|
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
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,007.51
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$312.30 |
| Max. Negotiated Rate |
$2,007.51 |
| Rate for Payer: Aetna Commercial |
$1,806.76
|
| Rate for Payer: Aetna Medicare |
$570.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$713.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$713.68
|
| Rate for Payer: ASR ASR |
$1,947.28
|
| Rate for Payer: BCBS Complete |
$327.95
|
| Rate for Payer: BCBS MAPPO |
$570.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,556.42
|
| Rate for Payer: BCN Commercial |
$1,556.42
|
| Rate for Payer: BCN Medicare Advantage |
$570.94
|
| Rate for Payer: Cash Price |
$1,606.01
|
| Rate for Payer: Cash Price |
$1,606.01
|
| Rate for Payer: Cofinity Commercial |
$1,887.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.94
|
| Rate for Payer: Healthscope Commercial |
$2,007.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,947.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$570.94
|
| Rate for Payer: Mclaren Commercial |
$1,806.76
|
| Rate for Payer: Mclaren Medicaid |
$312.30
|
| Rate for Payer: Mclaren Medicare |
$570.94
|
| Rate for Payer: Meridian Medicaid |
$327.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$599.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$656.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,706.38
|
| Rate for Payer: PACE Medicare |
$542.39
|
| Rate for Payer: PACE SWMI |
$570.94
|
| Rate for Payer: PHP Commercial |
$628.03
|
| Rate for Payer: PHP Medicaid |
$312.30
|
| Rate for Payer: PHP Medicare Advantage |
$570.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.00
|
| Rate for Payer: Priority Health Medicare |
$570.94
|
| Rate for Payer: Priority Health Narrow Network |
$752.80
|
| Rate for Payer: Railroad Medicare Medicare |
$570.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,766.61
|
| Rate for Payer: UHC Medicare Advantage |
$588.07
|
| Rate for Payer: VA VA |
$570.94
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,007.51
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,405.26 |
| Max. Negotiated Rate |
$2,007.51 |
| Rate for Payer: Aetna Commercial |
$1,806.76
|
| Rate for Payer: ASR ASR |
$1,947.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,556.42
|
| Rate for Payer: BCN Commercial |
$1,556.42
|
| Rate for Payer: Cash Price |
$1,606.01
|
| Rate for Payer: Cofinity Commercial |
$1,887.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,606.01
|
| Rate for Payer: Healthscope Commercial |
$2,007.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,947.28
|
| Rate for Payer: Mclaren Commercial |
$1,806.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,706.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,766.61
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,391.19
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.35 |
| Max. Negotiated Rate |
$1,391.19 |
| Rate for Payer: Aetna Commercial |
$1,252.07
|
| Rate for Payer: Aetna Medicare |
$393.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.11
|
| Rate for Payer: ASR ASR |
$1,349.45
|
| Rate for Payer: BCBS Complete |
$226.14
|
| Rate for Payer: BCBS MAPPO |
$393.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,078.59
|
| Rate for Payer: BCN Commercial |
$1,078.59
|
| Rate for Payer: BCN Medicare Advantage |
$393.69
|
| Rate for Payer: Cash Price |
$1,112.95
|
| Rate for Payer: Cash Price |
$1,112.95
|
| Rate for Payer: Cofinity Commercial |
$1,307.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,112.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.69
|
| Rate for Payer: Healthscope Commercial |
$1,391.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,349.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.69
|
| Rate for Payer: Mclaren Commercial |
$1,252.07
|
| Rate for Payer: Mclaren Medicaid |
$215.35
|
| Rate for Payer: Mclaren Medicare |
$393.69
|
| Rate for Payer: Meridian Medicaid |
$226.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$413.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,182.51
|
| Rate for Payer: PACE Medicare |
$374.01
|
| Rate for Payer: PACE SWMI |
$393.69
|
| Rate for Payer: PHP Commercial |
$433.06
|
| Rate for Payer: PHP Medicaid |
$215.35
|
| Rate for Payer: PHP Medicare Advantage |
$393.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.39
|
| Rate for Payer: Priority Health Medicare |
$393.69
|
| Rate for Payer: Priority Health Narrow Network |
