|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$151.98
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.39 |
| Max. Negotiated Rate |
$151.98 |
| Rate for Payer: Aetna Commercial |
$136.78
|
| Rate for Payer: ASR ASR |
$147.42
|
| Rate for Payer: BCBS Trust/PPO |
$117.83
|
| Rate for Payer: BCN Commercial |
$117.83
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$142.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.58
|
| Rate for Payer: Healthscope Commercial |
$151.98
|
| Rate for Payer: Healthscope Whirlpool |
$147.42
|
| Rate for Payer: Mclaren Commercial |
$136.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.74
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$314.16
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$314.16 |
| Rate for Payer: Aetna Commercial |
$282.74
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$304.74
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$243.57
|
| Rate for Payer: BCN Commercial |
$243.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cofinity Commercial |
$295.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$314.16
|
| Rate for Payer: Healthscope Whirlpool |
$304.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$282.74
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.89
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$223.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.46
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$314.16
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$219.91 |
| Max. Negotiated Rate |
$314.16 |
| Rate for Payer: Aetna Commercial |
$282.74
|
| Rate for Payer: ASR ASR |
$304.74
|
| Rate for Payer: BCBS Trust/PPO |
$243.57
|
| Rate for Payer: BCN Commercial |
$243.57
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cofinity Commercial |
$295.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.33
|
| Rate for Payer: Healthscope Commercial |
$314.16
|
| Rate for Payer: Healthscope Whirlpool |
$304.74
|
| Rate for Payer: Mclaren Commercial |
$282.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.46
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$115.47
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$115.47 |
| Rate for Payer: Aetna Commercial |
$103.92
|
| Rate for Payer: ASR ASR |
$112.01
|
| Rate for Payer: BCBS Trust/PPO |
$89.52
|
| Rate for Payer: BCN Commercial |
$89.52
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$108.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Healthscope Whirlpool |
$112.01
|
| Rate for Payer: Mclaren Commercial |
$103.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.61
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$115.47
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$115.47 |
| Rate for Payer: Aetna Commercial |
$103.92
|
| Rate for Payer: ASR ASR |
$112.01
|
| Rate for Payer: BCBS Complete |
$46.19
|
| Rate for Payer: BCBS Trust/PPO |
$89.52
|
| Rate for Payer: BCN Commercial |
$89.52
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$108.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$115.47
|
| Rate for Payer: Healthscope Whirlpool |
$112.01
|
| Rate for Payer: Mclaren Commercial |
$103.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.08
|
| Rate for Payer: Priority Health Narrow Network |
$81.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.61
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
IP
|
$584.10
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$408.87 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna Commercial |
$525.69
|
| Rate for Payer: ASR ASR |
$566.58
|
| Rate for Payer: BCBS Trust/PPO |
$452.85
|
| Rate for Payer: BCN Commercial |
$452.85
|
| Rate for Payer: Cash Price |
$467.28
|
| Rate for Payer: Cofinity Commercial |
$549.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.28
|
| Rate for Payer: Healthscope Commercial |
$584.10
|
| Rate for Payer: Healthscope Whirlpool |
$566.58
|
| Rate for Payer: Mclaren Commercial |
$525.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.01
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$584.10
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.64 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Aetna Commercial |
$525.69
|
| Rate for Payer: ASR ASR |
$566.58
|
| Rate for Payer: BCBS Complete |
$233.64
|
| Rate for Payer: BCBS Trust/PPO |
$452.85
|
| Rate for Payer: BCN Commercial |
$452.85
|
| Rate for Payer: Cash Price |
$467.28
|
| Rate for Payer: Cofinity Commercial |
$549.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.28
|
| Rate for Payer: Healthscope Commercial |
$584.10
|
| Rate for Payer: Healthscope Whirlpool |
$566.58
|
| Rate for Payer: Mclaren Commercial |
$525.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.53
|
| Rate for Payer: Priority Health Narrow Network |
$414.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.01
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Trust/PPO |
$81.41
|
| Rate for Payer: BCN Commercial |
$81.41
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$105.00
|
| Rate for Payer: Healthscope Whirlpool |
$101.85
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.40
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$33.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.90
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$81.41
|
| Rate for Payer: BCN Commercial |
$81.41
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$105.00
|
| Rate for Payer: Healthscope Whirlpool |
$101.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.52
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Mclaren Medicare |
$33.52
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$31.84
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Commercial |
$36.87
|
| Rate for Payer: PHP Medicaid |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.76
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$31.81
|
| Rate for Payer: Railroad Medicare Medicare |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.40
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
| Rate for Payer: VA VA |
$33.52
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: ASR ASR |
$329.80
|
| Rate for Payer: BCBS Trust/PPO |
$263.60
|
