|
HC DEVICE NOT RETURNED WATCHPAT
|
Professional
|
Both
|
$5,049.00
|
|
|
Service Code
|
HCPCS 00604
|
| Hospital Charge Code |
27000604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,019.60 |
| Max. Negotiated Rate |
$3,281.85 |
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: BCBS Complete |
$2,019.60
|
| Rate for Payer: Cash Price |
$4,039.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,281.85
|
|
|
HC DEVICE NOT RETURNED WATCHPAT
|
Professional
|
Both
|
$5,049.00
|
|
|
Service Code
|
HCPCS 00604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,019.60 |
| Max. Negotiated Rate |
$3,281.85 |
| Rate for Payer: Aetna Medicare |
$2,524.50
|
| Rate for Payer: BCBS Complete |
$2,019.60
|
| Rate for Payer: Cash Price |
$4,039.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,281.85
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
IP
|
$541.62
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$352.05 |
| Max. Negotiated Rate |
$541.62 |
| Rate for Payer: Aetna Commercial |
$487.46
|
| Rate for Payer: ASR ASR |
$525.37
|
| Rate for Payer: ASR Commercial |
$525.37
|
| Rate for Payer: BCBS Trust/PPO |
$441.37
|
| Rate for Payer: BCN Commercial |
$419.92
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.30
|
| Rate for Payer: Healthscope Commercial |
$541.62
|
| Rate for Payer: Healthscope Whirlpool |
$525.37
|
| Rate for Payer: Mclaren Commercial |
$487.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.38
|
| Rate for Payer: Nomi Health Commercial |
$444.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.63
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$541.62
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$541.62 |
| Rate for Payer: Aetna Commercial |
$487.46
|
| 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 |
$525.37
|
| Rate for Payer: ASR Commercial |
$525.37
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$443.53
|
| Rate for Payer: BCN Commercial |
$419.92
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cofinity Commercial |
$509.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$541.62
|
| Rate for Payer: Healthscope Whirlpool |
$525.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$487.46
|
| 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 |
$460.38
|
| Rate for Payer: Nomi Health Commercial |
$444.13
|
| 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 |
$352.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.72
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$257.38
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.63
|
| 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 DEXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$204.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$204.23 |
| Rate for Payer: Aetna Commercial |
$183.81
|
| Rate for Payer: ASR ASR |
$198.10
|
| Rate for Payer: ASR Commercial |
$198.10
|
| Rate for Payer: BCBS Trust/PPO |
$166.43
|
| Rate for Payer: BCN Commercial |
$158.34
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$191.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.38
|
| Rate for Payer: Healthscope Commercial |
$204.23
|
| Rate for Payer: Healthscope Whirlpool |
$198.10
|
| Rate for Payer: Mclaren Commercial |
$183.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.60
|
| Rate for Payer: Nomi Health Commercial |
$167.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.72
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$204.23
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$227.84 |
| Rate for Payer: Aetna Commercial |
$183.81
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$198.10
|
| Rate for Payer: ASR Commercial |
$198.10
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$167.24
|
| Rate for Payer: BCN Commercial |
$158.34
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cash Price |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$191.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$204.23
|
| Rate for Payer: Healthscope Whirlpool |
$198.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$183.81
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.60
|
| Rate for Payer: Nomi Health Commercial |
$167.47
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.84
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$182.27
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$150.43
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$135.39
|
| 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 |
$145.92
|
| Rate for Payer: ASR Commercial |
$145.92
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$123.19
|
| Rate for Payer: BCN Commercial |
$116.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cofinity Commercial |
$141.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$150.43
|
| Rate for Payer: Healthscope Whirlpool |
$145.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$135.39
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| 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 |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.87
|
| Rate for Payer: Nomi Health Commercial |
$123.35
|
| 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 |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$150.43
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.78 |
| Max. Negotiated Rate |
$150.43 |
| Rate for Payer: Aetna Commercial |
$135.39
|
| Rate for Payer: ASR ASR |
$145.92
|
| Rate for Payer: ASR Commercial |
$145.92
|
| Rate for Payer: BCBS Trust/PPO |
$122.59
|
| Rate for Payer: BCN Commercial |
$116.63
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cofinity Commercial |
$141.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.34
|
| Rate for Payer: Healthscope Commercial |
$150.43
|
| Rate for Payer: Healthscope Whirlpool |
$145.92
|
| Rate for Payer: Mclaren Commercial |
$135.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.87
|
| Rate for Payer: Nomi Health Commercial |
$123.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.38
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
OP
|
$37.41
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$37.41 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: ASR ASR |
$36.29
|
| Rate for Payer: ASR Commercial |
$36.29
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS Trust/PPO |
$30.64
|
| Rate for Payer: BCN Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$35.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$37.41
|
| Rate for Payer: Healthscope Whirlpool |
$36.29
|
| Rate for Payer: Mclaren Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.78
|
| Rate for Payer: Priority Health Narrow Network |
$26.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.92
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
IP
|
$37.41
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$37.41 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: ASR ASR |
$36.29
|
| Rate for Payer: ASR Commercial |
$36.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.49
|
| Rate for Payer: BCN Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$35.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$37.41
|
| Rate for Payer: Healthscope Whirlpool |
$36.29
|
| Rate for Payer: Mclaren Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.92
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
OP
|
$37.41
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$37.41 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: ASR ASR |
$36.29
|
| Rate for Payer: ASR Commercial |
$36.29
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS Trust/PPO |
$30.64
|
| Rate for Payer: BCN Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$35.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$37.41
|
| Rate for Payer: Healthscope Whirlpool |
$36.29
|
| Rate for Payer: Mclaren Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.78
|
| Rate for Payer: Priority Health Narrow Network |
$26.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.92
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
IP
|
$37.41
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$37.41 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: ASR ASR |
$36.29
|
| Rate for Payer: ASR Commercial |
$36.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.49
|
| Rate for Payer: BCN Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$35.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$37.41
|
| Rate for Payer: Healthscope Whirlpool |
$36.29
|
| Rate for Payer: Mclaren Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.92
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
