercial |
$14,403.60
|
| Rate for Payer: Aetna Medicare |
$5,586.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: ASR ASR |
$15,523.88
|
| Rate for Payer: ASR Commercial |
$15,523.88
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$13,105.68
|
| Rate for Payer: BCN Commercial |
$12,407.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Cash Price |
$12,803.20
|
| Rate for Payer: Cash Price |
$12,803.20
|
| Rate for Payer: Cofinity Commercial |
$15,043.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,803.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Healthscope Commercial |
$16,004.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,523.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,586.24
|
| Rate for Payer: Mclaren Commercial |
$14,403.60
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,603.40
|
| Rate for Payer: Nomi Health Commercial |
$13,123.28
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Commercial |
$6,144.86
|
| Rate for Payer: PHP Medicaid |
$2,994.22
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,402.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,022.70
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$11,218.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,083.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$8,658.67
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP DNSP |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$2,994.22
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
HC TRANS CATH RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ
|
Facility
|
IP
|
$16,004.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
36000125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,402.60 |
| Max. Negotiated Rate |
$16,004.00 |
| Rate for Payer: Aetna Commercial |
$14,403.60
|
| Rate for Payer: ASR ASR |
$15,523.88
|
| Rate for Payer: ASR Commercial |
$15,523.88
|
| Rate for Payer: BCBS Trust/PPO |
$13,041.66
|
| Rate for Payer: BCN Commercial |
$12,407.90
|
| Rate for Payer: Cash Price |
$12,803.20
|
| Rate for Payer: Cofinity Commercial |
$15,043.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,803.20
|
| Rate for Payer: Healthscope Commercial |
$16,004.00
|
| Rate for Payer: Healthscope Whirlpool |
$15,523.88
|
| Rate for Payer: Mclaren Commercial |
$14,403.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,603.40
|
| Rate for Payer: Nomi Health Commercial |
$13,123.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,402.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,083.52
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
IP
|
$563.36
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$366.18 |
| Max. Negotiated Rate |
$563.36 |
| Rate for Payer: Aetna Commercial |
$507.02
|
| Rate for Payer: ASR ASR |
$546.46
|
| Rate for Payer: ASR Commercial |
$546.46
|
| Rate for Payer: BCBS Trust/PPO |
$459.08
|
| Rate for Payer: BCN Commercial |
$436.77
|
| Rate for Payer: Cash Price |
$450.69
|
| Rate for Payer: Cofinity Commercial |
$529.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.69
|
| Rate for Payer: Healthscope Commercial |
$563.36
|
| Rate for Payer: Healthscope Whirlpool |
$546.46
|
| Rate for Payer: Mclaren Commercial |
$507.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Nomi Health Commercial |
$461.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.76
|
|
|
HC TRANSCERVICAL AMNIOINFUSION
|
Facility
|
OP
|
$563.36
|
|
| Hospital Charge Code |
27000647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$225.34 |
| Max. Negotiated Rate |
$563.36 |
| Rate for Payer: Aetna Commercial |
$507.02
|
| Rate for Payer: Aetna Medicare |
$281.68
|
| Rate for Payer: ASR ASR |
$546.46
|
| Rate for Payer: ASR Commercial |
$546.46
|
| Rate for Payer: BCBS Complete |
$225.34
|
| Rate for Payer: BCBS Trust/PPO |
$461.34
|
| Rate for Payer: BCN Commercial |
$436.77
|
| Rate for Payer: Cash Price |
$450.69
|
| Rate for Payer: Cofinity Commercial |
$529.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.69
|
| Rate for Payer: Healthscope Commercial |
$563.36
|
| Rate for Payer: Healthscope Whirlpool |
$546.46
|
| Rate for Payer: Mclaren Commercial |
$507.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Nomi Health Commercial |
$461.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$493.62
|
| Rate for Payer: Priority Health Narrow Network |
$394.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.76
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
OP
|
$1,618.27
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,618.27 |
| Rate for Payer: Aetna Commercial |
$1,456.44
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,569.72
|
| Rate for Payer: ASR Commercial |
$1,569.72
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,325.20
|
| Rate for Payer: BCN Commercial |
$1,254.64
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,294.62
|
| Rate for Payer: Cash Price |
$1,294.62
|
| Rate for Payer: Cofinity Commercial |
$1,521.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,618.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,456.44
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.53
|
| Rate for Payer: Nomi Health Commercial |
$1,326.98
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,417.93
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.41
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,424.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC TRANSCRANIAL USN IMAGING COMPL
|
Facility
|
IP
|
$1,618.27
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,051.88 |
| Max. Negotiated Rate |
$1,618.27 |
| Rate for Payer: Aetna Commercial |
$1,456.44
|
| Rate for Payer: ASR ASR |
$1,569.72
|
| Rate for Payer: ASR Commercial |
$1,569.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.73
|
| Rate for Payer: BCN Commercial |
$1,254.64
|
| Rate for Payer: Cash Price |
$1,294.62
|
| Rate for Payer: Cofinity Commercial |
$1,521.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.62
|
| Rate for Payer: Healthscope Commercial |
$1,618.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.72
|
| Rate for Payer: Mclaren Commercial |
$1,456.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.53
|
| Rate for Payer: Nomi Health Commercial |
$1,326.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,424.08
