|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,557.06
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,917.80 |
| Max. Negotiated Rate |
$2,557.06 |
| Rate for Payer: Aetna Commercial |
$2,301.35
|
| Rate for Payer: ASR ASR |
$2,480.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,099.86
|
| Rate for Payer: BCN Commercial |
$2,099.86
|
| Rate for Payer: Cash Price |
$2,045.65
|
| Rate for Payer: Cofinity Commercial |
$2,403.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.65
|
| Rate for Payer: Healthscope Commercial |
$2,480.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,557.06
|
| Rate for Payer: Mclaren Commercial |
$2,301.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,173.50
|
| Rate for Payer: Nomi Health Commercial |
$2,096.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,250.21
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,557.06
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$2,557.06 |
| Rate for Payer: Aetna Commercial |
$2,301.35
|
| Rate for Payer: Aetna Medicare |
$855.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: ASR ASR |
$2,480.35
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.30
|
| Rate for Payer: BCN Commercial |
$2,108.30
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$2,045.65
|
| Rate for Payer: Cash Price |
$2,045.65
|
| Rate for Payer: Cofinity Commercial |
$2,403.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$2,480.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,557.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$855.65
|
| Rate for Payer: Mclaren Commercial |
$2,301.35
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$469.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,173.50
|
| Rate for Payer: Nomi Health Commercial |
$2,096.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.80
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$941.22
|
| Rate for Payer: PHP Medicaid |
$458.63
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,240.50
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.50
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,250.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,326.26
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP DNSP |
$855.65
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$801.64
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$801.64 |
| Rate for Payer: Aetna Commercial |
$721.48
|
| Rate for Payer: Aetna Medicare |
$215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: ASR ASR |
$777.59
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$660.95
|
| Rate for Payer: BCN Commercial |
$660.95
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$641.31
|
| Rate for Payer: Cash Price |
$641.31
|
| Rate for Payer: Cofinity Commercial |
$753.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$777.59
|
| Rate for Payer: Healthscope Whirlpool |
$801.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$215.15
|
| Rate for Payer: Mclaren Commercial |
$721.48
|
| Rate for Payer: Mclaren Medicaid |
$215.15
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$118.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.39
|
| Rate for Payer: Nomi Health Commercial |
$657.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.23
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$236.66
|
| Rate for Payer: PHP Medicaid |
$115.32
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$702.40
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health Narrow Network |
$561.95
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$333.48
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP DNSP |
$215.15
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$801.64
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$801.64 |
| Rate for Payer: Aetna Commercial |
$721.48
|
| Rate for Payer: ASR ASR |
$777.59
|
| Rate for Payer: BCBS Trust/PPO |
$658.31
|
| Rate for Payer: BCN Commercial |
$658.31
|
| Rate for Payer: Cash Price |
$641.31
|
| Rate for Payer: Cofinity Commercial |
$753.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.31
|
| Rate for Payer: Healthscope Commercial |
$777.59
|
| Rate for Payer: Healthscope Whirlpool |
$801.64
|
| Rate for Payer: Mclaren Commercial |
$721.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.39
|
| Rate for Payer: Nomi Health Commercial |
$657.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$705.44
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$412.15
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.11 |
| Max. Negotiated Rate |
$412.15 |
| Rate for Payer: Aetna Commercial |
$370.94
|
| Rate for Payer: ASR ASR |
$399.79
|
| Rate for Payer: BCBS Trust/PPO |
$338.46
|
| Rate for Payer: BCN Commercial |
$338.46
|
| Rate for Payer: Cash Price |
$329.72
|
| Rate for Payer: Cofinity Commercial |
$387.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.72
|
| Rate for Payer: Healthscope Commercial |
