|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.52 |
| Max. Negotiated Rate |
$1,487.89 |
| Rate for Payer: Aetna Commercial |
$1,339.10
|
| Rate for Payer: Aetna Medicare |
$550.52
|
| Rate for Payer: ASR ASR |
$1,443.25
|
| Rate for Payer: BCBS Complete |
$595.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.77
|
| Rate for Payer: BCN Commercial |
$1,226.77
|
| Rate for Payer: Cash Price |
$1,190.31
|
| Rate for Payer: Cofinity Commercial |
$1,398.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.31
|
| Rate for Payer: Healthscope Commercial |
$1,443.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.89
|
| Rate for Payer: Mclaren Commercial |
$1,339.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Nomi Health Commercial |
$1,220.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,303.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,043.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.34
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,685.90 |
| Max. Negotiated Rate |
$4,556.50 |
| Rate for Payer: Aetna Commercial |
$4,100.85
|
| Rate for Payer: Aetna Medicare |
$1,685.90
|
| Rate for Payer: ASR ASR |
$4,419.81
|
| Rate for Payer: BCBS Complete |
$1,822.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,756.83
|
| Rate for Payer: BCN Commercial |
$3,756.83
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Commercial |
$4,283.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.20
|
| Rate for Payer: Healthscope Commercial |
$4,419.81
|
| Rate for Payer: Healthscope Whirlpool |
$4,556.50
|
| Rate for Payer: Mclaren Commercial |
$4,100.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,645.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,873.03
|
| Rate for Payer: Nomi Health Commercial |
$3,736.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,417.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,992.41
|
| Rate for Payer: Priority Health Narrow Network |
$3,194.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,009.72
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
IP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,417.38 |
| Max. Negotiated Rate |
$4,556.50 |
| Rate for Payer: Aetna Commercial |
$4,100.85
|
| Rate for Payer: ASR ASR |
$4,419.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,741.80
|
| Rate for Payer: BCN Commercial |
$3,741.80
|
| Rate for Payer: Cash Price |
$3,645.20
|
| Rate for Payer: Cofinity Commercial |
$4,283.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.20
|
| Rate for Payer: Healthscope Commercial |
$4,419.81
|
| Rate for Payer: Healthscope Whirlpool |
$4,556.50
|
| Rate for Payer: Mclaren Commercial |
$4,100.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,873.03
|
| Rate for Payer: Nomi Health Commercial |
$3,736.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,417.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,009.72
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$613.49 |
| Max. Negotiated Rate |
$1,658.07 |
| Rate for Payer: Aetna Commercial |
$1,492.26
|
| Rate for Payer: Aetna Medicare |
$613.49
|
| Rate for Payer: ASR ASR |
$1,608.33
|
| Rate for Payer: BCBS Complete |
$663.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.08
|
| Rate for Payer: BCN Commercial |
$1,367.08
|
| Rate for Payer: Cash Price |
$1,326.46
|
| Rate for Payer: Cofinity Commercial |
$1,558.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.46
|
| Rate for Payer: Healthscope Commercial |
$1,608.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,658.07
|
| Rate for Payer: Mclaren Commercial |
$1,492.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,326.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.36
|
| Rate for Payer: Nomi Health Commercial |
$1,359.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,243.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,452.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,162.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,459.10
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,243.55 |
| Max. Negotiated Rate |
$1,658.07 |
| Rate for Payer: Aetna Commercial |
$1,492.26
|
| Rate for Payer: ASR ASR |
$1,608.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,361.61
|
| Rate for Payer: BCN Commercial |
$1,361.61
|
| Rate for Payer: Cash Price |
$1,326.46
|
| Rate for Payer: Cofinity Commercial |
$1,558.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.46
|
| Rate for Payer: Healthscope Commercial |
$1,608.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,658.07
|
| Rate for Payer: Mclaren Commercial |
$1,492.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.36
|
| Rate for Payer: Nomi Health Commercial |
$1,359.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,243.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,459.10
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
OP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,881.24 |
| Max. Negotiated Rate |
$5,084.43 |
| Rate for Payer: Aetna Commercial |
$4,575.99
|
| Rate for Payer: Aetna Medicare |
$1,881.24
|
| Rate for Payer: ASR ASR |
$4,931.90
|
| Rate for Payer: BCBS Complete |
$2,033.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,192.11
|
| Rate for Payer: BCN Commercial |
$4,192.11
|
| Rate for Payer: Cash Price |
$4,067.54
|
| Rate for Payer: Cofinity Commercial |
$4,779.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,067.54
|
| Rate for Payer: Healthscope Commercial |
$4,931.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,084.43
|
| Rate for Payer: Mclaren Commercial |
$4,575.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,067.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,321.77
|
| Rate for Payer: Nomi Health Commercial |
$4,169.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,813.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,454.98
|
| Rate for Payer: Priority Health Narrow Network |
$3,564.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,474.30
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
IP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,813.32 |
| Max. Negotiated Rate |
$5,084.43 |
| Rate for Payer: Aetna Commercial |
$4,575.99
|
| Rate for Payer: ASR ASR |
$4,931.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,175.33
|
| Rate for Payer: BCN Commercial |
$4,175.33
|
| Rate for Payer: Cash Price |
$4,067.54
|
