|
HC DEVICE NOT RETURNED WATCHPAT
|
Professional
|
Both
|
$4,950.00
|
|
|
Service Code
|
HCPCS 00604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,980.00 |
| Max. Negotiated Rate |
$3,465.00 |
| Rate for Payer: BCBS Complete |
$1,980.00
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,465.00
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Facility
|
OP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,980.00 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,455.00
|
| Rate for Payer: ASR ASR |
$4,801.50
|
| Rate for Payer: BCBS Complete |
$1,980.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,837.74
|
| Rate for Payer: BCN Commercial |
$3,837.74
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Cofinity Commercial |
$4,653.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,960.00
|
| Rate for Payer: Healthscope Commercial |
$4,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,801.50
|
| Rate for Payer: Mclaren Commercial |
$4,455.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,207.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,465.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,504.50
|
| Rate for Payer: Priority Health Narrow Network |
$3,514.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,356.00
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Facility
|
IP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,465.00 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,455.00
|
| Rate for Payer: ASR ASR |
$4,801.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,837.74
|
| Rate for Payer: BCN Commercial |
$3,837.74
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Cofinity Commercial |
$4,653.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,960.00
|
| Rate for Payer: Healthscope Commercial |
$4,950.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,801.50
|
| Rate for Payer: Mclaren Commercial |
$4,455.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,207.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,465.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,356.00
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Professional
|
Both
|
$4,950.00
|
|
|
Service Code
|
HCPCS 00604
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,980.00 |
| Max. Negotiated Rate |
$3,465.00 |
| Rate for Payer: BCBS Complete |
$1,980.00
|
| Rate for Payer: Cash Price |
$3,960.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,465.00
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: ASR ASR |
$515.07
|
| Rate for Payer: BCBS Trust/PPO |
$411.68
|
| Rate for Payer: BCN Commercial |
$411.68
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$499.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.80
|
| Rate for Payer: Healthscope Commercial |
$531.00
|
| Rate for Payer: Healthscope Whirlpool |
$515.07
|
| Rate for Payer: Mclaren Commercial |
$477.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.28
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$515.07
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$411.68
|
| Rate for Payer: BCN Commercial |
$411.68
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$499.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$531.00
|
| Rate for Payer: Healthscope Whirlpool |
$515.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$477.90
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.35
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.67
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$240.54
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.28
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$200.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$200.23 |
| Rate for Payer: Aetna Commercial |
$180.21
|
| Rate for Payer: ASR ASR |
$194.22
|
| Rate for Payer: BCBS Trust/PPO |
$155.24
|
| Rate for Payer: BCN Commercial |
$155.24
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$188.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$200.23
|
| Rate for Payer: Healthscope Whirlpool |
$194.22
|
| Rate for Payer: Mclaren Commercial |
$180.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.20
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$200.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$212.93 |
| Rate for Payer: Aetna Commercial |
$180.21
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$194.22
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$155.24
|
| Rate for Payer: BCN Commercial |
$155.24
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$188.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$200.23
|
| Rate for Payer: Healthscope Whirlpool |
$194.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$180.21
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.20
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.93
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$170.34
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.20
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$147.48
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$132.73
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$143.06
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$114.34
|
| Rate for Payer: BCN Commercial |
$114.34
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$117.98
|
| Rate for Payer: Cash Price |
$117.98
|
| Rate for Payer: Cofinity Commercial |
$138.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$147.48
|
| Rate for Payer: Healthscope Whirlpool |
