|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
OP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$531.54 |
| Rate for Payer: Aetna Commercial |
$478.39
|
| Rate for Payer: Aetna Medicare |
$265.77
|
| Rate for Payer: ASR ASR |
$515.59
|
| Rate for Payer: ASR Commercial |
$515.59
|
| Rate for Payer: BCBS Complete |
$212.62
|
| Rate for Payer: BCBS Trust/PPO |
$435.28
|
| Rate for Payer: BCN Commercial |
$412.10
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$499.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$531.54
|
| Rate for Payer: Healthscope Whirlpool |
$515.59
|
| Rate for Payer: Mclaren Commercial |
$478.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: Nomi Health Commercial |
$435.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.74
|
| Rate for Payer: Priority Health Narrow Network |
$372.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.76
|
|
|
HC MINOR PROCEDURE WO SEDATION
|
Facility
|
IP
|
$531.54
|
|
| Hospital Charge Code |
36000076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$345.50 |
| Max. Negotiated Rate |
$531.54 |
| Rate for Payer: Aetna Commercial |
$478.39
|
| Rate for Payer: ASR ASR |
$515.59
|
| Rate for Payer: ASR Commercial |
$515.59
|
| Rate for Payer: BCBS Trust/PPO |
$433.15
|
| Rate for Payer: BCN Commercial |
$412.10
|
| Rate for Payer: Cash Price |
$425.23
|
| Rate for Payer: Cofinity Commercial |
$499.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.23
|
| Rate for Payer: Healthscope Commercial |
$531.54
|
| Rate for Payer: Healthscope Whirlpool |
$515.59
|
| Rate for Payer: Mclaren Commercial |
$478.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.81
|
| Rate for Payer: Nomi Health Commercial |
$435.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.76
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
OP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$246.37 |
| Max. Negotiated Rate |
$615.92 |
| Rate for Payer: Aetna Commercial |
$554.33
|
| Rate for Payer: Aetna Medicare |
$307.96
|
| Rate for Payer: ASR ASR |
$597.44
|
| Rate for Payer: ASR Commercial |
$597.44
|
| Rate for Payer: BCBS Complete |
$246.37
|
| Rate for Payer: BCBS Trust/PPO |
$504.38
|
| Rate for Payer: BCN Commercial |
$477.52
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$578.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$615.92
|
| Rate for Payer: Healthscope Whirlpool |
$597.44
|
| Rate for Payer: Mclaren Commercial |
$554.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: Nomi Health Commercial |
$505.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.67
|
| Rate for Payer: Priority Health Narrow Network |
$431.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.01
|
|
|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
IP
|
$615.92
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$400.35 |
| Max. Negotiated Rate |
$615.92 |
| Rate for Payer: Aetna Commercial |
$554.33
|
| Rate for Payer: ASR ASR |
$597.44
|
| Rate for Payer: ASR Commercial |
$597.44
|
| Rate for Payer: BCBS Trust/PPO |
$501.91
|
| Rate for Payer: BCN Commercial |
$477.52
|
| Rate for Payer: Cash Price |
$492.74
|
| Rate for Payer: Cofinity Commercial |
$578.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.74
|
| Rate for Payer: Healthscope Commercial |
$615.92
|
| Rate for Payer: Healthscope Whirlpool |
$597.44
|
| Rate for Payer: Mclaren Commercial |
$554.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.53
|
| Rate for Payer: Nomi Health Commercial |
$505.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.01
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| 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 |
$113.99
|
| Rate for Payer: ASR Commercial |
$113.99
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$96.24
|
| Rate for Payer: BCN Commercial |
$91.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$110.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$117.52
|
| Rate for Payer: Healthscope Whirlpool |
$113.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$105.77
|
| 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 |
$99.89
|
| Rate for Payer: Nomi Health Commercial |
$96.37
|
| 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 |
$76.39
|
| 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 |
$103.42
|
| 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 MITOTANE (LYSODREN)
|
Facility
|
IP
|
$117.52
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$117.52 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: ASR ASR |