$399.79
|
| Rate for Payer: Healthscope Whirlpool |
$412.15
|
| Rate for Payer: Mclaren Commercial |
$370.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.33
|
| Rate for Payer: Nomi Health Commercial |
$337.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.69
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$412.15
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.50 |
| Max. Negotiated Rate |
$412.15 |
| Rate for Payer: Aetna Commercial |
$370.94
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: ASR ASR |
$399.79
|
| Rate for Payer: BCBS Complete |
$164.86
|
| Rate for Payer: BCBS Trust/PPO |
$339.82
|
| Rate for Payer: BCN Commercial |
$339.82
|
| Rate for Payer: Cash Price |
$329.72
|
| Rate for Payer: Cofinity Commercial |
$387.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.72
|
| Rate for Payer: Healthscope Commercial |
$399.79
|
| Rate for Payer: Healthscope Whirlpool |
$412.15
|
| Rate for Payer: Mclaren Commercial |
$370.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.33
|
| Rate for Payer: Nomi Health Commercial |
$337.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$361.13
|
| Rate for Payer: Priority Health Narrow Network |
$288.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.69
|
|
|
HC ERCP
|
Facility
|
IP
|
$3,464.90
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,598.68 |
| Max. Negotiated Rate |
$3,464.90 |
| Rate for Payer: Aetna Commercial |
$3,118.41
|
| Rate for Payer: ASR ASR |
$3,360.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,845.38
|
| Rate for Payer: BCN Commercial |
$2,845.38
|
| Rate for Payer: Cash Price |
$2,771.92
|
| Rate for Payer: Cofinity Commercial |
$3,257.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.92
|
| Rate for Payer: Healthscope Commercial |
$3,360.95
|
| Rate for Payer: Healthscope Whirlpool |
$3,464.90
|
| Rate for Payer: Mclaren Commercial |
$3,118.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,945.16
|
| Rate for Payer: Nomi Health Commercial |
$2,841.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,598.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,049.11
|
|
|
HC ERCP
|
Facility
|
OP
|
$3,464.90
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,282.01 |
| Max. Negotiated Rate |
$3,464.90 |
| Rate for Payer: Aetna Commercial |
$3,118.41
|
| Rate for Payer: Aetna Medicare |
$1,282.01
|
| Rate for Payer: ASR ASR |
$3,360.95
|
| Rate for Payer: BCBS Complete |
$1,385.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,856.81
|
| Rate for Payer: BCN Commercial |
$2,856.81
|
| Rate for Payer: Cash Price |
$2,771.92
|
| Rate for Payer: Cofinity Commercial |
$3,257.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.92
|
| Rate for Payer: Healthscope Commercial |
$3,360.95
|
| Rate for Payer: Healthscope Whirlpool |
$3,464.90
|
| Rate for Payer: Mclaren Commercial |
$3,118.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,771.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,945.16
|
| Rate for Payer: Nomi Health Commercial |
$2,841.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,598.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,035.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,428.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,049.11
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
IP
|
$4,126.82
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,095.11 |
| Max. Negotiated Rate |
$4,126.82 |
| Rate for Payer: Aetna Commercial |
$3,714.14
|
| Rate for Payer: ASR ASR |
$4,003.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,388.94
|
| Rate for Payer: BCN Commercial |
$3,388.94
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cofinity Commercial |
$3,879.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.46
|
| Rate for Payer: Healthscope Commercial |
$4,003.02
|
| Rate for Payer: Healthscope Whirlpool |
$4,126.82
|
| Rate for Payer: Mclaren Commercial |
$3,714.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.80
|
| Rate for Payer: Nomi Health Commercial |
$3,383.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,095.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,631.60
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
OP
|
$4,126.82
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,526.92 |
| Max. Negotiated Rate |
$4,126.82 |
| Rate for Payer: Aetna Commercial |
$3,714.14
|
| Rate for Payer: Aetna Medicare |
$1,526.92
|
| Rate for Payer: ASR ASR |
$4,003.02
|
| Rate for Payer: BCBS Complete |
$1,650.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,402.56
|
| Rate for Payer: BCN Commercial |
$3,402.56
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cofinity Commercial |
$3,879.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.46
|
| Rate for Payer: Healthscope Commercial |
$4,003.02
|
| Rate for Payer: Healthscope Whirlpool |
$4,126.82
|
| Rate for Payer: Mclaren Commercial |