| Rate for Payer: Cofinity Commercial |
$4,779.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,067.54
|
| Rate for Payer: Healthscope Commercial |
$4,931.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,084.43
|
| Rate for Payer: Mclaren Commercial |
$4,575.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,321.77
|
| Rate for Payer: Nomi Health Commercial |
$4,169.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,813.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,474.30
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,558.89 |
| Max. Negotiated Rate |
$2,078.52 |
| Rate for Payer: Aetna Commercial |
$1,870.67
|
| Rate for Payer: ASR ASR |
$2,016.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,706.88
|
| Rate for Payer: BCN Commercial |
$1,706.88
|
| Rate for Payer: Cash Price |
$1,662.82
|
| Rate for Payer: Cofinity Commercial |
$1,953.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.82
|
| Rate for Payer: Healthscope Commercial |
$2,016.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,078.52
|
| Rate for Payer: Mclaren Commercial |
$1,870.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,766.74
|
| Rate for Payer: Nomi Health Commercial |
$1,704.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,558.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,829.10
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.05 |
| Max. Negotiated Rate |
$2,078.52 |
| Rate for Payer: Aetna Commercial |
$1,870.67
|
| Rate for Payer: Aetna Medicare |
$769.05
|
| Rate for Payer: ASR ASR |
$2,016.16
|
| Rate for Payer: BCBS Complete |
$831.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.74
|
| Rate for Payer: BCN Commercial |
$1,713.74
|
| Rate for Payer: Cash Price |
$1,662.82
|
| Rate for Payer: Cofinity Commercial |
$1,953.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,662.82
|
| Rate for Payer: Healthscope Commercial |
$2,016.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,078.52
|
| Rate for Payer: Mclaren Commercial |
$1,870.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,662.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,766.74
|
| Rate for Payer: Nomi Health Commercial |
$1,704.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,558.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,821.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,457.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,829.10
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$78.33
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$78.33 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$75.98
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$64.58
|
| Rate for Payer: BCN Commercial |
$64.58
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$73.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$75.98
|
| Rate for Payer: Healthscope Whirlpool |
$78.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$70.50
|
| Rate for Payer: Mclaren Medicaid |
$13.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.58
|
| Rate for Payer: Nomi Health Commercial |
$64.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.75
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.85
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$18.28
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$78.33
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$78.33 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: ASR ASR |
$75.98
|
| Rate for Payer: BCBS Trust/PPO |
$64.32
|
| Rate for Payer: BCN Commercial |
$64.32
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cofinity Commercial |
$73.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.66
|
| Rate for Payer: Healthscope Commercial |
$75.98
|
| Rate for Payer: Healthscope Whirlpool |
$78.33
|
| Rate for Payer: Mclaren Commercial |
$70.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.58
|
| Rate for Payer: Nomi Health Commercial |
$64.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.93
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,923.65
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$991.14 |
| Max. Negotiated Rate |
$3,923.65 |
| Rate for Payer: Aetna Commercial |
$3,531.28
|
| Rate for Payer: Aetna Medicare |
$1,451.75
|
| Rate for Payer: ASR ASR |
$3,805.94
|
| Rate for Payer: BCBS Complete |
$1,569.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,235.05
|
| Rate for Payer: BCN Commercial |
$3,235.05
|
| Rate for Payer: Cash Price |
$3,138.92
|
| Rate for Payer: Cash Price |
$3,138.92
|
| Rate for Payer: Cofinity Commercial |
$3,688.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.92
|
| Rate for Payer: Healthscope Commercial |
$3,805.94
|
| Rate for Payer: Healthscope Whirlpool |
$3,923.65
|
| Rate for Payer: Mclaren Commercial |
$3,531.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,138.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,335.10
|
| Rate for Payer: Nomi Health Commercial |
$3,217.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,942.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,238.93
|
| Rate for Payer: Priority Health Narrow Network |
$991.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,452.81
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,923.65
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,942.74 |
| Max. Negotiated Rate |
$3,923.65 |
| Rate for Payer: Aetna Commercial |
$3,531.28
|
| Rate for Payer: ASR ASR |
$3,805.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,222.10
|
| Rate for Payer: BCN Commercial |
$3,222.10
|
| Rate for Payer: Cash Price |
$3,138.92
|
| Rate for Payer: Cofinity Commercial |
$3,688.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.92
|
| Rate for Payer: Healthscope Commercial |
$3,805.94
|
| Rate for Payer: Healthscope Whirlpool |
$3,923.65
|
| Rate for Payer: Mclaren Commercial |
$3,531.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,335.10
|
| Rate for Payer: Nomi Health Commercial |
$3,217.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,942.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,452.81
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.36
|
| Rate for Payer: BCN Commercial |
$65.36
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$143.46 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.46
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$114.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: ASR ASR |