$113.99
|
| Rate for Payer: ASR Commercial |
$113.99
|
| Rate for Payer: BCBS Trust/PPO |
$95.77
|
| Rate for Payer: BCN Commercial |
$91.11
|
| Rate for Payer: Cash Price |
$94.02
|
| Rate for Payer: Cofinity Commercial |
$110.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.02
|
| Rate for Payer: Healthscope Commercial |
$117.52
|
| Rate for Payer: Healthscope Whirlpool |
$113.99
|
| Rate for Payer: Mclaren Commercial |
$105.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.89
|
| Rate for Payer: Nomi Health Commercial |
$96.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.42
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$54.62
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Complete |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$89.46
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.10
|
| Rate for Payer: Priority Health Narrow Network |
$86.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCN Commercial |
$84.69
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: ASR ASR |
$50.05
|
| Rate for Payer: ASR Commercial |
$50.05
|
| Rate for Payer: BCBS Trust/PPO |
$42.05
|
| Rate for Payer: BCN Commercial |
$40.01
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$51.60
|
| Rate for Payer: Healthscope Whirlpool |
$50.05
|
| Rate for Payer: Mclaren Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: Nomi Health Commercial |
$42.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.41
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$51.60
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Aetna Medicare |
$25.80
|
| Rate for Payer: ASR ASR |
$50.05
|
| Rate for Payer: ASR Commercial |
$50.05
|
| Rate for Payer: BCBS Complete |
$20.64
|
| Rate for Payer: BCBS Trust/PPO |
$42.26
|
| Rate for Payer: BCN Commercial |
$40.01
|
| Rate for Payer: Cash Price |
$41.28
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$51.60
|
| Rate for Payer: Healthscope Whirlpool |
$50.05
|
| Rate for Payer: Mclaren Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.86
|
| Rate for Payer: Nomi Health Commercial |
$42.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$36.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.41
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$60.53 |
| Rate for Payer: Aetna Commercial |
$54.48
|
| Rate for Payer: Aetna Medicare |
$30.26
|
| Rate for Payer: ASR ASR |
$58.71
|
| Rate for Payer: ASR Commercial |
$58.71
|
| Rate for Payer: BCBS Complete |
$24.21
|
| Rate for Payer: BCBS Trust/PPO |
$49.57
|
| Rate for Payer: BCN Commercial |
$46.93
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$56.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.42
|
| Rate for Payer: Healthscope Commercial |
$60.53
|
| Rate for Payer: Healthscope Whirlpool |
$58.71
|
| Rate for Payer: Mclaren Commercial |
$54.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.45
|
| Rate for Payer: Nomi Health Commercial |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.04
|
| Rate for Payer: Priority Health Narrow Network |
$42.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.27
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$60.53
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$60.53 |
| Rate for Payer: Aetna Commercial |
$54.48
|
| Rate for Payer: ASR ASR |
$58.71
|
| Rate for Payer: ASR Commercial |
$58.71
|
| Rate for Payer: BCBS Trust/PPO |
$49.33
|
| Rate for Payer: BCN Commercial |
$46.93
|
| Rate for Payer: Cash Price |
$48.42
|
| Rate for Payer: Cofinity Commercial |
$56.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.42
|
| Rate for Payer: Healthscope Commercial |
$60.53
|
| Rate for Payer: Healthscope Whirlpool |
$58.71
|
| Rate for Payer: Mclaren Commercial |
$54.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.45
|
| Rate for Payer: Nomi Health Commercial |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.27
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$90.13 |
| Max. Negotiated Rate |
$138.66 |
| Rate for Payer: Aetna Commercial |
$124.79
|
| Rate for Payer: ASR ASR |
$134.50
|
| Rate for Payer: ASR Commercial |
$134.50
|
| Rate for Payer: BCBS Trust/PPO |
$112.99
|
| Rate for Payer: BCN Commercial |
$107.50
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$130.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.93
|
| Rate for Payer: Healthscope Commercial |
$138.66
|
| Rate for Payer: Healthscope Whirlpool |
$134.50
|
| Rate for Payer: Mclaren Commercial |
$124.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.86
|
