|
HC DEVICE NOT RETURNED RU SLEEPING
|
Facility
|
OP
|
$495.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$183.15 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: Aetna Medicare |
$183.15
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS Trust/PPO |
$408.13
|
| Rate for Payer: BCN Commercial |
$408.13
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$480.15
|
| Rate for Payer: Healthscope Whirlpool |
$495.00
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$433.72
|
| Rate for Payer: Priority Health Narrow Network |
$347.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Professional
|
Both
|
$520.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.00
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Professional
|
Both
|
$520.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.00
|
|
|
HC DEVICE NOT RETURNED RU SLEEPING
|
Facility
|
IP
|
$495.00
|
|
| Hospital Charge Code |
27000614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$445.50
|
| Rate for Payer: ASR ASR |
$480.15
|
| Rate for Payer: BCBS Trust/PPO |
$406.49
|
| Rate for Payer: BCN Commercial |
$406.49
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$465.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$480.15
|
| Rate for Payer: Healthscope Whirlpool |
$495.00
|
| Rate for Payer: Mclaren Commercial |
$445.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.60
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY
|
Professional
|
Both
|
$5,200.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,080.00 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: BCBS Complete |
$2,080.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,900.00
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY
|
Professional
|
Both
|
$5,200.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,080.00 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: BCBS Complete |
$2,080.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,900.00
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY
|
Facility
|
IP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,712.50 |
| 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 |
$4,064.94
|
| Rate for Payer: BCN Commercial |
$4,064.94
|
| 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 |
$4,801.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,950.00
|
| Rate for Payer: Mclaren Commercial |
$4,455.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,207.50
|
| Rate for Payer: Nomi Health Commercial |
$4,059.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,712.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,356.00
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY
|
Facility
|
OP
|
$4,950.00
|
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,831.50 |
| Max. Negotiated Rate |
$4,950.00 |
| Rate for Payer: Aetna Commercial |
$4,455.00
|
| Rate for Payer: Aetna Medicare |
$1,831.50
|
| Rate for Payer: ASR ASR |
$4,801.50
|
| Rate for Payer: BCBS Complete |
$1,980.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,081.28
|
| Rate for Payer: BCN Commercial |
$4,081.28
|
| 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 |
$4,801.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,950.00
|
| Rate for Payer: Mclaren Commercial |
$4,455.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,960.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,207.50
|
| Rate for Payer: Nomi Health Commercial |
$4,059.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,712.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,337.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,469.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,356.00
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Facility
|
OP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$572.76 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna Commercial |
$1,393.20
|
| Rate for Payer: Aetna Medicare |
$572.76
|
| Rate for Payer: ASR ASR |
$1,501.56
|
| Rate for Payer: BCBS Complete |
$619.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,276.33
|
| Rate for Payer: BCN Commercial |
$1,276.33
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,501.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,548.00
|
| Rate for Payer: Mclaren Commercial |
$1,393.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,238.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,356.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,085.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.24
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Facility
|
IP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,161.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna Commercial |
$1,393.20
|
| Rate for Payer: ASR ASR |
$1,501.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.22
|
| Rate for Payer: BCN Commercial |
$1,271.22
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,501.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,548.00
|
| Rate for Payer: Mclaren Commercial |
$1,393.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.24
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Professional
|
Both
|
$1,626.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.50
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Professional
|
Both
|
$1,626.00
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.50
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$552.45
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$552.45 |
| Rate for Payer: Aetna Commercial |
$497.20
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$535.88
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$455.50
|
| Rate for Payer: BCN Commercial |
$455.50
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cofinity Commercial |
$519.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$535.88
|
| Rate for Payer: Healthscope Whirlpool |
$552.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$497.20
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.58
|
| Rate for Payer: Nomi Health Commercial |
$453.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.34
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$354.70
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$283.76
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
IP
|
$552.45
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$552.45 |
| Rate for Payer: Aetna Commercial |
$497.20
|
| Rate for Payer: ASR ASR |
$535.88
|
| Rate for Payer: BCBS Trust/PPO |
$453.67
|
| Rate for Payer: BCN Commercial |
$453.67
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cofinity Commercial |
$519.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.96
|
| Rate for Payer: Healthscope Commercial |
$535.88
|
| Rate for Payer: Healthscope Whirlpool |
$552.45
|
| Rate for Payer: Mclaren Commercial |
$497.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.58
|
| Rate for Payer: Nomi Health Commercial |
$453.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.16
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$208.31
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$208.31 |
| Rate for Payer: Aetna Commercial |
$187.48
|
| Rate for Payer: ASR ASR |
$202.06
|
| Rate for Payer: BCBS Trust/PPO |
$171.06
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$195.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Healthscope Commercial |
$202.06
|
| Rate for Payer: Healthscope Whirlpool |
$208.31
|
| Rate for Payer: Mclaren Commercial |
$187.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.31
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$208.31
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$251.19 |
| Rate for Payer: Aetna Commercial |
$187.48
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$202.06
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$171.75
|
| Rate for Payer: BCN Commercial |
$171.75
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$195.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$202.06
|
| Rate for Payer: Healthscope Whirlpool |
$208.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$187.48
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.19
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$200.95
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$153.44
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$138.10
|
| 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 |
$148.84
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$126.51
|
| Rate for Payer: BCN Commercial |
$126.51
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cofinity Commercial |
$144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$148.84
|
| Rate for Payer: Healthscope Whirlpool |
$153.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$138.10
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.42
|
| Rate for Payer: Nomi Health Commercial |
$125.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.08
|
| 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 |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$153.44
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$153.44 |
| Rate for Payer: Aetna Commercial |
$138.10
|
| Rate for Payer: ASR ASR |
$148.84
|
| Rate for Payer: BCBS Trust/PPO |
$126.00
|
| Rate for Payer: BCN Commercial |
$126.00
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cofinity Commercial |
$144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.75
|
| Rate for Payer: Healthscope Commercial |
$148.84
|
| Rate for Payer: Healthscope Whirlpool |
$153.44
|
| Rate for Payer: Mclaren Commercial |
$138.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.42
|
| Rate for Payer: Nomi Health Commercial |
$125.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.03
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$8.71
|
| Rate for Payer: BCN Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$8.75
|
| Rate for Payer: BCN Commercial |
$8.75
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: ASR ASR |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.68
|
| Rate for Payer: BCN Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Whirlpool |
$19.09
|
| Rate for Payer: Mclaren Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.80
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: Aetna Medicare |
$7.06
|
| Rate for Payer: ASR ASR |
$18.52
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.74
|
| Rate for Payer: BCN Commercial |
$15.74
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Whirlpool |
$19.09
|
| Rate for Payer: Mclaren Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.73
|
| Rate for Payer: Priority Health Narrow Network |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.80
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: ASR ASR |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$15.68
|
| Rate for Payer: BCN Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Whirlpool |
$19.09
|
| Rate for Payer: Mclaren Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.80
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: Aetna Medicare |
$7.06
|
| Rate for Payer: ASR ASR |
$18.52
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.74
|
| Rate for Payer: BCN Commercial |
$15.74
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Whirlpool |
$19.09
|
| Rate for Payer: Mclaren Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.73
|
| Rate for Payer: Priority Health Narrow Network |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.80
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: Aetna Medicare |
$7.06
|
| Rate for Payer: ASR ASR |
$18.52
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.74
|
| Rate for Payer: BCN Commercial |
$15.74
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Whirlpool |
$19.09
|
| Rate for Payer: Mclaren Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.73
|
| Rate for Payer: Priority Health Narrow Network |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.80
|
|