$181.65
|
| Rate for Payer: BCBS Trust/PPO |
$153.79
|
| Rate for Payer: BCN Commercial |
$153.79
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$181.65
|
| Rate for Payer: Healthscope Whirlpool |
$187.27
|
| Rate for Payer: Mclaren Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.80
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$181.65
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$154.40
|
| Rate for Payer: BCN Commercial |
$154.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$181.65
|
| Rate for Payer: Healthscope Whirlpool |
$187.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$168.54
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.46
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$114.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$80.65
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$143.46 |
| Rate for Payer: Aetna Commercial |
$72.58
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: ASR ASR |
$78.23
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$66.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cofinity Commercial |
$75.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$78.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$72.58
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.55
|
| Rate for Payer: Nomi Health Commercial |
$66.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.49
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Medicaid |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.46
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$114.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$80.65
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$80.65 |
| Rate for Payer: Aetna Commercial |
$72.58
|
| Rate for Payer: ASR ASR |
$78.23
|
| Rate for Payer: BCBS Trust/PPO |
$66.23
|
| Rate for Payer: BCN Commercial |
$66.23
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cofinity Commercial |
$75.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.52
|
| Rate for Payer: Healthscope Commercial |
$78.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.65
|
| Rate for Payer: Mclaren Commercial |
$72.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.55
|
| Rate for Payer: Nomi Health Commercial |
$66.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.97
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$8.07
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.69
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$14.69
|
| Rate for Payer: Mclaren Medicare |
$14.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: Meridian Medicaid |
$8.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicaid |
$7.87
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.69
|
| Rate for Payer: UHC Exchange |
$22.77
|
| Rate for Payer: UHC Medicaid |
$7.68
|
| Rate for Payer: UHCCP DNSP |
$14.69
|
| Rate for Payer: UHCCP Medicaid |
$7.68
|
| Rate for Payer: VA VA |
$14.69
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
IP
|
$383.29
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$287.47 |
| Max. Negotiated Rate |
$383.29 |
| Rate for Payer: Aetna Commercial |
$344.96
|
| Rate for Payer: ASR ASR |
$371.79
|
| Rate for Payer: BCBS Trust/PPO |
$314.76
|
| Rate for Payer: BCN Commercial |
$314.76
|
| Rate for Payer: Cash Price |
$306.63
|
| Rate for Payer: Cofinity Commercial |
$360.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.63
|
| Rate for Payer: Healthscope Commercial |
$371.79
|
| Rate for Payer: Healthscope Whirlpool |
$383.29
|
| Rate for Payer: Mclaren Commercial |
$344.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.80
|
| Rate for Payer: Nomi Health Commercial |
$314.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.30
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
OP
|
$383.29
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$141.82 |
| Max. Negotiated Rate |
$383.29 |
| Rate for Payer: Aetna Commercial |
$344.96
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: ASR ASR |
$371.79
|
| Rate for Payer: BCBS Complete |
$153.32
|
| Rate for Payer: BCBS Trust/PPO |
$316.02
|
| Rate for Payer: BCN Commercial |
$316.02
|
| Rate for Payer: Cash Price |
$306.63
|
| Rate for Payer: Cofinity Commercial |
$360.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.63
|
| Rate for Payer: Healthscope Commercial |
$371.79
|
| Rate for Payer: Healthscope Whirlpool |
$383.29
|
| Rate for Payer: Mclaren Commercial |
$344.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.80
|
| Rate for Payer: Nomi Health Commercial |
$314.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$335.84
|
| Rate for Payer: Priority Health Narrow Network |
$268.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$337.30
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$128.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Aetna Commercial |
$115.88
|
| Rate for Payer: ASR ASR |
$124.89
|
| Rate for Payer: BCBS Trust/PPO |
$105.73
|
| Rate for Payer: BCN Commercial |
$105.73
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cofinity Commercial |
$121.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.00
|
| Rate for Payer: Healthscope Commercial |
$124.89
|
| Rate for Payer: Healthscope Whirlpool |
$128.75
|
| Rate for Payer: Mclaren Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.44
|
| Rate for Payer: Nomi Health Commercial |
$105.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.30
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$128.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Aetna Commercial |
$115.88
|
| Rate for Payer: Aetna Medicare |
$47.64
|
| Rate for Payer: ASR ASR |
$124.89
|
| Rate for Payer: BCBS Complete |
$51.50
|
| Rate for Payer: BCBS Trust/PPO |
$106.15
|
| Rate for Payer: BCN Commercial |
$106.15
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cofinity Commercial |
$121.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.00
|
| Rate for Payer: Healthscope Commercial |
$124.89
|
| Rate for Payer: Healthscope Whirlpool |
$128.75
|
| Rate for Payer: Mclaren Commercial |
$115.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.44
|
| Rate for Payer: Nomi Health Commercial |
$105.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$112.81
|
| Rate for Payer: Priority Health Narrow Network |
$90.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.30
|
|
