|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
OP
|
$26.81
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Aetna Commercial |
$24.13
|
| Rate for Payer: ASR ASR |
$26.01
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$20.79
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$25.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$26.81
|
| Rate for Payer: Healthscope Whirlpool |
$26.01
|
| Rate for Payer: Mclaren Commercial |
$24.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.40
|
| Rate for Payer: Priority Health Narrow Network |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.59
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
IP
|
$26.81
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$26.81 |
| Rate for Payer: Aetna Commercial |
$24.13
|
| Rate for Payer: ASR ASR |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$20.79
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$25.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.45
|
| Rate for Payer: Healthscope Commercial |
$26.81
|
| Rate for Payer: Healthscope Whirlpool |
$26.01
|
| Rate for Payer: Mclaren Commercial |
$24.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.59
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.08
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.82
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.42
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.84
|
| Rate for Payer: Priority Health Narrow Network |
$17.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$47.28
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$47.28 |
| Rate for Payer: Aetna Commercial |
$42.55
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$45.86
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$36.66
|
| Rate for Payer: BCN Commercial |
$36.66
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cofinity Commercial |
$44.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$47.28
|
| Rate for Payer: Healthscope Whirlpool |
$45.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$42.55
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.19
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.02
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.57
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.61
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$47.28
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$47.28 |
| Rate for Payer: Aetna Commercial |
$42.55
|
| Rate for Payer: ASR ASR |
$45.86
|
| Rate for Payer: BCBS Trust/PPO |
$36.66
|
| Rate for Payer: BCN Commercial |
$36.66
|
| Rate for Payer: Cash Price |
$37.82
|
| Rate for Payer: Cofinity Commercial |
$44.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.82
|
| Rate for Payer: Healthscope Commercial |
$47.28
|
| Rate for Payer: Healthscope Whirlpool |
$45.86
|
| Rate for Payer: Mclaren Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.61
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.25
|
| Rate for Payer: Priority Health Narrow Network |
$53.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$38.74
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$34.87
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: ASR ASR |
$37.58
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$30.04
|
| Rate for Payer: BCN Commercial |
$30.04
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Healthscope Whirlpool |
$37.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.74
|
| Rate for Payer: Mclaren Commercial |
$34.87
|
| Rate for Payer: Mclaren Medicaid |
$7.52
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Medicaid |
$7.52
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.09
|
| Rate for Payer: UHC Medicare Advantage |
$14.15
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$38.74
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$34.87
|
| Rate for Payer: ASR ASR |
$37.58
|
| Rate for Payer: BCBS Trust/PPO |
$30.04
|
| Rate for Payer: BCN Commercial |
$30.04
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Healthscope Whirlpool |
$37.58
|
| Rate for Payer: Mclaren Commercial |
$34.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.09
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.79
|
| Rate for Payer: Priority Health Narrow Network |
$270.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$172.74
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.92 |
| Max. Negotiated Rate |
$172.74 |
| Rate for Payer: Aetna Commercial |
$155.47
|
| Rate for Payer: ASR ASR |
$167.56
|
| Rate for Payer: BCBS Trust/PPO |
$133.93
|
| Rate for Payer: BCN Commercial |
$133.93
|
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$162.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.19
|
| Rate for Payer: Healthscope Commercial |
$172.74
|
| Rate for Payer: Healthscope Whirlpool |
$167.56
|
| Rate for Payer: Mclaren Commercial |
$155.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.01
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$172.74
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.10 |
| Max. Negotiated Rate |
$172.74 |
| Rate for Payer: Aetna Commercial |
$155.47
|
| Rate for Payer: ASR ASR |
$167.56
|
| Rate for Payer: BCBS Complete |
$69.10
|
| Rate for Payer: BCBS Trust/PPO |
$133.93
|
| Rate for Payer: BCN Commercial |
$133.93
|
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Cofinity Commercial |
$162.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.19
|
| Rate for Payer: Healthscope Commercial |
$172.74
|
| Rate for Payer: Healthscope Whirlpool |
$167.56
|
| Rate for Payer: Mclaren Commercial |
$155.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.19
|
| Rate for Payer: Priority Health Narrow Network |
$122.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.01
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$75.17
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: ASR ASR |
$72.91
|
| Rate for Payer: BCBS Complete |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| Rate for Payer: BCN Commercial |
$58.28
|
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Cofinity Commercial |
$70.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.14
|
