|
HC PATHOLOGY LEVEL V
|
Facility
|
OP
|
$451.85
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
31000049
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.77 |
| Max. Negotiated Rate |
$451.85 |
| Rate for Payer: Aetna Commercial |
$406.66
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$438.29
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$350.32
|
| Rate for Payer: BCCCP Commercial |
$292.71
|
| Rate for Payer: BCN Commercial |
$350.32
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cofinity Commercial |
$424.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$451.85
|
| Rate for Payer: Healthscope Whirlpool |
$438.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$406.66
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.07
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.71
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$147.77
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.63
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC PATHOLOGY LEVEL V
|
Facility
|
IP
|
$451.85
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
31000049
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$316.30 |
| Max. Negotiated Rate |
$451.85 |
| Rate for Payer: Aetna Commercial |
$406.66
|
| Rate for Payer: ASR ASR |
$438.29
|
| Rate for Payer: BCBS Trust/PPO |
$350.32
|
| Rate for Payer: BCN Commercial |
$350.32
|
| Rate for Payer: Cash Price |
$361.48
|
| Rate for Payer: Cofinity Commercial |
$424.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.48
|
| Rate for Payer: Healthscope Commercial |
$451.85
|
| Rate for Payer: Healthscope Whirlpool |
$438.29
|
| Rate for Payer: Mclaren Commercial |
$406.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.63
|
|
|
HC PATHOLOGY LEVEL VI
|
Facility
|
OP
|
$643.06
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
31000050
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$955.41 |
| Rate for Payer: Aetna Commercial |
$578.75
|
| Rate for Payer: Aetna Medicare |
$764.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$955.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$955.41
|
| Rate for Payer: ASR ASR |
$623.77
|
| Rate for Payer: BCBS Complete |
$439.03
|
| Rate for Payer: BCBS MAPPO |
$764.33
|
| Rate for Payer: BCBS Trust/PPO |
$498.56
|
| Rate for Payer: BCN Commercial |
$498.56
|
| Rate for Payer: BCN Medicare Advantage |
$764.33
|
| Rate for Payer: Cash Price |
$514.45
|
| Rate for Payer: Cash Price |
$514.45
|
| Rate for Payer: Cofinity Commercial |
$604.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.33
|
| Rate for Payer: Healthscope Commercial |
$643.06
|
| Rate for Payer: Healthscope Whirlpool |
$623.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$764.33
|
| Rate for Payer: Mclaren Commercial |
$578.75
|
| Rate for Payer: Mclaren Medicaid |
$418.09
|
| Rate for Payer: Mclaren Medicare |
$764.33
|
| Rate for Payer: Meridian Medicaid |
$439.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$878.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.60
|
| Rate for Payer: PACE Medicare |
$726.11
|
| Rate for Payer: PACE SWMI |
$764.33
|
| Rate for Payer: PHP Commercial |
$840.76
|
| Rate for Payer: PHP Medicaid |
$418.09
|
| Rate for Payer: PHP Medicare Advantage |
$764.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.00
|
| Rate for Payer: Priority Health Medicare |
$764.33
|
| Rate for Payer: Priority Health Narrow Network |
$156.80
|
| Rate for Payer: Railroad Medicare Medicare |
$764.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.89
|
| Rate for Payer: UHC Medicare Advantage |
$787.26
|
| Rate for Payer: VA VA |
$764.33
|
|
|
HC PATHOLOGY LEVEL VI
|
Facility
|
IP
|
$643.06
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
31000050
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$450.14 |
| Max. Negotiated Rate |
$643.06 |
| Rate for Payer: Aetna Commercial |
$578.75
|
| Rate for Payer: ASR ASR |
$623.77
|
| Rate for Payer: BCBS Trust/PPO |
$498.56
|
| Rate for Payer: BCN Commercial |