| Rate for Payer: Nomi Health Commercial |
$113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.02
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$138.66
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.14 |
| Max. Negotiated Rate |
$138.66 |
| Rate for Payer: Aetna Commercial |
$124.79
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: ASR ASR |
$134.50
|
| Rate for Payer: ASR Commercial |
$134.50
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$113.55
|
| Rate for Payer: BCN Commercial |
$107.50
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cash Price |
$110.93
|
| Rate for Payer: Cofinity Commercial |
$130.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.93
|
| Rate for Payer: Healthscope Commercial |
$138.66
|
| Rate for Payer: Healthscope Whirlpool |
$134.50
|
| Rate for Payer: Mclaren Commercial |
$124.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.86
|
| Rate for Payer: Nomi Health Commercial |
$113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.92
|
| Rate for Payer: Priority Health Narrow Network |
$35.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.02
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$122.56
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$79.66 |
| Max. Negotiated Rate |
$122.56 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: ASR ASR |
$118.88
|
| Rate for Payer: ASR Commercial |
$118.88
|
| Rate for Payer: BCBS Trust/PPO |
$99.87
|
| Rate for Payer: BCN Commercial |
$95.02
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.05
|
| Rate for Payer: Healthscope Commercial |
$122.56
|
| Rate for Payer: Healthscope Whirlpool |
$118.88
|
| Rate for Payer: Mclaren Commercial |
$110.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.18
|
| Rate for Payer: Nomi Health Commercial |
$100.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.85
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$122.56
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$122.56 |
| Rate for Payer: Aetna Commercial |
$110.30
|
| Rate for Payer: Aetna Medicare |
$61.28
|
| Rate for Payer: ASR ASR |
$118.88
|
| Rate for Payer: ASR Commercial |
$118.88
|
| Rate for Payer: BCBS Complete |
$49.02
|
| Rate for Payer: BCBS Trust/PPO |
$100.36
|
| Rate for Payer: BCN Commercial |
$95.02
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cash Price |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$115.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.05
|
| Rate for Payer: Healthscope Commercial |
$122.56
|
| Rate for Payer: Healthscope Whirlpool |
$118.88
|
| Rate for Payer: Mclaren Commercial |
$110.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.18
|
| Rate for Payer: Nomi Health Commercial |
$100.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Narrow Network |
$26.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.85
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$348.08 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$481.95
|
| Rate for Payer: ASR ASR |
$519.44
|
| Rate for Payer: ASR Commercial |
$519.44
|
| Rate for Payer: BCBS Trust/PPO |
$436.38
|
| Rate for Payer: BCN Commercial |
$415.17
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$503.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Healthscope Whirlpool |
$519.44
|
| Rate for Payer: Mclaren Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.24
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$535.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$481.95
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$519.44
|
| Rate for Payer: ASR Commercial |
$519.44
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$438.52
|
| Rate for Payer: BCN Commercial |
$415.17
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$503.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Healthscope Whirlpool |
$519.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$481.95
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.11
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$193.25 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$62.65
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.25
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$154.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$491.37 |
| Max. Negotiated Rate |
$755.95 |
| Rate for Payer: Aetna Commercial |
$680.36
|
| Rate for Payer: ASR ASR |
$733.27
|
| Rate for Payer: ASR Commercial |
$733.27
|
| Rate for Payer: BCBS Trust/PPO |
$616.02
|
| Rate for Payer: BCN Commercial |
$586.09
