|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.29
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Medicaid |
$8.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$16.82
|
| Rate for Payer: PHP Medicaid |
$8.36
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
| Rate for Payer: UHC Medicare Advantage |
$15.75
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$42.07 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Aetna Medicare |
$13.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.40
|
| Rate for Payer: ASR ASR |
$35.62
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCBS Trust/PPO |
$28.47
|
| Rate for Payer: BCN Commercial |
$28.47
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$34.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$35.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.12
|
| Rate for Payer: Mclaren Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$7.18
|
| Rate for Payer: Mclaren Medicare |
$13.12
|
| Rate for Payer: Meridian Medicaid |
$7.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$14.43
|
| Rate for Payer: PHP Medicaid |
$7.18
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health Narrow Network |
$33.66
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.31
|
| Rate for Payer: UHC Medicare Advantage |
$13.51
|
| Rate for Payer: VA VA |
$13.12
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$92.52
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.60
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$84.73
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.54 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: BCBS Trust/PPO |
$92.52
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.54 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: BCBS Trust/PPO |
$92.52
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$92.52
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$47.12
|
| Rate for Payer: PHP Medicaid |
$23.43
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.60
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$84.73
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,098.32
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$768.82 |
| Max. Negotiated Rate |
$1,098.32 |
| Rate for Payer: Aetna Commercial |
$988.49
|
| Rate for Payer: ASR ASR |
$1,065.37
|
| Rate for Payer: BCBS Trust/PPO |
$851.53
|
| Rate for Payer: BCN Commercial |
$851.53
|
| Rate for Payer: Cash Price |
$878.66
|
| Rate for Payer: Cofinity Commercial |
$1,032.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.66
|
| Rate for Payer: Healthscope Commercial |
$1,098.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,065.37
|
| Rate for Payer: Mclaren Commercial |
$988.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$933.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$966.52
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,098.32
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$1,098.32 |
| Rate for Payer: Aetna Commercial |
$988.49
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$1,065.37
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$851.53
|
| Rate for Payer: BCN Commercial |
$851.53
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$878.66
|
| Rate for Payer: Cash Price |
$878.66
|
| Rate for Payer: Cofinity Commercial |
$1,032.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$878.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$1,098.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,065.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$988.49
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$933.57
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$999.47
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$779.81
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$966.52
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,457.76
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$2,457.76 |
| Rate for Payer: Aetna Commercial |
$2,211.98
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$2,384.03
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,905.50
|
| Rate for Payer: BCN Commercial |
$1,905.50
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,966.21
|
| Rate for Payer: Cash Price |
$1,966.21
|
| Rate for Payer: Cofinity Commercial |
$2,310.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$2,457.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,384.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$2,211.98
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,089.10
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,720.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,236.56
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,745.01
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,162.83
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,457.76
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,720.43 |
| Max. Negotiated Rate |
$2,457.76 |
| Rate for Payer: Aetna Commercial |
$2,211.98
|
| Rate for Payer: ASR ASR |
$2,384.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,905.50
|
| Rate for Payer: BCN Commercial |
$1,905.50
|
| Rate for Payer: Cash Price |
$1,966.21
|
| Rate for Payer: Cofinity Commercial |
$2,310.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.21
|
| Rate for Payer: Healthscope Commercial |