$513.91
|
| Rate for Payer: Railroad Medicare Medicare |
$393.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,224.25
|
| Rate for Payer: UHC Medicare Advantage |
$405.50
|
| Rate for Payer: VA VA |
$393.69
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,391.19
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.83 |
| Max. Negotiated Rate |
$1,391.19 |
| Rate for Payer: Aetna Commercial |
$1,252.07
|
| Rate for Payer: ASR ASR |
$1,349.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,078.59
|
| Rate for Payer: BCN Commercial |
$1,078.59
|
| Rate for Payer: Cash Price |
$1,112.95
|
| Rate for Payer: Cofinity Commercial |
$1,307.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,112.95
|
| Rate for Payer: Healthscope Commercial |
$1,391.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,349.45
|
| Rate for Payer: Mclaren Commercial |
$1,252.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,182.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,224.25
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$252.31
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.62 |
| Max. Negotiated Rate |
$252.31 |
| Rate for Payer: Aetna Commercial |
$227.08
|
| Rate for Payer: ASR ASR |
$244.74
|
| Rate for Payer: BCBS Trust/PPO |
$195.62
|
| Rate for Payer: BCN Commercial |
$195.62
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$237.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.85
|
| Rate for Payer: Healthscope Commercial |
$252.31
|
| Rate for Payer: Healthscope Whirlpool |
$244.74
|
| Rate for Payer: Mclaren Commercial |
$227.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.03
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$252.31
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$252.31 |
| Rate for Payer: Aetna Commercial |
$227.08
|
| Rate for Payer: Aetna Medicare |
$78.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.65
|
| Rate for Payer: ASR ASR |
$244.74
|
| Rate for Payer: BCBS Complete |
$45.33
|
| Rate for Payer: BCBS MAPPO |
$78.92
|
| Rate for Payer: BCBS Trust/PPO |
$195.62
|
| Rate for Payer: BCN Commercial |
$195.62
|
| Rate for Payer: BCN Medicare Advantage |
$78.92
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cash Price |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$237.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.92
|
| Rate for Payer: Healthscope Commercial |
$252.31
|
| Rate for Payer: Healthscope Whirlpool |
$244.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$78.92
|
| Rate for Payer: Mclaren Commercial |
$227.08
|
| Rate for Payer: Mclaren Medicaid |
$43.17
|
| Rate for Payer: Mclaren Medicare |
$78.92
|
| Rate for Payer: Meridian Medicaid |
$45.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.46
|
| Rate for Payer: PACE Medicare |
$74.97
|
| Rate for Payer: PACE SWMI |
$78.92
|
| Rate for Payer: PHP Commercial |
$86.81
|
| Rate for Payer: PHP Medicaid |
$43.17
|
| Rate for Payer: PHP Medicare Advantage |
$78.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.16
|
| Rate for Payer: Priority Health Medicare |
$78.92
|
| Rate for Payer: Priority Health Narrow Network |
$130.53
|
| Rate for Payer: Railroad Medicare Medicare |
$78.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.03
|
| Rate for Payer: UHC Medicare Advantage |
$81.29
|
| Rate for Payer: VA VA |
$78.92
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$885.90
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$885.90 |
| Rate for Payer: Aetna Commercial |
$797.31
|
| Rate for Payer: Aetna Medicare |
$253.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$317.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$317.01
|
| Rate for Payer: ASR ASR |
$859.32
|
| Rate for Payer: BCBS Complete |
$145.67
|
| Rate for Payer: BCBS MAPPO |
$253.61
|
| Rate for Payer: BCBS Trust/PPO |
$686.84
|
| Rate for Payer: BCN Commercial |
$686.84
|
| Rate for Payer: BCN Medicare Advantage |
$253.61
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Commercial |
$832.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.61
|
| Rate for Payer: Healthscope Commercial |
$885.90
|
| Rate for Payer: Healthscope Whirlpool |
$859.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$253.61
|
| Rate for Payer: Mclaren Commercial |
$797.31
|
| Rate for Payer: Mclaren Medicaid |
$138.72
|
| Rate for Payer: Mclaren Medicare |
$253.61
|
| Rate for Payer: Meridian Medicaid |
$145.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$266.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$753.02