| Rate for Payer: BCN Commercial |
$263.60
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$319.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$340.00
|
| Rate for Payer: Healthscope Whirlpool |
$329.80
|
| Rate for Payer: Mclaren Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.20
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$329.80
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$263.60
|
| Rate for Payer: BCN Commercial |
$263.60
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$319.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$340.00
|
| Rate for Payer: Healthscope Whirlpool |
$329.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$306.00
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.00
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.96
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$99.17
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.20
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS EA 30 DAY
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$101.25
|
| Rate for Payer: ASR ASR |
$109.12
|
| Rate for Payer: BCBS Trust/PPO |
$87.22
|
| Rate for Payer: BCN Commercial |
$87.22
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cofinity Commercial |
$105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Healthscope Whirlpool |
$109.12
|
| Rate for Payer: Mclaren Commercial |
$101.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.00
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS EA 30 DAY
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$101.25
|
| Rate for Payer: Aetna Medicare |
$33.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.90
|
| Rate for Payer: ASR ASR |
$109.12
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$87.22
|
| Rate for Payer: BCN Commercial |
$87.22
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cofinity Commercial |
$105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Healthscope Whirlpool |
$109.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.52
|
| Rate for Payer: Mclaren Commercial |
$101.25
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Mclaren Medicare |
$33.52
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.62
|
| Rate for Payer: PACE Medicare |
$31.84
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Commercial |
$36.87
|
| Rate for Payer: PHP Medicaid |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.38
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$79.88
|
| Rate for Payer: Railroad Medicare Medicare |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.00
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
| Rate for Payer: VA VA |
$33.52
|
|
|
HC REMOTE THER MON SETUP & EDU
|
Facility
|
IP
|
$358.96
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$251.27 |
| Max. Negotiated Rate |
$358.96 |
| Rate for Payer: Aetna Commercial |
$323.06
|
| Rate for Payer: ASR ASR |
$348.19
|
| Rate for Payer: BCBS Trust/PPO |
$278.30
|
| Rate for Payer: BCN Commercial |
$278.30
|
| Rate for Payer: Cash Price |
$287.17
|
| Rate for Payer: Cofinity Commercial |
$337.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.17
|
| Rate for Payer: Healthscope Commercial |
$358.96
|
| Rate for Payer: Healthscope Whirlpool |
$348.19
|
| Rate for Payer: Mclaren Commercial |
$323.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.88
|
|
|
HC REMOTE THER MON SETUP & EDU
|
Facility
|
OP
|
$358.96
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
42000062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$358.96 |
| Rate for Payer: Aetna Commercial |
$323.06
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$348.19
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$278.30
|
| Rate for Payer: BCN Commercial |
$278.30
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$287.17
|
| Rate for Payer: Cash Price |
$287.17
|
| Rate for Payer: Cofinity Commercial |
$337.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$358.96
|
| Rate for Payer: Healthscope Whirlpool |
$348.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.50
|
| Rate for Payer: Mclaren Commercial |
$323.06
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.12
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$129.25
|
| Rate for Payer: PHP Medicaid |
$64.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.65
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$254.86
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.88
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HC REMOVAL BILIARY STONE
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
36100516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$454.59 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna Commercial |
$584.48
|
| Rate for Payer: ASR ASR |
$629.94
|
| Rate for Payer: BCBS Trust/PPO |
$503.50
|
| Rate for Payer: BCN Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Healthscope Whirlpool |
$629.94
|
| Rate for Payer: Mclaren Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.49
|
|
|
HC REMOVAL BILIARY STONE
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47544
|
| Hospital Charge Code |
36100516
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$259.77 |
| Max. Negotiated Rate |
$649.42 |
| Rate for Payer: Aetna Commercial |
$584.48
|
| Rate for Payer: ASR ASR |
$629.94
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS Trust/PPO |
$503.50
|
| Rate for Payer: BCN Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$649.42
|
| Rate for Payer: Healthscope Whirlpool |
$629.94
|
| Rate for Payer: Mclaren Commercial |
$584.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$590.97
|
| Rate for Payer: Priority Health Narrow Network |
$461.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.49
|
|
|
HC REMOVAL CHEST PORT OR PUMP
|
Facility
|
OP
|
$2,135.56
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36100141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.69 |
| Max. Negotiated Rate |
$2,135.56 |
| Rate for Payer: Aetna Commercial |
$1,922.00
|
| Rate for Payer: Aetna Medicare |
$1,423.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: ASR ASR |
$2,071.49
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.70
|
| Rate for Payer: BCN Commercial |