$2,457.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,384.03
|
| Rate for Payer: Mclaren Commercial |
$2,211.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,089.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,720.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,162.83
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$770.51
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$770.51 |
| Rate for Payer: Aetna Commercial |
$693.46
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$747.39
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$597.38
|
| Rate for Payer: BCN Commercial |
$597.38
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$616.41
|
| Rate for Payer: Cash Price |
$616.41
|
| Rate for Payer: Cofinity Commercial |
$724.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$770.51
|
| Rate for Payer: Healthscope Whirlpool |
$747.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$693.46
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.93
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$701.16
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$547.06
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.05
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$770.51
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$539.36 |
| Max. Negotiated Rate |
$770.51 |
| Rate for Payer: Aetna Commercial |
$693.46
|
| Rate for Payer: ASR ASR |
$747.39
|
| Rate for Payer: BCBS Trust/PPO |
$597.38
|
| Rate for Payer: BCN Commercial |
$597.38
|
| Rate for Payer: Cash Price |
$616.41
|
| Rate for Payer: Cofinity Commercial |
$724.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.41
|
| Rate for Payer: Healthscope Commercial |
$770.51
|
| Rate for Payer: Healthscope Whirlpool |
$747.39
|
| Rate for Payer: Mclaren Commercial |
$693.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.05
|
|
|
HC ERBE IRRIGATION
|
Facility
|
OP
|
$309.64
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.86 |
| Max. Negotiated Rate |
$309.64 |
| Rate for Payer: Aetna Commercial |
$278.68
|
| Rate for Payer: ASR ASR |
$300.35
|
| Rate for Payer: BCBS Complete |
$123.86
|
| Rate for Payer: BCBS Trust/PPO |
$240.06
|
| Rate for Payer: BCN Commercial |
$240.06
|
| Rate for Payer: Cash Price |
$247.71
|
| Rate for Payer: Cofinity Commercial |
$291.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.71
|
| Rate for Payer: Healthscope Commercial |
$309.64
|
| Rate for Payer: Healthscope Whirlpool |
$300.35
|
| Rate for Payer: Mclaren Commercial |
$278.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.77
|
| Rate for Payer: Priority Health Narrow Network |
$219.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.48
|
|
|
HC ERBE IRRIGATION
|
Facility
|
IP
|
$309.64
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$309.64 |
| Rate for Payer: Aetna Commercial |
$278.68
|
| Rate for Payer: ASR ASR |
$300.35
|
| Rate for Payer: BCBS Trust/PPO |
$240.06
|
| Rate for Payer: BCN Commercial |
$240.06
|
| Rate for Payer: Cash Price |
$247.71
|
| Rate for Payer: Cofinity Commercial |
$291.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.71
|
| Rate for Payer: Healthscope Commercial |
$309.64
|
| Rate for Payer: Healthscope Whirlpool |
$300.35
|
| Rate for Payer: Mclaren Commercial |
$278.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.48
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$396.15
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Aetna Commercial |
$356.54
|
| Rate for Payer: ASR ASR |
$384.27
|
| Rate for Payer: BCBS Complete |
$158.46
|
| Rate for Payer: BCBS Trust/PPO |
$307.14
|
| Rate for Payer: BCN Commercial |
$307.14
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$372.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$396.15
|
| Rate for Payer: Healthscope Whirlpool |
$384.27
|
| Rate for Payer: Mclaren Commercial |
$356.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.50
|
| Rate for Payer: Priority Health Narrow Network |
$281.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.61
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$396.15
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.30 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Aetna Commercial |
$356.54
|
| Rate for Payer: ASR ASR |
$384.27
|
| Rate for Payer: BCBS Trust/PPO |
$307.14
|
| Rate for Payer: BCN Commercial |
$307.14
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$372.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$396.15
|
| Rate for Payer: Healthscope Whirlpool |
$384.27
|
| Rate for Payer: Mclaren Commercial |
$356.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.61
|
|
|
HC ERCP
|
Facility
|
OP
|
$3,330.35
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,332.14 |
| Max. Negotiated Rate |
$3,330.35 |
| Rate for Payer: Aetna Commercial |
$2,997.32
|
| Rate for Payer: ASR ASR |
$3,230.44
|
| Rate for Payer: BCBS Complete |
$1,332.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,582.02
|
| Rate for Payer: BCN Commercial |
$2,582.02
|
| Rate for Payer: Cash Price |
$2,664.28
|
| Rate for Payer: Cofinity Commercial |
$3,130.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,664.28
|
| Rate for Payer: Healthscope Commercial |
$3,330.35
|
| Rate for Payer: Healthscope Whirlpool |
$3,230.44
|
| Rate for Payer: Mclaren Commercial |