$498.56
|
| Rate for Payer: Cash Price |
$514.45
|
| Rate for Payer: Cofinity Commercial |
$604.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.45
|
| Rate for Payer: Healthscope Commercial |
$643.06
|
| Rate for Payer: Healthscope Whirlpool |
$623.77
|
| Rate for Payer: Mclaren Commercial |
$578.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$546.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.89
|
|
|
HC PATH SURGERY CYTO ADDITIONAL
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: BCBS Trust/PPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
|
|
HC PATH SURGERY CYTO ADDITIONAL
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 88334
|
| Hospital Charge Code |
30000068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: BCBS Complete |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.05
|
| Rate for Payer: Priority Health Narrow Network |
$39.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
|
|
HC PATH SURGERY CYTO INITIAL SITE
|
Facility
|
OP
|
$88.74
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$955.41 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: Aetna Medicare |
$764.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$955.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$955.41
|
| Rate for Payer: ASR ASR |
$86.08
|
| Rate for Payer: BCBS Complete |
$439.03
|
| Rate for Payer: BCBS MAPPO |
$764.33
|
| Rate for Payer: BCBS Trust/PPO |
$68.80
|
| Rate for Payer: BCN Commercial |
$68.80
|
| Rate for Payer: BCN Medicare Advantage |
$764.33
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.33
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$764.33
|
| Rate for Payer: Mclaren Commercial |
$79.87
|
| Rate for Payer: Mclaren Medicaid |
$418.09
|
| Rate for Payer: Mclaren Medicare |
$764.33
|
| Rate for Payer: Meridian Medicaid |
$439.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$878.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.43
|
| Rate for Payer: PACE Medicare |
$726.11
|
| Rate for Payer: PACE SWMI |
$764.33
|
| Rate for Payer: PHP Commercial |
$840.76
|
| Rate for Payer: PHP Medicaid |
$418.09
|
| Rate for Payer: PHP Medicare Advantage |
$764.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.75
|
| Rate for Payer: Priority Health Medicare |
$764.33
|
| Rate for Payer: Priority Health Narrow Network |
$63.01
|
| Rate for Payer: Railroad Medicare Medicare |
$764.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.09
|
| Rate for Payer: UHC Medicare Advantage |
$787.26
|
| Rate for Payer: VA VA |
$764.33
|
|
|
HC PATH SURGERY CYTO INITIAL SITE
|
Facility
|
IP
|
$88.74
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$88.74 |
| Rate for Payer: Aetna Commercial |
$79.87
|
| Rate for Payer: ASR ASR |
$86.08
|
| Rate for Payer: BCBS Trust/PPO |
$68.80
|
| Rate for Payer: BCN Commercial |
$68.80
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$83.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Healthscope Whirlpool |
$86.08
|
| Rate for Payer: Mclaren Commercial |
$79.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.09
|
|
|
HC PCP SCREEN URIN
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| Rate for Payer: ASR ASR |
$89.90
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
|
|
HC PCP SCREEN URIN
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna Commercial |
$83.41
|
| 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 |
$89.90
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$71.85
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$87.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$92.68
|
| Rate for Payer: Healthscope Whirlpool |
$89.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| 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 |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.34
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$65.80
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC PCP SCREEN URN.
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC PCP SCREEN URN.