| Rate for Payer: Healthscope Commercial |
$75.17
|
| Rate for Payer: Healthscope Whirlpool |
$72.91
|
| Rate for Payer: Mclaren Commercial |
$67.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.40
|
| Rate for Payer: Priority Health Narrow Network |
$53.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.15
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$75.17
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: ASR ASR |
$72.91
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| Rate for Payer: BCN Commercial |
$58.28
|
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Cofinity Commercial |
$70.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.14
|
| Rate for Payer: Healthscope Commercial |
$75.17
|
| Rate for Payer: Healthscope Whirlpool |
$72.91
|
| Rate for Payer: Mclaren Commercial |
$67.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.15
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$158.30
|
| Rate for Payer: BCBS Trust/PPO |
$126.53
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$163.20
|
| Rate for Payer: Healthscope Whirlpool |
$158.30
|
| Rate for Payer: Mclaren Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.62
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$146.88
|
| Rate for Payer: ASR ASR |
$158.30
|
| Rate for Payer: BCBS Complete |
$65.28
|
| Rate for Payer: BCBS Trust/PPO |
$126.53
|
| Rate for Payer: BCN Commercial |
$126.53
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$153.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$163.20
|
| Rate for Payer: Healthscope Whirlpool |
$158.30
|
| Rate for Payer: Mclaren Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.51
|
| Rate for Payer: Priority Health Narrow Network |
$115.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.62
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$166.83
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$116.78 |
| Max. Negotiated Rate |
$166.83 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: ASR ASR |
$161.83
|
| Rate for Payer: BCBS Trust/PPO |
$129.34
|
| Rate for Payer: BCN Commercial |
$129.34
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.46
|
| Rate for Payer: Healthscope Commercial |
$166.83
|
| Rate for Payer: Healthscope Whirlpool |
$161.83
|
| Rate for Payer: Mclaren Commercial |
$150.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.81
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$166.83
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$66.73 |
| Max. Negotiated Rate |
$180.09 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: ASR ASR |
$161.83
|
| Rate for Payer: BCBS Complete |
$66.73
|
| Rate for Payer: BCBS Trust/PPO |
$129.34
|
| Rate for Payer: BCN Commercial |
$129.34
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.46
|
| Rate for Payer: Healthscope Commercial |
$166.83
|
| Rate for Payer: Healthscope Whirlpool |
$161.83
|
| Rate for Payer: Mclaren Commercial |
$150.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.09
|
| Rate for Payer: Priority Health Narrow Network |
$144.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.81
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,461.13
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,722.79 |
| Max. Negotiated Rate |
$12,461.13 |
| Rate for Payer: Aetna Commercial |
$11,215.02
|
| Rate for Payer: ASR ASR |
$12,087.30
|
| Rate for Payer: BCBS Trust/PPO |
$9,661.11
|
| Rate for Payer: BCN Commercial |
$9,661.11
|
| Rate for Payer: Cash Price |
$9,968.90
|
| Rate for Payer: Cofinity Commercial |
$11,713.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,968.90
|
| Rate for Payer: Healthscope Commercial |
$12,461.13
|
| Rate for Payer: Healthscope Whirlpool |
$12,087.30
|
| Rate for Payer: Mclaren Commercial |
$11,215.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,591.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,722.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,965.79
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,461.13
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,130.74 |
| Max. Negotiated Rate |
$12,461.13 |
| Rate for Payer: Aetna Commercial |
$11,215.02
|
| Rate for Payer: Aetna Medicare |
$7,551.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,439.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,439.52
|
| Rate for Payer: ASR ASR |
$12,087.30
|
| Rate for Payer: BCBS Complete |
$4,337.65
|
| Rate for Payer: BCBS MAPPO |
$7,551.62
|
| Rate for Payer: BCBS Trust/PPO |
$9,661.11
|
| Rate for Payer: BCN Commercial |
$9,661.11
|
| Rate for Payer: BCN Medicare Advantage |
$7,551.62
|
| Rate for Payer: Cash Price |
$9,968.90
|
| Rate for Payer: Cash Price |
$9,968.90
|
| Rate for Payer: Cofinity Commercial |
$11,713.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,968.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,551.62
|
| Rate for Payer: Healthscope Commercial |
$12,461.13
|
| Rate for Payer: Healthscope Whirlpool |
$12,087.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,551.62
|
| Rate for Payer: Mclaren Commercial |
$11,215.02
|
| Rate for Payer: Mclaren Medicaid |
$4,130.74
|
| Rate for Payer: Mclaren Medicare |
$7,551.62
|
| Rate for Payer: Meridian Medicaid |
$4,337.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,929.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,684.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,591.96
|
| Rate for Payer: PACE Medicare |
$7,174.04
|
| Rate for Payer: PACE SWMI |
$7,551.62
|
| Rate for Payer: PHP Commercial |
$8,306.78
|
| Rate for Payer: PHP Medicaid |
$4,130.74
|
| Rate for Payer: PHP Medicare Advantage |
$7,551.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,130.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,722.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,339.63
|
| Rate for Payer: Priority Health Medicare |
$7,551.62
|
| Rate for Payer: Priority Health Narrow Network |
$8,847.40
|
| Rate for Payer: Railroad Medicare Medicare |
$7,551.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,965.79
|
| Rate for Payer: UHC Medicare Advantage |
$7,778.17
|
| Rate for Payer: VA VA |
$7,551.62
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
