|
HC ER LEVEL ONE 99281
|
Facility
|
IP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$231.62
|
| Rate for Payer: ASR ASR |
$249.64
|
| Rate for Payer: ASR Commercial |
$249.64
|
| Rate for Payer: BCBS Trust/PPO |
$209.72
|
| Rate for Payer: BCN Commercial |
$199.53
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$241.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Healthscope Whirlpool |
$249.64
|
| Rate for Payer: Mclaren Commercial |
$231.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: Nomi Health Commercial |
$211.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.48
|
|
|
HC ER LEVEL ONE 99281
|
Facility
|
OP
|
$257.36
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
45000020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$231.62
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$249.64
|
| Rate for Payer: ASR Commercial |
$249.64
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$210.75
|
| Rate for Payer: BCN Commercial |
$199.53
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cash Price |
$205.89
|
| Rate for Payer: Cofinity Commercial |
$241.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Healthscope Whirlpool |
$249.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$231.62
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.76
|
| Rate for Payer: Nomi Health Commercial |
$211.04
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.50
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$180.41
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
OP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna Commercial |
$813.26
|
| Rate for Payer: Aetna Medicare |
$270.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$337.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$337.56
|
| Rate for Payer: ASR ASR |
$876.51
|
| Rate for Payer: ASR Commercial |
$876.51
|
| Rate for Payer: BCBS Complete |
$151.98
|
| Rate for Payer: BCBS MAPPO |
$270.05
|
| Rate for Payer: BCBS Trust/PPO |
$739.97
|
| Rate for Payer: BCN Commercial |
$700.58
|
| Rate for Payer: BCN Medicare Advantage |
$270.05
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cofinity Commercial |
$849.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.05
|
| Rate for Payer: Healthscope Commercial |
$903.62
|
| Rate for Payer: Healthscope Whirlpool |
$876.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$270.05
|
| Rate for Payer: Mclaren Commercial |
$813.26
|
| Rate for Payer: Mclaren Medicaid |
$144.75
|
| Rate for Payer: Mclaren Medicare |
$270.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.55
|
| Rate for Payer: Meridian Medicaid |
$151.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: Nomi Health Commercial |
$740.97
|
| Rate for Payer: PACE Medicare |
$256.55
|
| Rate for Payer: PACE SWMI |
$270.05
|
| Rate for Payer: PHP Commercial |
$297.06
|
| Rate for Payer: PHP Medicaid |
$144.75
|
| Rate for Payer: PHP Medicare Advantage |
$270.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$791.75
|
| Rate for Payer: Priority Health Medicare |
$270.05
|
| Rate for Payer: Priority Health Narrow Network |
$633.44
|
| Rate for Payer: Railroad Medicare Medicare |
$270.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.05
|
| Rate for Payer: UHC Exchange |
$418.58
|
| Rate for Payer: UHC Medicare Advantage |
$270.05
|
| Rate for Payer: UHCCP DNSP |
$270.05
|
| Rate for Payer: UHCCP Medicaid |
$144.75
|
| Rate for Payer: VA VA |
$270.05
|
|
|
HC ER LEVEL THREE 99283
|
Facility
|
IP
|
$903.62
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
45000022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.35 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna Commercial |
$813.26
|
| Rate for Payer: ASR ASR |
$876.51
|
| Rate for Payer: ASR Commercial |
$876.51
|
| Rate for Payer: BCBS Trust/PPO |
$736.36
|
| Rate for Payer: BCN Commercial |
$700.58
|
| Rate for Payer: Cash Price |
$722.90
|
| Rate for Payer: Cofinity Commercial |
$849.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.90
|
| Rate for Payer: Healthscope Commercial |
$903.62
|
| Rate for Payer: Healthscope Whirlpool |
$876.51
|
| Rate for Payer: Mclaren Commercial |
$813.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$768.08
|
| Rate for Payer: Nomi Health Commercial |
$740.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.19
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
IP
|
$512.06
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.84 |
| Max. Negotiated Rate |
$512.06 |
| Rate for Payer: Aetna Commercial |
$460.85
|
| Rate for Payer: ASR ASR |
$496.70
|
| Rate for Payer: ASR Commercial |
$496.70
|
| Rate for Payer: BCBS Trust/PPO |
$417.28
|
| Rate for Payer: BCN Commercial |
$397.00
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cofinity Commercial |
$481.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.65
|
| Rate for Payer: Healthscope Commercial |
$512.06
|
| Rate for Payer: Healthscope Whirlpool |
$496.70
|
| Rate for Payer: Mclaren Commercial |
$460.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: Nomi Health Commercial |
$419.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.61
|
|
|
HC ER LEVEL TWO 99282
|
Facility
|
OP
|
$512.06
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.79 |
| Max. Negotiated Rate |
$512.06 |
| Rate for Payer: Aetna Commercial |
$460.85
|
| Rate for Payer: Aetna Medicare |
$154.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.06
|
| Rate for Payer: ASR ASR |
$496.70
|
| Rate for Payer: ASR Commercial |
$496.70
|
| Rate for Payer: BCBS Complete |
$86.92
|
| Rate for Payer: BCBS MAPPO |
$154.45
|
| Rate for Payer: BCBS Trust/PPO |
$419.33
|
| Rate for Payer: BCN Commercial |
$397.00
|
| Rate for Payer: BCN Medicare Advantage |
$154.45
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cash Price |
$409.65
|
| Rate for Payer: Cofinity Commercial |
$481.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.45
|
| Rate for Payer: Healthscope Commercial |
$512.06
|