$143.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$132.73
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.36
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.87
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.78
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$147.48
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.24 |
| Max. Negotiated Rate |
$147.48 |
| Rate for Payer: Aetna Commercial |
$132.73
|
| Rate for Payer: ASR ASR |
$143.06
|
| Rate for Payer: BCBS Trust/PPO |
$114.34
|
| Rate for Payer: BCN Commercial |
$114.34
|
| Rate for Payer: Cash Price |
$117.98
|
| Rate for Payer: Cofinity Commercial |
$138.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.98
|
| Rate for Payer: Healthscope Commercial |
$147.48
|
| Rate for Payer: Healthscope Whirlpool |
$143.06
|
| Rate for Payer: Mclaren Commercial |
$132.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.78
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.28
|
| Rate for Payer: Priority Health Narrow Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC DHEA
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$146.74 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| Rate for Payer: Aetna Medicare |
$25.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.59
|
| Rate for Payer: ASR ASR |
$48.48
|
| Rate for Payer: BCBS Complete |
$14.52
|
| Rate for Payer: BCBS MAPPO |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$38.75
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.27
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$46.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.27
|
| Rate for Payer: Healthscope Commercial |
$49.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.27
|
| Rate for Payer: Mclaren Commercial |
$44.98
|
| Rate for Payer: Mclaren Medicaid |
$13.82
|
| Rate for Payer: Mclaren Medicare |
$25.27
|
| Rate for Payer: Meridian Medicaid |
$14.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PACE Medicare |
$24.01
|
| Rate for Payer: PACE SWMI |
$25.27
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: PHP Medicaid |
$13.82
|
| Rate for Payer: PHP Medicare Advantage |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.74
|
| Rate for Payer: Priority Health Medicare |
$25.27
|
| Rate for Payer: Priority Health Narrow Network |
$117.39
|
| Rate for Payer: Railroad Medicare Medicare |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.98
|
| Rate for Payer: UHC Medicare Advantage |
$26.03
|
| Rate for Payer: VA VA |
$25.27
|
|
|
HC DHEA
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| Rate for Payer: ASR ASR |
$48.48
|
| Rate for Payer: BCBS Trust/PPO |
$38.75
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$46.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$49.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.48
|
| Rate for Payer: Mclaren Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.98
|
|
|
HC DHEA-SULFATE
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: BCBS Trust/PPO |
$42.70
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
|
|
HC DHEA-SULFATE
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$64.65 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Aetna Medicare |
$22.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.79
|
| Rate for Payer: ASR ASR |
$53.43
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS MAPPO |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$42.70
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: BCN Medicare Advantage |
$22.23
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$51.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.23
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Healthscope Whirlpool |
$53.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.23
|
| Rate for Payer: Mclaren Commercial |
$49.57
|
| Rate for Payer: Mclaren Medicaid |
$12.16
|
| Rate for Payer: Mclaren Medicare |
$22.23
|
| Rate for Payer: Meridian Medicaid |
$12.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PACE Medicare |
$21.12
|
| Rate for Payer: PACE SWMI |
$22.23
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Medicaid |
$12.16
|
| Rate for Payer: PHP Medicare Advantage |
$22.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.65
|
| Rate for Payer: Priority Health Medicare |
$22.23
|
| Rate for Payer: Priority Health Narrow Network |
$51.72
|
| Rate for Payer: Railroad Medicare Medicare |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.47
|
| Rate for Payer: UHC Medicare Advantage |
$22.90
|
| Rate for Payer: VA VA |
$22.23
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
IP
|
$61.85
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: BCBS Trust/PPO |
$47.95
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
OP
|
$61.85
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$47.95
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.96
|
| Rate for Payer: Priority Health Narrow Network |
$30.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
IP
|
$47.73
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$47.73 |
| Rate for Payer: Aetna Commercial |
$42.96
|
| Rate for Payer: ASR ASR |
$46.30
|
| Rate for Payer: BCBS Trust/PPO |
$37.01
|
| Rate for Payer: BCN Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$44.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$47.73
|
| Rate for Payer: Healthscope Whirlpool |
$46.30
|
| Rate for Payer: Mclaren Commercial |
$42.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.00
