|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
IP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$705.49 |
| Max. Negotiated Rate |
$940.65 |
| Rate for Payer: Aetna Commercial |
$846.59
|
| Rate for Payer: ASR ASR |
$912.43
|
| Rate for Payer: BCBS Trust/PPO |
$772.46
|
| Rate for Payer: BCN Commercial |
$772.46
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Commercial |
$884.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Healthscope Commercial |
$912.43
|
| Rate for Payer: Healthscope Whirlpool |
$940.65
|
| Rate for Payer: Mclaren Commercial |
$846.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$771.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.77
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
OP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$940.65 |
| Rate for Payer: Aetna Commercial |
$846.59
|
| 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 |
$912.43
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$775.57
|
| Rate for Payer: BCN Commercial |
$775.57
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Commercial |
$884.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$912.43
|
| Rate for Payer: Healthscope Whirlpool |
$940.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$846.59
|
| 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 |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$771.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| 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 |
$824.20
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$659.40
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.77
|
| 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 GROSHONG REPAIR KIT
|
Facility
|
OP
|
$473.46
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.18 |
| Max. Negotiated Rate |
$473.46 |
| Rate for Payer: Aetna Commercial |
$426.11
|
| Rate for Payer: Aetna Medicare |
$175.18
|
| Rate for Payer: ASR ASR |
$459.26
|
| Rate for Payer: BCBS Complete |
$189.38
|
| Rate for Payer: BCBS Trust/PPO |
$390.37
|
| Rate for Payer: BCN Commercial |
$390.37
|
| Rate for Payer: Cash Price |
$378.77
|
| Rate for Payer: Cofinity Commercial |
$445.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.77
|
| Rate for Payer: Healthscope Commercial |
$459.26
|
| Rate for Payer: Healthscope Whirlpool |
$473.46
|
| Rate for Payer: Mclaren Commercial |
$426.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.44
|
| Rate for Payer: Nomi Health Commercial |
$388.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$414.85
|
| Rate for Payer: Priority Health Narrow Network |
$331.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.64
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
IP
|
$473.46
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.10 |
| Max. Negotiated Rate |
$473.46 |
| Rate for Payer: Aetna Commercial |
$426.11
|
| Rate for Payer: ASR ASR |
$459.26
|
| Rate for Payer: BCBS Trust/PPO |
$388.81
|
| Rate for Payer: BCN Commercial |
$388.81
|
| Rate for Payer: Cash Price |
$378.77
|
| Rate for Payer: Cofinity Commercial |
$445.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.77
|
| Rate for Payer: Healthscope Commercial |
$459.26
|
| Rate for Payer: Healthscope Whirlpool |
$473.46
|
| Rate for Payer: Mclaren Commercial |
$426.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.44
|
| Rate for Payer: Nomi Health Commercial |
$388.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$416.64
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$87.15
|
| Rate for Payer: BCN Commercial |
$87.15
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$102.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.12
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$87.50
|
| Rate for Payer: BCN Commercial |
$87.50
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$102.94
|
| Rate for Payer: Healthscope Whirlpool |
$106.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.98
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$74.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$126.53 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: Aetna Medicare |
$101.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$83.13
|
| Rate for Payer: BCN Commercial |
$83.13
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.22
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Mclaren Medicaid |
$101.22
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$55.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$111.34
|
| Rate for Payer: PHP Medicaid |
$54.25
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.34
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health Narrow Network |
$70.67
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP DNSP |
$101.22
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$82.79
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
|
|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
IP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: ASR ASR |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$52.84
|
| Rate for Payer: BCN Commercial |
$52.84
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$64.35
|
| Rate for Payer: Mclaren Commercial |
$57.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.63
|
|
|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
OP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Aetna Commercial |
$57.91
|
| Rate for Payer: Aetna Medicare |
$23.81
|
| Rate for Payer: ASR ASR |
$62.42
|
| Rate for Payer: BCBS Complete |
$25.74
|
| Rate for Payer: BCBS Trust/PPO |
$53.06
|
| Rate for Payer: BCN Commercial |
$53.06
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$64.35
|
| Rate for Payer: Mclaren Commercial |
$57.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.63
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
IP
|
$109.35
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Aetna Commercial |
$98.42