$3,714.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,301.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.80
|
| Rate for Payer: Nomi Health Commercial |
$3,383.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,095.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,615.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,892.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,631.60
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
OP
|
$958.04
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.47 |
| Max. Negotiated Rate |
$958.04 |
| Rate for Payer: Aetna Commercial |
$862.24
|
| Rate for Payer: Aetna Medicare |
$354.47
|
| Rate for Payer: ASR ASR |
$929.30
|
| Rate for Payer: BCBS Complete |
$383.22
|
| Rate for Payer: BCBS Trust/PPO |
$789.90
|
| Rate for Payer: BCN Commercial |
$789.90
|
| Rate for Payer: Cash Price |
$766.43
|
| Rate for Payer: Cofinity Commercial |
$900.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.43
|
| Rate for Payer: Healthscope Commercial |
$929.30
|
| Rate for Payer: Healthscope Whirlpool |
$958.04
|
| Rate for Payer: Mclaren Commercial |
$862.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$766.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.33
|
| Rate for Payer: Nomi Health Commercial |
$785.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$839.43
|
| Rate for Payer: Priority Health Narrow Network |
$671.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.08
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$958.04
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$718.53 |
| Max. Negotiated Rate |
$958.04 |
| Rate for Payer: Aetna Commercial |
$862.24
|
| Rate for Payer: ASR ASR |
$929.30
|
| Rate for Payer: BCBS Trust/PPO |
$786.74
|
| Rate for Payer: BCN Commercial |
$786.74
|
| Rate for Payer: Cash Price |
$766.43
|
| Rate for Payer: Cofinity Commercial |
$900.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.43
|
| Rate for Payer: Healthscope Commercial |
$929.30
|
| Rate for Payer: Healthscope Whirlpool |
$958.04
|
| Rate for Payer: Mclaren Commercial |
$862.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.33
|
| Rate for Payer: Nomi Health Commercial |
$785.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.08
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
OP
|
$3,673.91
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$430.46 |
| Max. Negotiated Rate |
$3,673.91 |
| Rate for Payer: Aetna Commercial |
$3,306.52
|
| Rate for Payer: Aetna Medicare |
$823.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,028.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,028.83
|
| Rate for Payer: ASR ASR |
$3,563.69
|
| Rate for Payer: BCBS Complete |
$452.02
|
| Rate for Payer: BCBS MAPPO |
$823.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,029.14
|
| Rate for Payer: BCN Commercial |
$3,029.14
|
| Rate for Payer: BCN Medicare Advantage |
$823.06
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cofinity Commercial |
$3,453.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.06
|
| Rate for Payer: Healthscope Commercial |
$3,563.69
|
| Rate for Payer: Healthscope Whirlpool |
$3,673.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$823.06
|
| Rate for Payer: Mclaren Commercial |
$3,306.52
|
| Rate for Payer: Mclaren Medicaid |
$823.06
|
| Rate for Payer: Mclaren Medicare |
$823.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.21
|
| Rate for Payer: Meridian Medicaid |
$452.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$946.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$905.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,122.82
|
| Rate for Payer: Nomi Health Commercial |
$3,012.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,755.43
|
| Rate for Payer: PACE Medicare |
$781.91
|
| Rate for Payer: PACE SWMI |
$823.06
|
| Rate for Payer: PHP Commercial |
$905.37
|
| Rate for Payer: PHP Medicaid |
$441.16
|
| Rate for Payer: PHP Medicare Advantage |
$823.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,219.08
|
| Rate for Payer: Priority Health Medicare |
$823.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,575.41
|
| Rate for Payer: Railroad Medicare Medicare |
$823.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,233.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$823.06
|
| Rate for Payer: UHC Exchange |
$1,275.74
|
| Rate for Payer: UHC Medicaid |
$430.46
|
| Rate for Payer: UHCCP DNSP |
$823.06
|
| Rate for Payer: UHCCP Medicaid |
$430.46
|
| Rate for Payer: VA VA |
$823.06
|
|
|
HC ER CRITICAL CARE INITIAL 30-74 MIN
|
Facility
|
IP
|
$3,673.91
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,755.43 |
| Max. Negotiated Rate |
$3,673.91 |
| Rate for Payer: Aetna Commercial |
$3,306.52
|
| Rate for Payer: ASR ASR |
$3,563.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,017.01
|
| Rate for Payer: BCN Commercial |
$3,017.01
|
| Rate for Payer: Cash Price |
$2,939.13
|