|
| Rate for Payer: PACE Medicare |
$240.93
|
| Rate for Payer: PACE SWMI |
$253.61
|
| Rate for Payer: PHP Commercial |
$278.97
|
| Rate for Payer: PHP Medicaid |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$253.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.41
|
| Rate for Payer: Priority Health Medicare |
$253.61
|
| Rate for Payer: Priority Health Narrow Network |
$357.93
|
| Rate for Payer: Railroad Medicare Medicare |
$253.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$779.59
|
| Rate for Payer: UHC Medicare Advantage |
$261.22
|
| Rate for Payer: VA VA |
$253.61
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$885.90
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$620.13 |
| Max. Negotiated Rate |
$885.90 |
| Rate for Payer: Aetna Commercial |
$797.31
|
| Rate for Payer: ASR ASR |
$859.32
|
| Rate for Payer: BCBS Trust/PPO |
$686.84
|
| Rate for Payer: BCN Commercial |
$686.84
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Commercial |
$832.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Healthscope Commercial |
$885.90
|
| Rate for Payer: Healthscope Whirlpool |
$859.32
|
| Rate for Payer: Mclaren Commercial |
$797.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$753.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$779.59
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$502.02
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.52 |
| Max. Negotiated Rate |
$502.02 |
| Rate for Payer: Aetna Commercial |
$451.82
|
| Rate for Payer: Aetna Medicare |
$145.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.72
|
| Rate for Payer: ASR ASR |
$486.96
|
| Rate for Payer: BCBS Complete |
$83.51
|
| Rate for Payer: BCBS MAPPO |
$145.38
|
| Rate for Payer: BCBS Trust/PPO |
$389.22
|
| Rate for Payer: BCN Commercial |
$389.22
|
| Rate for Payer: BCN Medicare Advantage |
$145.38
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$471.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.38
|
| Rate for Payer: Healthscope Commercial |
$502.02
|
| Rate for Payer: Healthscope Whirlpool |
$486.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$145.38
|
| Rate for Payer: Mclaren Commercial |
$451.82
|
| Rate for Payer: Mclaren Medicaid |
$79.52
|
| Rate for Payer: Mclaren Medicare |
$145.38
|
| Rate for Payer: Meridian Medicaid |
$83.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.72
|
| Rate for Payer: PACE Medicare |
$138.11
|
| Rate for Payer: PACE SWMI |
$145.38
|
| Rate for Payer: PHP Commercial |
$159.92
|
| Rate for Payer: PHP Medicaid |
$79.52
|
| Rate for Payer: PHP Medicare Advantage |
$145.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.55
|
| Rate for Payer: Priority Health Medicare |
$145.38
|
| Rate for Payer: Priority Health Narrow Network |
$174.04
|
| Rate for Payer: Railroad Medicare Medicare |
$145.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.78
|
| Rate for Payer: UHC Medicare Advantage |
$149.74
|
| Rate for Payer: VA VA |
$145.38
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$502.02
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.41 |
| Max. Negotiated Rate |
$502.02 |
| Rate for Payer: Aetna Commercial |
$451.82
|
| Rate for Payer: ASR ASR |
$486.96
|
| Rate for Payer: BCBS Trust/PPO |
$389.22
|
| Rate for Payer: BCN Commercial |
$389.22
|
| Rate for Payer: Cash Price |
$401.62
|
| Rate for Payer: Cofinity Commercial |
$471.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.62
|
| Rate for Payer: Healthscope Commercial |
$502.02
|
| Rate for Payer: Healthscope Whirlpool |
$486.96
|
| Rate for Payer: Mclaren Commercial |
$451.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$426.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.78
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,291.02
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$2,303.71 |
| Max. Negotiated Rate |
$3,291.02 |
| Rate for Payer: Aetna Commercial |
$2,961.92
|
| Rate for Payer: ASR ASR |
$3,192.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,551.53
|
| Rate for Payer: BCN Commercial |
$2,551.53
|
| Rate for Payer: Cash Price |
$2,632.82
|
| Rate for Payer: Cofinity Commercial |
$3,093.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,632.82
|
| Rate for Payer: Healthscope Commercial |
$3,291.02
|
| Rate for Payer: Healthscope Whirlpool |
$3,192.29
|
| Rate for Payer: Mclaren Commercial |
$2,961.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,797.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,303.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,896.10