|
| Rate for Payer: ASR ASR |
$106.07
|
| Rate for Payer: BCBS Trust/PPO |
$89.80
|
| Rate for Payer: BCN Commercial |
$89.80
|
| Rate for Payer: Cash Price |
$87.48
|
| Rate for Payer: Cofinity Commercial |
$102.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.48
|
| Rate for Payer: Healthscope Commercial |
$106.07
|
| Rate for Payer: Healthscope Whirlpool |
$109.35
|
| Rate for Payer: Mclaren Commercial |
$98.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.95
|
| Rate for Payer: Nomi Health Commercial |
$89.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.23
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
OP
|
$109.35
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$109.35 |
| Rate for Payer: Aetna Commercial |
$98.42
|
| Rate for Payer: Aetna Medicare |
$40.46
|
| Rate for Payer: ASR ASR |
$106.07
|
| Rate for Payer: BCBS Complete |
$43.74
|
| Rate for Payer: BCBS Trust/PPO |
$90.16
|
| Rate for Payer: BCN Commercial |
$90.16
|
| Rate for Payer: Cash Price |
$87.48
|
| Rate for Payer: Cash Price |
$87.48
|
| Rate for Payer: Cofinity Commercial |
$102.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.48
|
| Rate for Payer: Healthscope Commercial |
$106.07
|
| Rate for Payer: Healthscope Whirlpool |
$109.35
|
| Rate for Payer: Mclaren Commercial |
$98.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.95
|
| Rate for Payer: Nomi Health Commercial |
$89.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.23
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$16.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.84
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS MAPPO |
$16.67
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.67
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$16.67
|
| Rate for Payer: Mclaren Medicare |
$16.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.50
|
| Rate for Payer: Meridian Medicaid |
$9.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$15.84
|
| Rate for Payer: PACE SWMI |
$16.67
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Medicaid |
$8.94
|
| Rate for Payer: PHP Medicare Advantage |
$16.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$118.64
|
| Rate for Payer: Priority Health Medicare |
$16.67
|
| Rate for Payer: Priority Health Narrow Network |
$94.91
|
| Rate for Payer: Railroad Medicare Medicare |
$16.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.67
|
| Rate for Payer: UHC Exchange |
$25.84
|
| Rate for Payer: UHC Medicaid |
$8.72
|
| Rate for Payer: UHCCP DNSP |
$16.67
|
| Rate for Payer: UHCCP Medicaid |
$8.72
|
| Rate for Payer: VA VA |
$16.67
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
OP
|
$689.79
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$689.79 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: Aetna Medicare |
$211.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: ASR ASR |
$669.10
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$568.73
|
| Rate for Payer: BCN Commercial |
$568.73
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$551.83
|
| Rate for Payer: Cash Price |
$551.83
|
| Rate for Payer: Cofinity Commercial |
$648.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$669.10
|
| Rate for Payer: Healthscope Whirlpool |
$689.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$211.94
|
| Rate for Payer: Mclaren Commercial |
$620.81
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$116.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.32
|
| Rate for Payer: Nomi Health Commercial |
$565.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.34
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$233.13
|
| Rate for Payer: PHP Medicaid |
$113.60
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.10
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Narrow Network |
$248.88
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP DNSP |
$211.94
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
IP
|
$689.79
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.34 |
| Max. Negotiated Rate |
$689.79 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: ASR ASR |
$669.10
|
| Rate for Payer: BCBS Trust/PPO |
$566.46
|
| Rate for Payer: BCN Commercial |
$566.46
|
| Rate for Payer: Cash Price |
$551.83
|
| Rate for Payer: Cofinity Commercial |
$648.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.83
|
| Rate for Payer: Healthscope Commercial |
$669.10
|
| Rate for Payer: Healthscope Whirlpool |
$689.79
|
| Rate for Payer: Mclaren Commercial |
$620.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.32
|
| Rate for Payer: Nomi Health Commercial |
$565.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.02
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
IP
|
$588.03
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$441.02 |
| Max. Negotiated Rate |
$588.03 |
| Rate for Payer: Aetna Commercial |
$529.23
|
| Rate for Payer: ASR ASR |
$570.39
|
| Rate for Payer: BCBS Trust/PPO |
$482.89
|
| Rate for Payer: BCN Commercial |
$482.89
|
| Rate for Payer: Cash Price |
$470.42
|
| Rate for Payer: Cofinity Commercial |
$552.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.42
|
| Rate for Payer: Healthscope Commercial |
$570.39
|
| Rate for Payer: Healthscope Whirlpool |
$588.03
|
| Rate for Payer: Mclaren Commercial |
$529.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.83
|
| Rate for Payer: Nomi Health Commercial |
$482.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.47
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
OP
|
$588.03
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.57 |
| Max. Negotiated Rate |
$588.03 |
| Rate for Payer: Aetna Commercial |
$529.23
|
| Rate for Payer: Aetna Medicare |
$217.57
|
| Rate for Payer: ASR ASR |
$570.39
|
| Rate for Payer: BCBS Complete |
$235.21
|
| Rate for Payer: BCBS Trust/PPO |
$484.83
|
| Rate for Payer: BCN Commercial |
$484.83
|
| Rate for Payer: Cash Price |