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cofinity Commercial |
$710.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.76
|
| Rate for Payer: Healthscope Commercial |
$755.95
|
| Rate for Payer: Healthscope Whirlpool |
$733.27
|
| Rate for Payer: Mclaren Commercial |
$680.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: Nomi Health Commercial |
$619.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.24
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$755.95
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$755.95 |
| Rate for Payer: Aetna Commercial |
$680.36
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$733.27
|
| Rate for Payer: ASR Commercial |
$733.27
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$619.05
|
| Rate for Payer: BCN Commercial |
$586.09
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cash Price |
$604.76
|
| Rate for Payer: Cofinity Commercial |
$710.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$755.95
|
| Rate for Payer: Healthscope Whirlpool |
$733.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$680.36
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.56
|
| Rate for Payer: Nomi Health Commercial |
$619.88
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$662.36
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$529.92
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$665.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$244.93 |
| Rate for Payer: Aetna Commercial |
$220.44
|
| Rate for Payer: ASR ASR |
$237.58
|
| Rate for Payer: ASR Commercial |
$237.58
|
| Rate for Payer: BCBS Trust/PPO |
$199.59
|
| Rate for Payer: BCN Commercial |
$189.89
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$230.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$244.93
|
| Rate for Payer: Healthscope Whirlpool |
$237.58
|
| Rate for Payer: Mclaren Commercial |
$220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.54
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$244.93 |
| Rate for Payer: Aetna Commercial |
$220.44
|
| Rate for Payer: Aetna Medicare |
$123.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.20
|
| Rate for Payer: ASR ASR |
$237.58
|
| Rate for Payer: ASR Commercial |
$237.58
|
| Rate for Payer: BCBS Complete |
$69.43
|
| Rate for Payer: BCBS MAPPO |
$123.36
|
| Rate for Payer: BCBS Trust/PPO |
$200.57
|
| Rate for Payer: BCN Commercial |
$189.89
|
| Rate for Payer: BCN Medicare Advantage |
$123.36
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$230.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.36
|
| Rate for Payer: Healthscope Commercial |
$244.93
|
| Rate for Payer: Healthscope Whirlpool |
$237.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$123.36
|
| Rate for Payer: Mclaren Commercial |
$220.44
|
| Rate for Payer: Mclaren Medicaid |
$66.12
|
| Rate for Payer: Mclaren Medicare |
$123.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.53
|
| Rate for Payer: Meridian Medicaid |
$69.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PACE Medicare |
$117.19
|
| Rate for Payer: PACE SWMI |
$123.36
|
| Rate for Payer: PHP Commercial |
$135.70
|
| Rate for Payer: PHP Medicaid |
$66.12
|
| Rate for Payer: PHP Medicare Advantage |
$123.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$123.36
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$123.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.36
|
| Rate for Payer: UHC Exchange |
$191.21
|
| Rate for Payer: UHC Medicare Advantage |
$123.36
|
| Rate for Payer: UHCCP DNSP |
$123.36
|
| Rate for Payer: UHCCP Medicaid |
$66.12
|
| Rate for Payer: VA VA |
$123.36
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
OP
|
$437.50
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$393.75
|
| Rate for Payer: Aetna Medicare |
$218.75
|
| Rate for Payer: ASR ASR |
$424.38
|
| Rate for Payer: ASR Commercial |
$424.38
|
| Rate for Payer: BCBS Complete |
$175.00
|
| Rate for Payer: BCBS Trust/PPO |
$358.27
|
| Rate for Payer: BCN Commercial |
$339.19
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$411.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.00
|
| Rate for Payer: Healthscope Commercial |
$437.50
|
| Rate for Payer: Healthscope Whirlpool |
$424.38
|
| Rate for Payer: Mclaren Commercial |
$393.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.88
|
| Rate for Payer: Nomi Health Commercial |
$358.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.34
|
| Rate for Payer: Priority Health Narrow Network |
$306.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.00
|
|