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
OP
|
$47.73
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$218.58 |
| Rate for Payer: Aetna Commercial |
$42.96
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$46.30
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.01
|
| Rate for Payer: BCN Commercial |
$37.01
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$44.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$47.73
|
| Rate for Payer: Healthscope Whirlpool |
$46.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.41
|
| Rate for Payer: Mclaren Commercial |
$42.96
|
| Rate for Payer: Mclaren Medicaid |
$11.71
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.57
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Medicaid |
$11.71
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.58
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$174.86
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.00
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
IP
|
$146.83
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.78 |
| Max. Negotiated Rate |
$146.83 |
| Rate for Payer: Aetna Commercial |
$132.15
|
| Rate for Payer: ASR ASR |
$142.43
|
| Rate for Payer: BCBS Trust/PPO |
$113.84
|
| Rate for Payer: BCN Commercial |
$113.84
|
| Rate for Payer: Cash Price |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$138.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.46
|
| Rate for Payer: Healthscope Commercial |
$146.83
|
| Rate for Payer: Healthscope Whirlpool |
$142.43
|
| Rate for Payer: Mclaren Commercial |
$132.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.21
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$146.83
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$58.73 |
| Max. Negotiated Rate |
$146.83 |
| Rate for Payer: Aetna Commercial |
$132.15
|
| Rate for Payer: ASR ASR |
$142.43
|
| Rate for Payer: BCBS Complete |
$58.73
|
| Rate for Payer: BCBS Trust/PPO |
$113.84
|
| Rate for Payer: BCN Commercial |
$113.84
|
| Rate for Payer: Cash Price |
$117.46
|
| Rate for Payer: Cash Price |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$138.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.46
|
| Rate for Payer: Healthscope Commercial |
$146.83
|
| Rate for Payer: Healthscope Whirlpool |
$142.43
|
| Rate for Payer: Mclaren Commercial |
$132.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.83
|
| Rate for Payer: Priority Health Narrow Network |
$88.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.21
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
IP
|
$10,793.44
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,555.41 |
| Max. Negotiated Rate |
$10,793.44 |
| Rate for Payer: Aetna Commercial |
$9,714.10
|
| Rate for Payer: ASR ASR |
$10,469.64
|
| Rate for Payer: BCBS Trust/PPO |
$8,368.15
|
| Rate for Payer: BCN Commercial |
$8,368.15
|
| Rate for Payer: Cash Price |
$8,634.75
|
| Rate for Payer: Cofinity Commercial |
$10,145.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,634.75
|
| Rate for Payer: Healthscope Commercial |
$10,793.44
|
| Rate for Payer: Healthscope Whirlpool |
$10,469.64
|
| Rate for Payer: Mclaren Commercial |
$9,714.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,555.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,498.23
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
OP
|
$10,793.44
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,779.05 |
| Max. Negotiated Rate |
$10,793.44 |
| Rate for Payer: Aetna Commercial |
$9,714.10
|
| Rate for Payer: Aetna Medicare |
$5,080.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: ASR ASR |
$10,469.64
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$8,368.15
|
| Rate for Payer: BCN Commercial |
$8,368.15
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Cash Price |
$8,634.75
|
| Rate for Payer: Cash Price |
$8,634.75
|
| Rate for Payer: Cofinity Commercial |
$10,145.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,634.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Healthscope Commercial |
$10,793.44
|
| Rate for Payer: Healthscope Whirlpool |
$10,469.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,080.53
|
| Rate for Payer: Mclaren Commercial |
$9,714.10
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,174.42
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Commercial |
$5,588.58
|
| Rate for Payer: PHP Medicaid |
$2,779.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,555.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,822.03
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$7,663.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,498.23
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$2,104.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,472.83 |
| Max. Negotiated Rate |
$2,104.04 |
| Rate for Payer: Aetna Commercial |
$1,893.64
|
| Rate for Payer: ASR ASR |
$2,040.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.26
|
| Rate for Payer: BCN Commercial |
$1,631.26
|
| Rate for Payer: Cash Price |
$1,683.23
|
| Rate for Payer: Cofinity Commercial |
$1,977.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,683.23
|
| Rate for Payer: Healthscope Commercial |
$2,104.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,040.92
|
| Rate for Payer: Mclaren Commercial |
$1,893.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,788.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,851.56
|
|