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| 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 |
$39.58
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| 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 |
$6.89
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$295.80
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.32 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Aetna Commercial |
$266.22
|
| Rate for Payer: ASR ASR |
$286.93
|
| Rate for Payer: BCBS Complete |
$118.32
|
| Rate for Payer: BCBS Trust/PPO |
$229.33
|
| Rate for Payer: BCN Commercial |
$229.33
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$278.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Healthscope Commercial |
$295.80
|
| Rate for Payer: Healthscope Whirlpool |
$286.93
|
| Rate for Payer: Mclaren Commercial |
$266.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.18
|
| Rate for Payer: Priority Health Narrow Network |
$210.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.30
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$295.80
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Aetna Commercial |
$266.22
|
| Rate for Payer: ASR ASR |
$286.93
|
| Rate for Payer: BCBS Trust/PPO |
$229.33
|
| Rate for Payer: BCN Commercial |
$229.33
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$278.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Healthscope Commercial |
$295.80
|
| Rate for Payer: Healthscope Whirlpool |
$286.93
|
| Rate for Payer: Mclaren Commercial |
$266.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.30
|
|
|
HC PEAK FLOW METER
|
Facility
|
IP
|
$28.58
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna Commercial |
$25.72
|
| Rate for Payer: ASR ASR |
$27.72
|
| Rate for Payer: BCBS Trust/PPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$22.16
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$28.58
|
| Rate for Payer: Healthscope Whirlpool |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$25.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.15
|
|
|
HC PEAK FLOW METER
|
Facility
|
OP
|
$28.58
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$28.58 |
| Rate for Payer: Aetna Commercial |
$25.72
|
| Rate for Payer: ASR ASR |
$27.72
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$22.16
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$28.58
|
| Rate for Payer: Healthscope Whirlpool |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$25.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.01
|
| Rate for Payer: Priority Health Narrow Network |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.15
|
|
|
HC PEANUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| 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: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PEANUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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
|
|
|
HC PECAN NUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| 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: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PECAN NUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
OP
|
$126.49
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Aetna Commercial |
$113.84
|
| Rate for Payer: ASR ASR |
$122.70
|
| Rate for Payer: BCBS Complete |
$50.60
|
| Rate for Payer: BCBS Trust/PPO |
$98.07
|
| Rate for Payer: BCN Commercial |
$98.07
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$118.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Healthscope Commercial |
$126.49
|
| Rate for Payer: Healthscope Whirlpool |
$122.70
|
| Rate for Payer: Mclaren Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.11
|
| Rate for Payer: Priority Health Narrow Network |
$89.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.31
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
IP
|
$126.49
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.54 |
| Max. Negotiated Rate |
$126.49 |
| Rate for Payer: Aetna Commercial |
$113.84
|
| Rate for Payer: ASR ASR |
$122.70
|
| Rate for Payer: BCBS Trust/PPO |
$98.07
|
| Rate for Payer: BCN Commercial |
$98.07
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$118.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Healthscope Commercial |
$126.49
|
| Rate for Payer: Healthscope Whirlpool |
$122.70
|
| Rate for Payer: Mclaren Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.31
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$153.31
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$107.32 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna Commercial |
$137.98
|
| Rate for Payer: ASR ASR |
$148.71
|
| Rate for Payer: BCBS Trust/PPO |
$118.86
|
| Rate for Payer: BCN Commercial |
$118.86
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$144.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Healthscope Whirlpool |
$148.71
|
| Rate for Payer: Mclaren Commercial |
$137.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.91
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$153.31
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna Commercial |
$137.98
|
| Rate for Payer: ASR ASR |
$148.71
|
| Rate for Payer: BCBS Complete |
$61.32
|
| Rate for Payer: BCBS Trust/PPO |
$118.86
|
| Rate for Payer: BCN Commercial |
$118.86
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cofinity Commercial |
$144.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Healthscope Whirlpool |
$148.71
|
| Rate for Payer: Mclaren Commercial |
$137.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.91
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,221.18
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$3,654.83 |
| Max. Negotiated Rate |
$5,221.18 |
| Rate for Payer: Aetna Commercial |
$4,699.06
|
| Rate for Payer: ASR ASR |
$5,064.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,047.98
|
| Rate for Payer: BCN Commercial |
$4,047.98
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cofinity Commercial |
$4,907.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,176.94
|
| Rate for Payer: Healthscope Commercial |
$5,221.18
|
| Rate for Payer: Healthscope Whirlpool |
$5,064.54
|
| Rate for Payer: Mclaren Commercial |
$4,699.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,654.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,594.64
|
|
