|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$115.22
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$103.70
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$111.76
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$89.33
|
| Rate for Payer: BCN Commercial |
$89.33
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$92.18
|
| Rate for Payer: Cash Price |
$92.18
|
| Rate for Payer: Cofinity Commercial |
$108.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$115.22
|
| Rate for Payer: Healthscope Whirlpool |
$111.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$103.70
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.94
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.87
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$183.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.39
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$115.22
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$115.22 |
| Rate for Payer: Aetna Commercial |
$103.70
|
| Rate for Payer: ASR ASR |
$111.76
|
| Rate for Payer: BCBS Trust/PPO |
$89.33
|
| Rate for Payer: BCN Commercial |
$89.33
|
| Rate for Payer: Cash Price |
$92.18
|
| Rate for Payer: Cofinity Commercial |
$108.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.18
|
| Rate for Payer: Healthscope Commercial |
$115.22
|
| Rate for Payer: Healthscope Whirlpool |
$111.76
|
| Rate for Payer: Mclaren Commercial |
$103.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.39
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Complete |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.46
|
| Rate for Payer: Priority Health Narrow Network |
$76.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$50.59
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: ASR ASR |
$49.07
|
| Rate for Payer: BCBS Trust/PPO |
$39.22
|
| Rate for Payer: BCN Commercial |
$39.22
|
| Rate for Payer: Cash Price |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$47.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.47
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Healthscope Whirlpool |
$49.07
|
| Rate for Payer: Mclaren Commercial |
$45.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.52
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$50.59
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: ASR ASR |
$49.07
|
| Rate for Payer: BCBS Complete |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$39.22
|
| Rate for Payer: BCN Commercial |
$39.22
|
| Rate for Payer: Cash Price |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$47.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.47
|
| Rate for Payer: Healthscope Commercial |
$50.59
|
| Rate for Payer: Healthscope Whirlpool |
$49.07
|
| Rate for Payer: Mclaren Commercial |
$45.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.04
|
| Rate for Payer: Priority Health Narrow Network |
$35.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.52
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$59.34
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$59.34 |
| Rate for Payer: Aetna Commercial |
$53.41
|
| Rate for Payer: ASR ASR |
$57.56
|
| Rate for Payer: BCBS Trust/PPO |
$46.01
|
| Rate for Payer: BCN Commercial |
$46.01
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.47
|
| Rate for Payer: Healthscope Commercial |
$59.34
|
| Rate for Payer: Healthscope Whirlpool |
$57.56
|
| Rate for Payer: Mclaren Commercial |
$53.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.22
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$59.34
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$59.34 |
| Rate for Payer: Aetna Commercial |
$53.41
|
| Rate for Payer: ASR ASR |
$57.56
|
| Rate for Payer: BCBS Complete |
$23.74
|
| Rate for Payer: BCBS Trust/PPO |
$46.01
|
| Rate for Payer: BCN Commercial |
$46.01
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.47
|
| Rate for Payer: Healthscope Commercial |
$59.34
|
| Rate for Payer: Healthscope Whirlpool |
$57.56
|
| Rate for Payer: Mclaren Commercial |
$53.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.00
|
| Rate for Payer: Priority Health Narrow Network |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.22
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$135.94
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Aetna Commercial |
$122.35
|
| Rate for Payer: ASR ASR |
$131.86
|
| Rate for Payer: BCBS Complete |
$54.38
|
| Rate for Payer: BCBS Trust/PPO |
$105.39
|
| Rate for Payer: BCN Commercial |
$105.39
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$127.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.75
|
| Rate for Payer: Healthscope Commercial |
$135.94
|
| Rate for Payer: Healthscope Whirlpool |
$131.86
|
| Rate for Payer: Mclaren Commercial |
$122.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.05
|
| Rate for Payer: Priority Health Narrow Network |
$32.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.63
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$135.94
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$135.94 |
| Rate for Payer: Aetna Commercial |
$122.35
|
| Rate for Payer: ASR ASR |
$131.86
|
| Rate for Payer: BCBS Trust/PPO |
$105.39
|
| Rate for Payer: BCN Commercial |
$105.39
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$127.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.75
|
| Rate for Payer: Healthscope Commercial |
$135.94
|
| Rate for Payer: Healthscope Whirlpool |
$131.86
|
| Rate for Payer: Mclaren Commercial |
$122.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.63
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$120.16
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$120.16 |
| Rate for Payer: Aetna Commercial |
$108.14
|
| Rate for Payer: ASR ASR |
$116.56
|
| Rate for Payer: BCBS Complete |
$48.06
|
| Rate for Payer: BCBS Trust/PPO |
$93.16
|
| Rate for Payer: BCN Commercial |
$93.16
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$112.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.13
|
| Rate for Payer: Healthscope Commercial |
$120.16
|
| Rate for Payer: Healthscope Whirlpool |
$116.56
|
| Rate for Payer: Mclaren Commercial |
$108.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Narrow Network |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.74
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$120.16
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$84.11 |
| Max. Negotiated Rate |
$120.16 |