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
OP
|
$611.44
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$611.44 |
| Rate for Payer: Aetna Commercial |
$550.30
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$593.10
|
| Rate for Payer: ASR Commercial |
$593.10
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$500.71
|
| Rate for Payer: BCN Commercial |
$474.05
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cofinity Commercial |
$574.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$611.44
|
| Rate for Payer: Healthscope Whirlpool |
$593.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$550.30
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.72
|
| Rate for Payer: Nomi Health Commercial |
$501.38
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.74
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$428.62
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC TRANSCRANIAL USN IMAGING LIMIT
|
Facility
|
IP
|
$611.44
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
92100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$397.44 |
| Max. Negotiated Rate |
$611.44 |
| Rate for Payer: Aetna Commercial |
$550.30
|
| Rate for Payer: ASR ASR |
$593.10
|
| Rate for Payer: ASR Commercial |
$593.10
|
| Rate for Payer: BCBS Trust/PPO |
$498.26
|
| Rate for Payer: BCN Commercial |
$474.05
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cofinity Commercial |
$574.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.15
|
| Rate for Payer: Healthscope Commercial |
$611.44
|
| Rate for Payer: Healthscope Whirlpool |
$593.10
|
| Rate for Payer: Mclaren Commercial |
$550.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.72
|
| Rate for Payer: Nomi Health Commercial |
$501.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.07
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC TRANSCRAN LE MOTOR STIM
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 95929
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Trust/PPO |
$356.62
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC TRANSCRAN UE MOTOR STIM
|
Facility
|
IP
|
$626.24
|
|
|
Service Code
|
CPT 95928
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$407.06 |
| Max. Negotiated Rate |
$626.24 |
| Rate for Payer: Aetna Commercial |
$563.62
|
| Rate for Payer: ASR ASR |
$607.45
|
| Rate for Payer: ASR Commercial |
$607.45
|
| Rate for Payer: BCBS Trust/PPO |
$510.32
|
| Rate for Payer: BCN Commercial |
$485.52
|
| Rate for Payer: Cash Price |
$500.99
|
| Rate for Payer: Cofinity Commercial |
$588.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.99
|
| Rate for Payer: Healthscope Commercial |
$626.24
|
| Rate for Payer: Healthscope Whirlpool |
$607.45
|
| Rate for Payer: Mclaren Commercial |
$563.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.30
|
| Rate for Payer: Nomi Health Commercial |
$513.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.09
|
|
|
HC TRANSCRAN UE MOTOR STIM
|
Facility
|
OP
|
$626.24
|
|
|
Service Code
|
CPT 95928
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$407.06 |
| Max. Negotiated Rate |
$1,545.07 |
| Rate for Payer: Aetna Commercial |
$563.62
|
| Rate for Payer: Aetna Medicare |
$996.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,246.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,246.02
|
| Rate for Payer: ASR ASR |
$607.45
|
| Rate for Payer: ASR Commercial |
$607.45
|
| Rate for Payer: BCBS Complete |
$561.01
|
| Rate for Payer: BCBS MAPPO |
$996.82
|
| Rate for Payer: BCBS Trust/PPO |
$512.83
|
| Rate for Payer: BCN Commercial |
$485.52
|
| Rate for Payer: BCN Medicare Advantage |
$996.82
|
| Rate for Payer: Cash Price |
$500.99
|
| Rate for Payer: Cash Price |
$500.99
|
| Rate for Payer: Cofinity Commercial |
$588.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.82
|
| Rate for Payer: Healthscope Commercial |
$626.24
|
| Rate for Payer: Healthscope Whirlpool |
$607.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$996.82
|
| Rate for Payer: Mclaren Commercial |
$563.62
|
| Rate for Payer: Mclaren Medicaid |
$534.30
|
| Rate for Payer: Mclaren Medicare |
$996.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,046.66
|
| Rate for Payer: Meridian Medicaid |
$561.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,146.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.30
|
| Rate for Payer: Nomi Health Commercial |
$513.52
|
| Rate for Payer: PACE Medicare |
$946.98
|
| Rate for Payer: PACE SWMI |
$996.82
|
| Rate for Payer: PHP Commercial |
$1,096.50
|
| Rate for Payer: PHP Medicaid |
$534.30
|
| Rate for Payer: PHP Medicare Advantage |
$996.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$407.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.71
|
| Rate for Payer: Priority Health Medicare |
$996.82
|
| Rate for Payer: Priority Health Narrow Network |
$438.99
|
| Rate for Payer: Railroad Medicare Medicare |
$996.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.82
|
| Rate for Payer: UHC Exchange |
$1,545.07
|
| Rate for Payer: UHC Medicare Advantage |
$996.82
|
| Rate for Payer: UHCCP DNSP |
$996.82
|
| Rate for Payer: UHCCP Medicaid |
$534.30
|
| Rate for Payer: VA VA |
$996.82
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
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 TRANSFERRIN
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100443
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$69.18 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.95
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| 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 |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.76
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$6.84
|
| Rate for Payer: Mclaren Medicare |
$12.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: Meridian Medicaid |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$12.12
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: PHP Medicaid |
$6.84
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.18
|
| Rate for Payer: Priority Health Medicare |
$12.76
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.76
|
| Rate for Payer: UHC Exchange |
$19.78
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: UHCCP DNSP |
$12.76
|
| Rate for Payer: UHCCP Medicaid |
$6.84
|
| Rate for Payer: VA VA |
$12.76
|
|
