|
HC DRAW VENIPUNCTURE
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
IP
|
$370.40
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$240.76 |
| Max. Negotiated Rate |
$370.40 |
| Rate for Payer: Aetna Commercial |
$333.36
|
| Rate for Payer: ASR ASR |
$359.29
|
| Rate for Payer: ASR Commercial |
$359.29
|
| Rate for Payer: BCBS Trust/PPO |
$301.84
|
| Rate for Payer: BCN Commercial |
$287.17
|
| Rate for Payer: Cash Price |
$296.32
|
| Rate for Payer: Cofinity Commercial |
$348.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.32
|
| Rate for Payer: Healthscope Commercial |
$370.40
|
| Rate for Payer: Healthscope Whirlpool |
$359.29
|
| Rate for Payer: Mclaren Commercial |
$333.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.84
|
| Rate for Payer: Nomi Health Commercial |
$303.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.95
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
OP
|
$370.40
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$148.16 |
| Max. Negotiated Rate |
$370.40 |
| Rate for Payer: Aetna Commercial |
$333.36
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: ASR ASR |
$359.29
|
| Rate for Payer: ASR Commercial |
$359.29
|
| Rate for Payer: BCBS Complete |
$148.16
|
| Rate for Payer: BCBS Trust/PPO |
$303.32
|
| Rate for Payer: BCN Commercial |
$287.17
|
| Rate for Payer: Cash Price |
$296.32
|
| Rate for Payer: Cofinity Commercial |
$348.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.32
|
| Rate for Payer: Healthscope Commercial |
$370.40
|
| Rate for Payer: Healthscope Whirlpool |
$359.29
|
| Rate for Payer: Mclaren Commercial |
$333.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.84
|
| Rate for Payer: Nomi Health Commercial |
$303.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.54
|
| Rate for Payer: Priority Health Narrow Network |
$259.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.95
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
IP
|
$5.64
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: ASR ASR |
$5.47
|
| Rate for Payer: ASR Commercial |
$5.47
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$5.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$5.64
|
| Rate for Payer: Healthscope Whirlpool |
$5.47
|
| Rate for Payer: Mclaren Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.96
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: Aetna Medicare |
$2.82
|
| Rate for Payer: ASR ASR |
$5.47
|
| Rate for Payer: ASR Commercial |
$5.47
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$4.62
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$5.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$5.64
|
| Rate for Payer: Healthscope Whirlpool |
$5.47
|
| Rate for Payer: Mclaren Commercial |
$5.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.94
|
| Rate for Payer: Priority Health Narrow Network |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.96
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$27.35 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$13.68
|
| Rate for Payer: ASR ASR |
$26.53
|
| Rate for Payer: ASR Commercial |
$26.53
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.40
|
| Rate for Payer: BCN Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$25.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$27.35
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: Nomi Health Commercial |
$22.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.96
|
| Rate for Payer: Priority Health Narrow Network |
$19.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.07
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
IP
|
$27.35
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$27.35 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: ASR ASR |
$26.53
|
| Rate for Payer: ASR Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$22.29
|
| Rate for Payer: BCN Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$25.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$27.35
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: Nomi Health Commercial |
$22.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.07
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: ASR Commercial |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$84.78
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$104.04 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$100.92
|
| Rate for Payer: ASR Commercial |
$100.92
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$85.20
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$104.04
|
| Rate for Payer: Healthscope Whirlpool |
$100.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.16
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.93
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: ASR ASR |
$23.75
|
| Rate for Payer: ASR Commercial |
$23.75
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$20.05
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.45
|
| Rate for Payer: Priority Health Narrow Network |
$17.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: ASR ASR |
$23.75
|
| Rate for Payer: ASR Commercial |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$48.23 |
| Rate for Payer: Aetna Commercial |
$43.41
|
| Rate for Payer: ASR ASR |
$46.78
|
| Rate for Payer: ASR Commercial |
$46.78
|
| Rate for Payer: BCBS Trust/PPO |
$39.30
|
| Rate for Payer: BCN Commercial |
$37.39
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$45.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Healthscope Commercial |
$48.23
|
| Rate for Payer: Healthscope Whirlpool |
$46.78
|
| Rate for Payer: Mclaren Commercial |
$43.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Nomi Health Commercial |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.44
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$48.23 |
| Rate for Payer: Aetna Commercial |
$43.41
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$46.78
|
| Rate for Payer: ASR Commercial |
$46.78
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$39.50
|
| Rate for Payer: BCN Commercial |
$37.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$45.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$48.23