$470.42
|
| Rate for Payer: Cofinity Commercial |
$552.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.42
|
| Rate for Payer: Healthscope Commercial |
$570.39
|
| Rate for Payer: Healthscope Whirlpool |
$588.03
|
| Rate for Payer: Mclaren Commercial |
$529.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$470.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.83
|
| Rate for Payer: Nomi Health Commercial |
$482.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$515.23
|
| Rate for Payer: Priority Health Narrow Network |
$412.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.47
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
IP
|
$5,937.84
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,453.38 |
| Max. Negotiated Rate |
$5,937.84 |
| Rate for Payer: Aetna Commercial |
$5,344.06
|
| Rate for Payer: ASR ASR |
$5,759.70
|
| Rate for Payer: BCBS Trust/PPO |
$4,876.15
|
| Rate for Payer: BCN Commercial |
$4,876.15
|
| Rate for Payer: Cash Price |
$4,750.27
|
| Rate for Payer: Cofinity Commercial |
$5,581.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,750.27
|
| Rate for Payer: Healthscope Commercial |
$5,759.70
|
| Rate for Payer: Healthscope Whirlpool |
$5,937.84
|
| Rate for Payer: Mclaren Commercial |
$5,344.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,047.16
|
| Rate for Payer: Nomi Health Commercial |
$4,869.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,453.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,225.30
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
OP
|
$5,937.84
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.00 |
| Max. Negotiated Rate |
$5,937.84 |
| Rate for Payer: Aetna Commercial |
$5,344.06
|
| Rate for Payer: Aetna Medicare |
$2,197.00
|
| Rate for Payer: ASR ASR |
$5,759.70
|
| Rate for Payer: BCBS Complete |
$2,375.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,895.75
|
| Rate for Payer: BCN Commercial |
$4,895.75
|
| Rate for Payer: Cash Price |
$4,750.27
|
| Rate for Payer: Cofinity Commercial |
$5,581.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,750.27
|
| Rate for Payer: Healthscope Commercial |
$5,759.70
|
| Rate for Payer: Healthscope Whirlpool |
$5,937.84
|
| Rate for Payer: Mclaren Commercial |
$5,344.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,750.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,047.16
|
| Rate for Payer: Nomi Health Commercial |
$4,869.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,453.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,202.74
|
| Rate for Payer: Priority Health Narrow Network |
$4,162.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,225.30
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
IP
|
$10,560.06
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,920.05 |
| Max. Negotiated Rate |
$10,560.06 |
| Rate for Payer: Aetna Commercial |
$9,504.05
|
| Rate for Payer: ASR ASR |
$10,243.26
|
| Rate for Payer: BCBS Trust/PPO |
$8,671.92
|
| Rate for Payer: BCN Commercial |
$8,671.92
|
| Rate for Payer: Cash Price |
$8,448.05
|
| Rate for Payer: Cofinity Commercial |
$9,926.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,448.05
|
| Rate for Payer: Healthscope Commercial |
$10,243.26
|
| Rate for Payer: Healthscope Whirlpool |
$10,560.06
|
| Rate for Payer: Mclaren Commercial |
$9,504.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,976.05
|
| Rate for Payer: Nomi Health Commercial |
$8,659.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,920.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,292.85
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
OP
|
$10,560.06
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,907.22 |
| Max. Negotiated Rate |
$10,560.06 |
| Rate for Payer: Aetna Commercial |
$9,504.05
|
| Rate for Payer: Aetna Medicare |
$3,907.22
|
| Rate for Payer: ASR ASR |
$10,243.26
|
| Rate for Payer: BCBS Complete |
$4,224.02
|
| Rate for Payer: BCBS Trust/PPO |
$8,706.77
|
| Rate for Payer: BCN Commercial |
$8,706.77
|
| Rate for Payer: Cash Price |
$8,448.05
|
| Rate for Payer: Cofinity Commercial |
$9,926.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,448.05
|
| Rate for Payer: Healthscope Commercial |
$10,243.26
|
| Rate for Payer: Healthscope Whirlpool |
$10,560.06
|
| Rate for Payer: Mclaren Commercial |
$9,504.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,448.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,976.05
|
| Rate for Payer: Nomi Health Commercial |
$8,659.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,920.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,252.72
|
| Rate for Payer: Priority Health Narrow Network |
$7,402.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,292.85
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
OP
|
$13,517.92
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,001.63 |
| Max. Negotiated Rate |
$13,517.92 |
| Rate for Payer: Aetna Commercial |
$12,166.13
|
| Rate for Payer: Aetna Medicare |
$5,001.63
|
| Rate for Payer: ASR ASR |
$13,112.38
|
| Rate for Payer: BCBS Complete |
$5,407.17
|
| Rate for Payer: BCBS Trust/PPO |
$11,145.53
|
| Rate for Payer: BCN Commercial |
$11,145.53
|
| Rate for Payer: Cash Price |
$10,814.34
|
| Rate for Payer: Cofinity Commercial |
$12,706.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,814.34
|
| Rate for Payer: Healthscope Commercial |
$13,112.38
|
| Rate for Payer: Healthscope Whirlpool |
$13,517.92
|
| Rate for Payer: Mclaren Commercial |
$12,166.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,814.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,490.23
|
| Rate for Payer: Nomi Health Commercial |
$11,084.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,138.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,844.40
|
| Rate for Payer: Priority Health Narrow Network |
$9,476.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,895.77
|
|