$2,997.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,830.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,331.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,030.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,364.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,930.71
|
|
|
HC ERCP
|
Facility
|
IP
|
$3,330.35
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,331.24 |
| Max. Negotiated Rate |
$3,330.35 |
| Rate for Payer: Aetna Commercial |
$2,997.32
|
| Rate for Payer: ASR ASR |
$3,230.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,582.02
|
| Rate for Payer: BCN Commercial |
$2,582.02
|
| Rate for Payer: Cash Price |
$2,664.28
|
| Rate for Payer: Cofinity Commercial |
$3,130.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,664.28
|
| Rate for Payer: Healthscope Commercial |
$3,330.35
|
| Rate for Payer: Healthscope Whirlpool |
$3,230.44
|
| Rate for Payer: Mclaren Commercial |
$2,997.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,830.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,331.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,930.71
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
IP
|
$3,966.57
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,776.60 |
| Max. Negotiated Rate |
$3,966.57 |
| Rate for Payer: Aetna Commercial |
$3,569.91
|
| Rate for Payer: ASR ASR |
$3,847.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,075.28
|
| Rate for Payer: BCN Commercial |
$3,075.28
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cofinity Commercial |
$3,728.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.26
|
| Rate for Payer: Healthscope Commercial |
$3,966.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,847.57
|
| Rate for Payer: Mclaren Commercial |
$3,569.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,371.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,776.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,490.58
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
OP
|
$3,966.57
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,586.63 |
| Max. Negotiated Rate |
$3,966.57 |
| Rate for Payer: Aetna Commercial |
$3,569.91
|
| Rate for Payer: ASR ASR |
$3,847.57
|
| Rate for Payer: BCBS Complete |
$1,586.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,075.28
|
| Rate for Payer: BCN Commercial |
$3,075.28
|
| Rate for Payer: Cash Price |
$3,173.26
|
| Rate for Payer: Cofinity Commercial |
$3,728.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,173.26
|
| Rate for Payer: Healthscope Commercial |
$3,966.57
|
| Rate for Payer: Healthscope Whirlpool |
$3,847.57
|
| Rate for Payer: Mclaren Commercial |
$3,569.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,371.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,776.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,609.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,816.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,490.58
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$746.13
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$746.13 |
| Rate for Payer: Aetna Commercial |
$671.52
|
| Rate for Payer: ASR ASR |
$723.75
|
| Rate for Payer: BCBS Trust/PPO |
$578.47
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$596.90
|
| Rate for Payer: Cofinity Commercial |
$701.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.90
|
| Rate for Payer: Healthscope Commercial |
$746.13
|
| Rate for Payer: Healthscope Whirlpool |
$723.75
|
| Rate for Payer: Mclaren Commercial |
$671.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$634.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.59
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
OP
|
$746.13
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.45 |
| Max. Negotiated Rate |
$746.13 |
| Rate for Payer: Aetna Commercial |
$671.52
|
| Rate for Payer: ASR ASR |
$723.75
|
| Rate for Payer: BCBS Complete |
$298.45
|
| Rate for Payer: BCBS Trust/PPO |
$578.47
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$596.90
|
| Rate for Payer: Cofinity Commercial |
$701.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.90
|
| Rate for Payer: Healthscope Commercial |
$746.13
|
| Rate for Payer: Healthscope Whirlpool |
$723.75
|
| Rate for Payer: Mclaren Commercial |
$671.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$634.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$678.98
|
| Rate for Payer: Priority Health Narrow Network |
$529.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$656.59
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,366.24
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,356.37 |
| Max. Negotiated Rate |
$3,366.24 |
| Rate for Payer: Aetna Commercial |
$3,029.62
|
| Rate for Payer: ASR ASR |
$3,265.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,609.85
|
| Rate for Payer: BCN Commercial |
$2,609.85
|
| Rate for Payer: Cash Price |
$2,692.99
|
| Rate for Payer: Cofinity Commercial |
$3,164.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,692.99
|
| Rate for Payer: Healthscope Commercial |
$3,366.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,265.25
|
| Rate for Payer: Mclaren Commercial |
$3,029.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,861.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,356.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,962.29
|
|