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.43 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: BCBS Trust/PPO |
$535.43
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS Trust/PPO |
$535.43
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.46
|
| Rate for Payer: Priority Health Narrow Network |
$490.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS Trust/PPO |
$535.43
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.46
|
| Rate for Payer: Priority Health Narrow Network |
$490.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC ER SURGICAL HAND/FOOT CARE
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.43 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: BCBS Trust/PPO |
$535.43
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$67.73 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$18.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.49
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS MAPPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.79
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$10.28
|
| Rate for Payer: Mclaren Medicare |
$18.79
|
| Rate for Payer: Meridian Medicaid |
$10.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$17.85
|
| Rate for Payer: PACE SWMI |
$18.79
|
| Rate for Payer: PHP Commercial |
$20.67
|
| Rate for Payer: PHP Medicaid |
$10.28
|
| Rate for Payer: PHP Medicare Advantage |
$18.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.73
|
| Rate for Payer: Priority Health Medicare |
$18.79
|
| Rate for Payer: Priority Health Narrow Network |
$54.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: VA VA |
$18.79
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| 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 |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| 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 |
$43.35
|
| 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 |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ESOPHAGEAL IMPEDENCE MONITORIN
|
Facility
|
IP
|
$1,422.96
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$996.07 |
| Max. Negotiated Rate |
$1,422.96 |
| Rate for Payer: Aetna Commercial |
$1,280.66
|
| Rate for Payer: ASR ASR |
$1,380.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.22
|
| Rate for Payer: BCN Commercial |
$1,103.22
|
| Rate for Payer: Cash Price |
$1,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,337.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.37
|
| Rate for Payer: Healthscope Commercial |
$1,422.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.27
|
| Rate for Payer: Mclaren Commercial |
$1,280.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,209.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,252.20
|
|
|
HC ESOPHAGEAL IMPEDENCE MONITORIN
|
Facility
|
OP
|
$1,422.96
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$569.18 |
| Max. Negotiated Rate |
$1,422.96 |
| Rate for Payer: Aetna Commercial |
$1,280.66
|
| Rate for Payer: ASR ASR |
$1,380.27
|
| Rate for Payer: BCBS Complete |
$569.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.22
|
| Rate for Payer: BCN Commercial |
$1,103.22
|
| Rate for Payer: Cash Price |
$1,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,337.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.37
|
| Rate for Payer: Healthscope Commercial |
$1,422.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.27
|
| Rate for Payer: Mclaren Commercial |
$1,280.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,209.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,294.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,010.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,252.20
|
|
|
HC ESOPHAGEAL MAPPING CATHETER
|
Facility
|
IP
|
$1,410.81
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$987.57 |
| Max. Negotiated Rate |
$1,410.81 |
| Rate for Payer: Aetna Commercial |
$1,269.73
|
| Rate for Payer: ASR ASR |
$1,368.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.80
|
| Rate for Payer: BCN Commercial |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,326.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Healthscope Commercial |
$1,410.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,368.49
|
| Rate for Payer: Mclaren Commercial |
$1,269.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,199.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,241.51
|
|