|
| Rate for Payer: Healthscope Whirlpool |
$46.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$43.41
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Nomi Health Commercial |
$39.55
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.26
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$33.81
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.65
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.03
|
| Rate for Payer: Priority Health Narrow Network |
$53.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$39.51 |
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: ASR ASR |
$38.32
|
| Rate for Payer: ASR Commercial |
$38.32
|
| Rate for Payer: BCBS Trust/PPO |
$32.20
|
| Rate for Payer: BCN Commercial |
$30.63
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$39.51
|
| Rate for Payer: Healthscope Whirlpool |
$38.32
|
| Rate for Payer: Mclaren Commercial |
$35.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.77
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$39.51 |
| Rate for Payer: Aetna Commercial |
$35.56
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: ASR ASR |
$38.32
|
| Rate for Payer: ASR Commercial |
$38.32
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.35
|
| Rate for Payer: BCN Commercial |
$30.63
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$39.51
|
| Rate for Payer: Healthscope Whirlpool |
$38.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.74
|
| Rate for Payer: Mclaren Commercial |
$35.56
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Medicaid |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.24
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health Narrow Network |
$28.99
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Exchange |
$21.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.74
|
| Rate for Payer: UHCCP DNSP |
$13.74
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$611.41 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$194.36
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.41
|
| Rate for Payer: Priority Health Narrow Network |
$489.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$176.19 |
| Rate for Payer: Aetna Commercial |
$158.57
|
| Rate for Payer: ASR ASR |
$170.90
|
| Rate for Payer: ASR Commercial |
$170.90
|
| Rate for Payer: BCBS Trust/PPO |
$143.58
|
| Rate for Payer: BCN Commercial |
$136.60
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$165.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$176.19
|
| Rate for Payer: Healthscope Whirlpool |
$170.90
|
| Rate for Payer: Mclaren Commercial |
$158.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: Nomi Health Commercial |
$144.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.05
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.48 |
| Max. Negotiated Rate |
$176.19 |
| Rate for Payer: Aetna Commercial |
$158.57
|
| Rate for Payer: Aetna Medicare |
$88.10
|
| Rate for Payer: ASR ASR |
$170.90
|
| Rate for Payer: ASR Commercial |
$170.90
|
| Rate for Payer: BCBS Complete |
$70.48
|
| Rate for Payer: BCBS Trust/PPO |
$144.28
|
| Rate for Payer: BCN Commercial |
$136.60
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$165.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$176.19
|
| Rate for Payer: Healthscope Whirlpool |
$170.90
|
| Rate for Payer: Mclaren Commercial |
$158.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: Nomi Health Commercial |
$144.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.41
|
| Rate for Payer: Priority Health Narrow Network |
$93.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.05
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Aetna Commercial |
$69.00
|
| Rate for Payer: ASR ASR |
$74.37
|
| Rate for Payer: ASR Commercial |
$74.37
|
| Rate for Payer: BCBS Trust/PPO |
$62.48
|
| Rate for Payer: BCN Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$72.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$76.67
|
| Rate for Payer: Healthscope Whirlpool |
$74.37
|
| Rate for Payer: Mclaren Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: Nomi Health Commercial |
$62.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.47
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Aetna Commercial |
$69.00
|
| Rate for Payer: Aetna Medicare |
$38.34
|
| Rate for Payer: ASR ASR |
$74.37
|
| Rate for Payer: ASR Commercial |
$74.37
|
| Rate for Payer: BCBS Complete |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$62.79
|
| Rate for Payer: BCN Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$72.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$76.67
|
| Rate for Payer: Healthscope Whirlpool |
$74.37
|
| Rate for Payer: Mclaren Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: Nomi Health Commercial |
$62.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.05
|
| Rate for Payer: Priority Health Narrow Network |
$56.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.47
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.58 |
| Max. Negotiated Rate |
$177.69 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$83.23
|
| Rate for Payer: ASR ASR |
$161.47
|
| Rate for Payer: ASR Commercial |
$161.47
|
| Rate for Payer: BCBS Complete |
$66.58
|
| Rate for Payer: BCBS Trust/PPO |
$136.31
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$156.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$166.46
|
| Rate for Payer: Healthscope Whirlpool |
$161.47
|
| Rate for Payer: Mclaren Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.69
|
| Rate for Payer: Priority Health Narrow Network |
$142.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.48
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$166.46 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: ASR ASR |
$161.47
|
| Rate for Payer: ASR Commercial |
$161.47
|
| Rate for Payer: BCBS Trust/PPO |
$135.65
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$156.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$166.46
|
| Rate for Payer: Healthscope Whirlpool |
$161.47
|
| Rate for Payer: Mclaren Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.48
|
|