$1,655.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Cash Price |
$1,708.45
|
| Rate for Payer: Cash Price |
$1,708.45
|
| Rate for Payer: Cofinity Commercial |
$2,007.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,708.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Healthscope Commercial |
$2,135.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,071.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,423.57
|
| Rate for Payer: Mclaren Commercial |
$1,922.00
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,815.23
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Commercial |
$1,565.93
|
| Rate for Payer: PHP Medicaid |
$778.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,494.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,943.36
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,516.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,879.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
HC REMOVAL CHEST PORT OR PUMP
|
Facility
|
IP
|
$2,135.56
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36100141
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,494.89 |
| Max. Negotiated Rate |
$2,135.56 |
| Rate for Payer: Aetna Commercial |
$1,922.00
|
| Rate for Payer: ASR ASR |
$2,071.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.70
|
| Rate for Payer: BCN Commercial |
$1,655.70
|
| Rate for Payer: Cash Price |
$1,708.45
|
| Rate for Payer: Cofinity Commercial |
$2,007.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,708.45
|
| Rate for Payer: Healthscope Commercial |
$2,135.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,071.49
|
| Rate for Payer: Mclaren Commercial |
$1,922.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,815.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,494.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,879.29
|
|
|
HC REMOVAL DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$336.60
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna Commercial |
$302.94
|
| Rate for Payer: ASR ASR |
$326.50
|
| Rate for Payer: BCBS Trust/PPO |
$260.97
|
| Rate for Payer: BCN Commercial |
$260.97
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cofinity Commercial |
$316.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.28
|
| Rate for Payer: Healthscope Commercial |
$336.60
|
| Rate for Payer: Healthscope Whirlpool |
$326.50
|
| Rate for Payer: Mclaren Commercial |
$302.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.21
|
|
|
HC REMOVAL DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$336.60
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.73 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$302.94
|
| Rate for Payer: Aetna Medicare |
$354.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: ASR ASR |
$326.50
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$260.97
|
| Rate for Payer: BCN Commercial |
$260.97
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cash Price |
$269.28
|
| Rate for Payer: Cofinity Commercial |
$316.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$336.60
|
| Rate for Payer: Healthscope Whirlpool |
$326.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.16
|
| Rate for Payer: Mclaren Commercial |
$302.94
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$286.11
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Commercial |
$389.58
|
| Rate for Payer: PHP Medicaid |
$193.73
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.31
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$238.99
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.21
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
HC REMOVAL FB EXTERNAL EYE CORNEAL WO SLIT LAMP
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.58 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Aetna Medicare |
$354.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: ASR ASR |
$1,067.00
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$852.83
|
| Rate for Payer: BCN Commercial |
$852.83
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$1,034.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$1,100.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.16
|
| Rate for Payer: Mclaren Commercial |
$990.00
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Commercial |
$389.58
|
| Rate for Payer: PHP Medicaid |
$193.73
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.73
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$140.58
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$968.00
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
HC REMOVAL FB EXTERNAL EYE CORNEAL WO SLIT LAMP
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
76100401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: ASR ASR |
$1,067.00
|
| Rate for Payer: BCBS Trust/PPO |
$852.83
|
| Rate for Payer: BCN Commercial |
$852.83
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$1,034.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$1,100.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.00
|
| Rate for Payer: Mclaren Commercial |
$990.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$968.00
|
|
|
HC REMOVAL FOREIGN BODY INTRANASAL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$339.50
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$271.36
|
| Rate for Payer: BCN Commercial |
$271.36
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$350.00
|
| Rate for Payer: Healthscope Whirlpool |
$339.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$315.00
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.41
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$75.53
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.00
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC REMOVAL FOREIGN BODY INTRANASAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
76100451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: ASR ASR |
$339.50
|
| Rate for Payer: BCBS Trust/PPO |
$271.36
|
| Rate for Payer: BCN Commercial |
$271.36
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$350.00
|
| Rate for Payer: Healthscope Whirlpool |
$339.50
|
| Rate for Payer: Mclaren Commercial |
$315.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.00
|
|