| Rate for Payer: Healthscope Whirlpool |
$496.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$154.45
|
| Rate for Payer: Mclaren Commercial |
$460.85
|
| Rate for Payer: Mclaren Medicaid |
$82.79
|
| Rate for Payer: Mclaren Medicare |
$154.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.17
|
| Rate for Payer: Meridian Medicaid |
$86.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.25
|
| Rate for Payer: Nomi Health Commercial |
$419.89
|
| Rate for Payer: PACE Medicare |
$146.73
|
| Rate for Payer: PACE SWMI |
$154.45
|
| Rate for Payer: PHP Commercial |
$169.90
|
| Rate for Payer: PHP Medicaid |
$82.79
|
| Rate for Payer: PHP Medicare Advantage |
$154.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.67
|
| Rate for Payer: Priority Health Medicare |
$154.45
|
| Rate for Payer: Priority Health Narrow Network |
$358.95
|
| Rate for Payer: Railroad Medicare Medicare |
$154.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.45
|
| Rate for Payer: UHC Exchange |
$239.40
|
| Rate for Payer: UHC Medicare Advantage |
$154.45
|
| Rate for Payer: UHCCP DNSP |
$154.45
|
| Rate for Payer: UHCCP Medicaid |
$82.79
|
| Rate for Payer: VA VA |
$154.45
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC ER OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200002
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC ERO OR PACU R&B
|
Facility
|
IP
|
$3,356.84
|
|
| Hospital Charge Code |
12000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$2,181.95 |
| Max. Negotiated Rate |
$3,356.84 |
| Rate for Payer: Aetna Commercial |
$3,021.16
|
| Rate for Payer: ASR ASR |
$3,256.13
|
| Rate for Payer: ASR Commercial |
$3,256.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.49
|
| Rate for Payer: BCN Commercial |
$2,602.56
|
| Rate for Payer: Cash Price |
$2,685.47
|
| Rate for Payer: Cofinity Commercial |
$3,155.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,685.47
|
| Rate for Payer: Healthscope Commercial |
$3,356.84
|
| Rate for Payer: Healthscope Whirlpool |
$3,256.13
|
| Rate for Payer: Mclaren Commercial |
$3,021.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,853.31
|
| Rate for Payer: Nomi Health Commercial |
$2,752.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,181.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,954.02
|
|
|
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: Aetna Medicare |
$345.31
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: ASR Commercial |
$669.89
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS Trust/PPO |
$565.54
|
| 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 Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.11
|
| Rate for Payer: Priority Health Narrow Network |
$484.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC ER REDUCTION/DISLOCATION LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.90 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: ASR Commercial |
$669.89
|
| Rate for Payer: BCBS Trust/PPO |
$562.78
|
| 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 Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| 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: Aetna Medicare |
$345.31
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: ASR Commercial |
$669.89
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS Trust/PPO |
$565.54
|
| 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 Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.11
|
| Rate for Payer: Priority Health Narrow Network |
$484.12
|
| 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 |
$448.90 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: ASR Commercial |
$669.89
|
| Rate for Payer: BCBS Trust/PPO |
$562.78
|
| 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 Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| 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 |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$10.58
|
| Rate for Payer: BCBS MAPPO |
$18.79
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$18.79
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.79
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$10.07
|
| Rate for Payer: Mclaren Medicare |
$18.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.73
|
| Rate for Payer: Meridian Medicaid |
$10.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| 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 |
$10.07
|
| Rate for Payer: PHP Medicare Advantage |
$18.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$18.79
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.79
|
| Rate for Payer: UHC Exchange |
$29.12
|
| Rate for Payer: UHC Medicare Advantage |
$18.79
|
| Rate for Payer: UHCCP DNSP |
$18.79
|
| Rate for Payer: UHCCP Medicaid |
$10.07
|
| Rate for Payer: VA VA |
$18.79
|
|
|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.20 |
| Max. Negotiated Rate |
$1,377.23 |
| Rate for Payer: Aetna Commercial |
$1,239.51
|
| Rate for Payer: ASR ASR |
$1,335.91
|
| Rate for Payer: ASR Commercial |
$1,335.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.30
|
| Rate for Payer: BCN Commercial |
$1,067.77
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,294.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,377.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.91
|
| Rate for Payer: Mclaren Commercial |
$1,239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: Nomi Health Commercial |
$1,129.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.96
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.89 |
| Max. Negotiated Rate |
$1,377.23 |
| Rate for Payer: Aetna Commercial |
$1,239.51
|
| Rate for Payer: Aetna Medicare |
$688.62
|
| Rate for Payer: ASR ASR |
$1,335.91
|
| Rate for Payer: ASR Commercial |
$1,335.91
|
| Rate for Payer: BCBS Complete |
$550.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.81
|
| Rate for Payer: BCN Commercial |
$1,067.77
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,294.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,377.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.91