| Rate for Payer: Cofinity Commercial |
$3,453.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,939.13
|
| Rate for Payer: Healthscope Commercial |
$3,563.69
|
| Rate for Payer: Healthscope Whirlpool |
$3,673.91
|
| Rate for Payer: Mclaren Commercial |
$3,306.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,122.82
|
| Rate for Payer: Nomi Health Commercial |
$3,012.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,755.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,233.04
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
OP
|
$2,191.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.34 |
| Max. Negotiated Rate |
$2,191.00 |
| Rate for Payer: Aetna Commercial |
$1,971.90
|
| Rate for Payer: Aetna Medicare |
$593.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$741.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$741.74
|
| Rate for Payer: ASR ASR |
$2,125.27
|
| Rate for Payer: BCBS Complete |
$325.89
|
| Rate for Payer: BCBS MAPPO |
$593.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,806.48
|
| Rate for Payer: BCN Commercial |
$1,806.48
|
| Rate for Payer: BCN Medicare Advantage |
$593.39
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Commercial |
$2,059.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,752.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.39
|
| Rate for Payer: Healthscope Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,191.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$593.39
|
| Rate for Payer: Mclaren Commercial |
$1,971.90
|
| Rate for Payer: Mclaren Medicaid |
$593.39
|
| Rate for Payer: Mclaren Medicare |
$593.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.06
|
| Rate for Payer: Meridian Medicaid |
$325.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$682.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$652.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,862.35
|
| Rate for Payer: Nomi Health Commercial |
$1,796.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: PACE Medicare |
$563.72
|
| Rate for Payer: PACE SWMI |
$593.39
|
| Rate for Payer: PHP Commercial |
$652.73
|
| Rate for Payer: PHP Medicaid |
$318.06
|
| Rate for Payer: PHP Medicare Advantage |
$593.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,110.07
|
| Rate for Payer: Priority Health Medicare |
$593.39
|
| Rate for Payer: Priority Health Narrow Network |
$888.06
|
| Rate for Payer: Railroad Medicare Medicare |
$593.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,928.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$593.39
|
| Rate for Payer: UHC Exchange |
$919.75
|
| Rate for Payer: UHC Medicaid |
$310.34
|
| Rate for Payer: UHCCP DNSP |
$593.39
|
| Rate for Payer: UHCCP Medicaid |
$310.34
|
| Rate for Payer: VA VA |
$593.39
|
|
|
HC ER LEVEL FIVE 99285
|
Facility
|
IP
|
$2,191.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
45000025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,643.25 |
| Max. Negotiated Rate |
$2,191.00 |
| Rate for Payer: Aetna Commercial |
$1,971.90
|
| Rate for Payer: ASR ASR |
$2,125.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.25
|
| Rate for Payer: BCN Commercial |
$1,799.25
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Commercial |
$2,059.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,752.80
|
| Rate for Payer: Healthscope Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,191.00
|
| Rate for Payer: Mclaren Commercial |
$1,971.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,862.35
|
| Rate for Payer: Nomi Health Commercial |
$1,796.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,928.08
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
OP
|
$1,518.34
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.44 |
| Max. Negotiated Rate |
$1,518.34 |
| Rate for Payer: Aetna Commercial |
$1,366.51
|
| Rate for Payer: Aetna Medicare |
$415.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.70
|
| Rate for Payer: ASR ASR |
$1,472.79
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$415.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,251.87
|
| Rate for Payer: BCN Commercial |
$1,251.87
|
| Rate for Payer: BCN Medicare Advantage |
$415.76
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cofinity Commercial |
$1,427.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.76
|
| Rate for Payer: Healthscope Commercial |
$1,472.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,518.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$415.76
|
| Rate for Payer: Mclaren Commercial |
$1,366.51
|
| Rate for Payer: Mclaren Medicaid |
$415.76
|
| Rate for Payer: Mclaren Medicare |
$415.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.55
|
| Rate for Payer: Meridian Medicaid |
$228.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.59
|
| Rate for Payer: Nomi Health Commercial |
$1,245.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.76
|
| Rate for Payer: PACE Medicare |