| Rate for Payer: Aetna Commercial |
$108.14
|
| Rate for Payer: ASR ASR |
$116.56
|
| Rate for Payer: BCBS Trust/PPO |
$93.16
|
| Rate for Payer: BCN Commercial |
$93.16
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$112.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.13
|
| Rate for Payer: Healthscope Commercial |
$120.16
|
| Rate for Payer: Healthscope Whirlpool |
$116.56
|
| Rate for Payer: Mclaren Commercial |
$108.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.74
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$472.50
|
| Rate for Payer: ASR ASR |
$509.25
|
| Rate for Payer: BCBS Trust/PPO |
$407.03
|
| Rate for Payer: BCN Commercial |
$407.03
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$493.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.00
|
| Rate for Payer: Healthscope Commercial |
$525.00
|
| Rate for Payer: Healthscope Whirlpool |
$509.25
|
| Rate for Payer: Mclaren Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.00
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$472.50
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$509.25
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$407.03
|
| Rate for Payer: BCN Commercial |
$407.03
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$493.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$525.00
|
| Rate for Payer: Healthscope Whirlpool |
$509.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$472.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$180.61 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.61
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$741.13
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$518.79 |
| Max. Negotiated Rate |
$741.13 |
| Rate for Payer: Aetna Commercial |
$667.02
|
| Rate for Payer: ASR ASR |
$718.90
|
| Rate for Payer: BCBS Trust/PPO |
$574.60
|
| Rate for Payer: BCN Commercial |
$574.60
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$696.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.90
|
| Rate for Payer: Healthscope Commercial |
$741.13
|
| Rate for Payer: Healthscope Whirlpool |
$718.90
|
| Rate for Payer: Mclaren Commercial |
$667.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.19
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$741.13
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$741.13 |
| Rate for Payer: Aetna Commercial |
$667.02
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$718.90
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$574.60
|
| Rate for Payer: BCN Commercial |
$574.60
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$696.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$741.13
|
| Rate for Payer: Healthscope Whirlpool |
$718.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$667.02
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.96
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$674.43
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$526.20
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.19
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$240.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$240.13 |
| Rate for Payer: Aetna Commercial |
$216.12
|
| Rate for Payer: Aetna Medicare |
$117.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.81
|
| Rate for Payer: ASR ASR |
$232.93
|
| Rate for Payer: BCBS Complete |
$67.46
|
| Rate for Payer: BCBS MAPPO |
$117.45
|
| Rate for Payer: BCBS Trust/PPO |
$186.17
|
| Rate for Payer: BCN Commercial |
$186.17
|
| Rate for Payer: BCN Medicare Advantage |
$117.45
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$225.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$240.13
|
| Rate for Payer: Healthscope Whirlpool |
$232.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$117.45
|
| Rate for Payer: Mclaren Commercial |
$216.12
|
| Rate for Payer: Mclaren Medicaid |
$64.25
|
| Rate for Payer: Mclaren Medicare |
$117.45
|
| Rate for Payer: Meridian Medicaid |
$67.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PACE Medicare |
$111.58
|
| Rate for Payer: PACE SWMI |
$117.45
|
| Rate for Payer: PHP Commercial |
$129.20
|
| Rate for Payer: PHP Medicaid |
$64.25
|
| Rate for Payer: PHP Medicare Advantage |
$117.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.42
|
| Rate for Payer: Priority Health Medicare |
$117.45
|
| Rate for Payer: Priority Health Narrow Network |
$169.94
|
| Rate for Payer: Railroad Medicare Medicare |
$117.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.31
|
| Rate for Payer: UHC Medicare Advantage |
$120.97
|
| Rate for Payer: VA VA |
$117.45
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$240.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$168.09 |
| Max. Negotiated Rate |
$240.13 |
| Rate for Payer: Aetna Commercial |
$216.12
|
| Rate for Payer: ASR ASR |
$232.93
|
| Rate for Payer: BCBS Trust/PPO |
$186.17
|
| Rate for Payer: BCN Commercial |
$186.17
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$225.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.10
|
| Rate for Payer: Healthscope Commercial |
$240.13
|
| Rate for Payer: Healthscope Whirlpool |
$232.93
|
| Rate for Payer: Mclaren Commercial |
$216.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.31
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$105.30
|
| Rate for Payer: ASR ASR |
$113.49
|
| Rate for Payer: BCBS Trust/PPO |
$90.71
|
| Rate for Payer: BCN Commercial |
$90.71
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$109.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.60
|
| Rate for Payer: Healthscope Commercial |
$117.00
|
| Rate for Payer: Healthscope Whirlpool |
$113.49
|
| Rate for Payer: Mclaren Commercial |
$105.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.96
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$105.30
|
| Rate for Payer: ASR ASR |
$113.49
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$90.71
|
| Rate for Payer: BCN Commercial |
$90.71
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$109.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.60
|
| Rate for Payer: Healthscope Commercial |
$117.00
|
| Rate for Payer: Healthscope Whirlpool |
$113.49
|
| Rate for Payer: Mclaren Commercial |
$105.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.47
|
| Rate for Payer: Priority Health Narrow Network |
$83.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.96
|
|
|
HC MOUSE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