|
| Rate for Payer: Mclaren Commercial |
$1,239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: Nomi Health Commercial |
$1,129.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,206.73
|
| Rate for Payer: Priority Health Narrow Network |
$965.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.96
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
OP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,391.90 |
| Rate for Payer: Aetna Commercial |
$2,152.71
|
| Rate for Payer: Aetna Medicare |
$517.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: ASR ASR |
$2,320.14
|
| Rate for Payer: ASR Commercial |
$2,320.14
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,958.73
|
| Rate for Payer: BCN Commercial |
$1,854.44
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$2,248.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,391.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,320.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$517.48
|
| Rate for Payer: Mclaren Commercial |
$2,152.71
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: Nomi Health Commercial |
$1,961.36
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$569.23
|
| Rate for Payer: PHP Medicaid |
$277.37
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,095.78
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,676.72
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,104.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$802.09
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP DNSP |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
IP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,554.73 |
| Max. Negotiated Rate |
$2,391.90 |
| Rate for Payer: Aetna Commercial |
$2,152.71
|
| Rate for Payer: ASR ASR |
$2,320.14
|
| Rate for Payer: ASR Commercial |
$2,320.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.16
|
| Rate for Payer: BCN Commercial |
$1,854.44
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$2,248.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Healthscope Commercial |
$2,391.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,320.14
|
| Rate for Payer: Mclaren Commercial |
$2,152.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: Nomi Health Commercial |
$1,961.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,104.87
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
OP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$580.57 |
| Max. Negotiated Rate |
$1,451.42 |
| Rate for Payer: Aetna Commercial |
$1,306.28
|
| Rate for Payer: Aetna Medicare |
$725.71
|
| Rate for Payer: ASR ASR |
$1,407.88
|
| Rate for Payer: ASR Commercial |
$1,407.88
|
| Rate for Payer: BCBS Complete |
$580.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.57
|
| Rate for Payer: BCN Commercial |
$1,125.29
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,364.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,451.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,407.88
|
| Rate for Payer: Mclaren Commercial |
$1,306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: Nomi Health Commercial |
$1,190.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,271.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,017.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,277.25
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
IP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$943.42 |
| Max. Negotiated Rate |
$1,451.42 |
| Rate for Payer: Aetna Commercial |
$1,306.28
|
| Rate for Payer: ASR ASR |
$1,407.88
|
| Rate for Payer: ASR Commercial |
$1,407.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.76
|
| Rate for Payer: BCN Commercial |
$1,125.29
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,364.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,451.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,407.88
|
| Rate for Payer: Mclaren Commercial |
$1,306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: Nomi Health Commercial |
$1,190.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,277.25
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,232.87
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.15 |
| Max. Negotiated Rate |
$1,232.87 |
| Rate for Payer: Aetna Commercial |
$1,109.58
|
| Rate for Payer: Aetna Medicare |
$616.43
|
| Rate for Payer: ASR ASR |
$1,195.88
|
| Rate for Payer: ASR Commercial |
$1,195.88
|
| Rate for Payer: BCBS Complete |
$493.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.60
|
| Rate for Payer: BCN Commercial |
$955.84
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Commercial |
$1,158.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Healthscope Commercial |
$1,232.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.88
|
| Rate for Payer: Mclaren Commercial |
$1,109.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.94
|
| Rate for Payer: Nomi Health Commercial |
$1,010.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,080.24
|
| Rate for Payer: Priority Health Narrow Network |
$864.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.93
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,232.87
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$801.37 |
| Max. Negotiated Rate |
$1,232.87 |
| Rate for Payer: Aetna Commercial |
$1,109.58
|
| Rate for Payer: ASR ASR |
$1,195.88
|
| Rate for Payer: ASR Commercial |
$1,195.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.67
|
| Rate for Payer: BCN Commercial |
$955.84
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Commercial |
$1,158.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Healthscope Commercial |
$1,232.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.88
|
| Rate for Payer: Mclaren Commercial |
$1,109.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.94
|
| Rate for Payer: Nomi Health Commercial |
$1,010.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,084.93
|
|