$394.97
|
| Rate for Payer: PACE SWMI |
$415.76
|
| Rate for Payer: PHP Commercial |
$457.34
|
| Rate for Payer: PHP Medicaid |
$222.85
|
| Rate for Payer: PHP Medicare Advantage |
$415.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$757.82
|
| Rate for Payer: Priority Health Medicare |
$415.76
|
| Rate for Payer: Priority Health Narrow Network |
$606.25
|
| Rate for Payer: Railroad Medicare Medicare |
$415.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,336.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.76
|
| Rate for Payer: UHC Exchange |
$644.43
|
| Rate for Payer: UHC Medicaid |
$217.44
|
| Rate for Payer: UHCCP DNSP |
$415.76
|
| Rate for Payer: UHCCP Medicaid |
$217.44
|
| Rate for Payer: VA VA |
$415.76
|
|
|
HC ER LEVEL FOUR 99284
|
Facility
|
IP
|
$1,518.34
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
45000024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,138.76 |
| Max. Negotiated Rate |
$1,518.34 |
| Rate for Payer: Aetna Commercial |
$1,366.51
|
| Rate for Payer: ASR ASR |
$1,472.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.86
|
| Rate for Payer: BCN Commercial |
$1,246.86
|
| Rate for Payer: Cash Price |
$1,214.67
|
| Rate for Payer: Cofinity Commercial |
$1,427.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.67
|
| Rate for Payer: Healthscope Commercial |
$1,472.79
|
| Rate for Payer: Healthscope Whirlpool |
$1,518.34
|
| Rate for Payer: Mclaren Commercial |
$1,366.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.59
|
| Rate for Payer: Nomi Health Commercial |
$1,245.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,336.14
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$275.38
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$275.38 |
| Rate for Payer: Aetna Commercial |
$247.84
|
| Rate for Payer: Aetna Medicare |
$84.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.03
|
| Rate for Payer: ASR ASR |
$267.12
|
| Rate for Payer: BCBS Complete |
$46.14
|
| Rate for Payer: BCBS MAPPO |
$84.02
|
| Rate for Payer: BCBS Trust/PPO |
$227.05
|
| Rate for Payer: BCN Commercial |
$227.05
|
| Rate for Payer: BCN Medicare Advantage |
$84.02
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cofinity Commercial |
$258.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.02
|
| Rate for Payer: Healthscope Commercial |
$267.12
|
| Rate for Payer: Healthscope Whirlpool |
$275.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$84.02
|
| Rate for Payer: Mclaren Commercial |
$247.84
|
| Rate for Payer: Mclaren Medicaid |
$84.02
|
| Rate for Payer: Mclaren Medicare |
$84.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.22
|
| Rate for Payer: Meridian Medicaid |
$46.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.07
|
| Rate for Payer: Nomi Health Commercial |
$225.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.53
|
| Rate for Payer: PACE Medicare |
$79.82
|
| Rate for Payer: PACE SWMI |
$84.02
|
| Rate for Payer: PHP Commercial |
$92.42
|
| Rate for Payer: PHP Medicaid |
$45.03
|
| Rate for Payer: PHP Medicare Advantage |
$84.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$192.48
|
| Rate for Payer: Priority Health Medicare |
$84.02
|
| Rate for Payer: Priority Health Narrow Network |
$153.98
|
| Rate for Payer: Railroad Medicare Medicare |
$84.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.02
|
| Rate for Payer: UHC Exchange |
$130.23
|
| Rate for Payer: UHC Medicaid |
$43.94
|
| Rate for Payer: UHCCP DNSP |
$84.02
|
| Rate for Payer: UHCCP Medicaid |
$43.94
|
| Rate for Payer: VA VA |
$84.02
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$275.38
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.53 |
| Max. Negotiated Rate |
$275.38 |
| Rate for Payer: Aetna Commercial |
$247.84
|
| Rate for Payer: ASR ASR |
$267.12
|
| Rate for Payer: BCBS Trust/PPO |
$226.14
|
| Rate for Payer: BCN Commercial |
$226.14
|
| Rate for Payer: Cash Price |
$220.30
|
| Rate for Payer: Cofinity Commercial |
$258.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.30
|
| Rate for Payer: Healthscope Commercial |
$267.12
|
| Rate for Payer: Healthscope Whirlpool |
$275.38
|
| Rate for Payer: Mclaren Commercial |
$247.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.07
|
| Rate for Payer: Nomi Health Commercial |
$225.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.33
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$966.87
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.26 |
| Max. Negotiated Rate |
$966.87 |
| Rate for Payer: Aetna Commercial |
$870.18
|
| Rate for Payer: Aetna Medicare |
$272.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.00
|
| Rate for Payer: ASR ASR |
$937.86
|
| Rate for Payer: BCBS Complete |
$149.38
|
| Rate for Payer: BCBS MAPPO |
$272.00
|
| Rate for Payer: BCBS Trust/PPO |
$797.18
|
| Rate for Payer: BCN Commercial |
$797.18
|
| Rate for Payer: BCN Medicare Advantage |
$272.00
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cofinity Commercial |
$908.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$937.86
|
| Rate for Payer: Healthscope Whirlpool |
$966.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$272.00
|
| Rate for Payer: Mclaren Commercial |
$870.18
|
| Rate for Payer: Mclaren Medicaid |
$272.00
|
| Rate for Payer: Mclaren Medicare |
$272.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.60
|
| Rate for Payer: Meridian Medicaid |
$149.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.84
|
| Rate for Payer: Nomi Health Commercial |
$792.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.15
|
| Rate for Payer: PACE Medicare |
$258.40
|
| Rate for Payer: PACE SWMI |
$272.00
|
| Rate for Payer: PHP Commercial |
$299.20
|
| Rate for Payer: PHP Medicaid |
$145.79
|
| Rate for Payer: PHP Medicare Advantage |
$272.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$527.80
|
| Rate for Payer: Priority Health Medicare |
$272.00
|
| Rate for Payer: Priority Health Narrow Network |
$422.24
|
| Rate for Payer: Railroad Medicare Medicare |
$272.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$272.00
|
| Rate for Payer: UHC Exchange |
$421.60
|
| Rate for Payer: UHC Medicaid |
$142.26
|
| Rate for Payer: UHCCP DNSP |
$272.00
|
| Rate for Payer: UHCCP Medicaid |
$142.26
|
| Rate for Payer: VA VA |
$272.00
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$966.87
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.15 |
| Max. Negotiated Rate |
$966.87 |
| Rate for Payer: Aetna Commercial |
$870.18
|
| Rate for Payer: ASR ASR |
$937.86
|
| Rate for Payer: BCBS Trust/PPO |
$793.99
|
| Rate for Payer: BCN Commercial |
$793.99
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cofinity Commercial |
$908.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.50
|
| Rate for Payer: Healthscope Commercial |
$937.86
|
| Rate for Payer: Healthscope Whirlpool |
$966.87
|
| Rate for Payer: Mclaren Commercial |
$870.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.84
|
| Rate for Payer: Nomi Health Commercial |
$792.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.85
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$547.90
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$547.90 |
| Rate for Payer: Aetna Commercial |
$493.11
|
| Rate for Payer: Aetna Medicare |
$152.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.24
|
| Rate for Payer: ASR ASR |
$531.46
|
| Rate for Payer: BCBS Complete |
$84.02
|
| Rate for Payer: BCBS MAPPO |
$152.99
|
| Rate for Payer: BCBS Trust/PPO |
$451.74
|
| Rate for Payer: BCN Commercial |
$451.74
|
| Rate for Payer: BCN Medicare Advantage |
$152.99
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cofinity Commercial |
$515.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.99
|
| Rate for Payer: Healthscope Commercial |
$531.46
|
| Rate for Payer: Healthscope Whirlpool |
$547.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.99
|
| Rate for Payer: Mclaren Commercial |
$493.11
|
| Rate for Payer: Mclaren Medicaid |
$152.99
|
| Rate for Payer: Mclaren Medicare |
$152.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.64
|
| Rate for Payer: Meridian Medicaid |
$84.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.71
|
| Rate for Payer: Nomi Health Commercial |
$449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.93
|
| Rate for Payer: PACE Medicare |
$145.34
|
| Rate for Payer: PACE SWMI |
$152.99
|
| Rate for Payer: PHP Commercial |
$168.29
|
| Rate for Payer: PHP Medicaid |
$82.00
|
| Rate for Payer: PHP Medicare Advantage |
$152.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$256.64
|
| Rate for Payer: Priority Health Medicare |
$152.99
|
| Rate for Payer: Priority Health Narrow Network |
$205.31
|
| Rate for Payer: Railroad Medicare Medicare |
$152.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$152.99
|
| Rate for Payer: UHC Exchange |
$237.13
|
| Rate for Payer: UHC Medicaid |
$80.01
|
| Rate for Payer: UHCCP DNSP |
$152.99
|
| Rate for Payer: UHCCP Medicaid |
$80.01
|
| Rate for Payer: VA VA |
$152.99
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$547.90
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.93 |
| Max. Negotiated Rate |
$547.90 |
| Rate for Payer: Aetna Commercial |
$493.11
|
| Rate for Payer: ASR ASR |
$531.46
|
| Rate for Payer: BCBS Trust/PPO |
$449.94
|
| Rate for Payer: BCN Commercial |
$449.94
|
| Rate for Payer: Cash Price |
$438.32
|
| Rate for Payer: Cofinity Commercial |
$515.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.32
|
| Rate for Payer: Healthscope Commercial |
$531.46
|
| Rate for Payer: Healthscope Whirlpool |
$547.90
|
| Rate for Payer: Mclaren Commercial |
$493.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.71
|
| Rate for Payer: Nomi Health Commercial |
$449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.15
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
