|
HC PROCESS FEE
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: ASR ASR |
$34.92
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$27.91
|
| Rate for Payer: BCN Commercial |
$27.91
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$33.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Healthscope Whirlpool |
$34.92
|
| Rate for Payer: Mclaren Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.76
|
| Rate for Payer: Priority Health Narrow Network |
$25.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.68
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.78 |
| Max. Negotiated Rate |
$1,139.69 |
| Rate for Payer: Aetna Commercial |
$1,025.72
|
| Rate for Payer: ASR ASR |
$1,105.50
|
| Rate for Payer: BCBS Trust/PPO |
$883.60
|
| Rate for Payer: BCN Commercial |
$883.60
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$1,071.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Healthscope Commercial |
$1,139.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.50
|
| Rate for Payer: Mclaren Commercial |
$1,025.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.93
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$1,139.69 |
| Rate for Payer: Aetna Commercial |
$1,025.72
|
| Rate for Payer: Aetna Medicare |
$812.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: ASR ASR |
$1,105.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$883.60
|
| Rate for Payer: BCN Commercial |
$883.60
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$1,071.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$1,139.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,105.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$812.40
|
| Rate for Payer: Mclaren Commercial |
$1,025.72
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$893.64
|
| Rate for Payer: PHP Medicaid |
$444.38
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,037.12
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$809.18
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,002.93
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
OP
|
$37.78
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$36.65
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$29.29
|
| Rate for Payer: BCN Commercial |
$29.29
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$37.78
|
| Rate for Payer: Healthscope Whirlpool |
$36.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$34.00
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.38
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$26.82
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.25
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
IP
|
$37.78
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: ASR ASR |
$36.65
|
| Rate for Payer: BCBS Trust/PPO |
$29.29
|
| Rate for Payer: BCN Commercial |
$29.29
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$37.78
|
| Rate for Payer: Healthscope Whirlpool |
$36.65
|
| Rate for Payer: Mclaren Commercial |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.25
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
OP
|
$37.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$36.65
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$29.29
|
| Rate for Payer: BCN Commercial |
$29.29
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$37.78
|
| Rate for Payer: Healthscope Whirlpool |
$36.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$34.00
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.38
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$26.82
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.25
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
IP
|
$37.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: ASR ASR |
$36.65
|
| Rate for Payer: BCBS Trust/PPO |
$29.29
|
| Rate for Payer: BCN Commercial |
$29.29
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$35.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$37.78
|
| Rate for Payer: Healthscope Whirlpool |
$36.65
|
| Rate for Payer: Mclaren Commercial |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.25
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
IP
|
$76.97
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$76.97 |
| Rate for Payer: Aetna Commercial |
$69.27
|
| Rate for Payer: ASR ASR |
$74.66
|
| Rate for Payer: BCBS Trust/PPO |
$59.67
|
| Rate for Payer: BCN Commercial |
$59.67
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.58
|
| Rate for Payer: Healthscope Commercial |
$76.97
|
| Rate for Payer: Healthscope Whirlpool |
$74.66
|
| Rate for Payer: Mclaren Commercial |
$69.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.73
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
OP
|
$76.97
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$76.97 |
| Rate for Payer: Aetna Commercial |
$69.27
|
| Rate for Payer: Aetna Medicare |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.08
|
| Rate for Payer: ASR ASR |
$74.66
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS MAPPO |
$20.86
|
| Rate for Payer: BCBS Trust/PPO |
$59.67
|
| Rate for Payer: BCN Commercial |
$59.67
|
| Rate for Payer: BCN Medicare Advantage |
$20.86
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.86
|
| Rate for Payer: Healthscope Commercial |
$76.97
|
| Rate for Payer: Healthscope Whirlpool |
$74.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$20.86
|
| Rate for Payer: Mclaren Commercial |
$69.27
|
| Rate for Payer: Mclaren Medicaid |
$11.41
|
| Rate for Payer: Mclaren Medicare |
$20.86
|
| Rate for Payer: Meridian Medicaid |
$11.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.42
|
| Rate for Payer: PACE Medicare |
$19.82
|
| Rate for Payer: PACE SWMI |
$20.86
|
| Rate for Payer: PHP Commercial |
$22.95
|
| Rate for Payer: PHP Medicaid |
$11.41
|
| Rate for Payer: PHP Medicare Advantage |
$20.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.54
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health Narrow Network |
$48.43
|
| Rate for Payer: Railroad Medicare Medicare |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.73
|
| Rate for Payer: UHC Medicare Advantage |
$21.49
|
| Rate for Payer: VA VA |
$20.86
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$72.42 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: ASR ASR |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$56.15
|
| Rate for Payer: BCN Commercial |
$56.15
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$68.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$72.42
|
| Rate for Payer: Healthscope Whirlpool |
$70.25
|
| Rate for Payer: Mclaren Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.73
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$19.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.22
|
| Rate for Payer: ASR ASR |
$70.25
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$56.15
|
| Rate for Payer: BCN Commercial |
$56.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.38
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$68.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$72.42
|
| Rate for Payer: Healthscope Whirlpool |
$70.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.38
|
| Rate for Payer: Mclaren Commercial |
$65.18
|
| Rate for Payer: Mclaren Medicaid |
$10.60
|
| Rate for Payer: Mclaren Medicare |
$19.38
|
| Rate for Payer: Meridian Medicaid |
$11.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PACE Medicare |
$18.41
|
| Rate for Payer: PACE SWMI |
$19.38
|
| Rate for Payer: PHP Commercial |
$21.32
|
| Rate for Payer: PHP Medicaid |
$10.60
|
| Rate for Payer: PHP Medicare Advantage |
$19.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.50
|
| Rate for Payer: Priority Health Medicare |
$19.38
|
| Rate for Payer: Priority Health Narrow Network |
$94.00
|
| Rate for Payer: Railroad Medicare Medicare |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.73
|
| Rate for Payer: UHC Medicare Advantage |
$19.96
|
| Rate for Payer: VA VA |
$19.38
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
IP
|
$129.03
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.32 |
| Max. Negotiated Rate |
$129.03 |
| Rate for Payer: Aetna Commercial |
$116.13
|
| Rate for Payer: ASR ASR |
$125.16
|
| Rate for Payer: BCBS Trust/PPO |
$100.04
|
| Rate for Payer: BCN Commercial |
$100.04
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.03
|
| Rate for Payer: Healthscope Whirlpool |
$125.16
|
| Rate for Payer: Mclaren Commercial |
$116.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.55
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
OP
|
$129.03
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$129.03 |
| Rate for Payer: Aetna Commercial |
$116.13
|
| Rate for Payer: ASR ASR |
$125.16
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: BCBS Trust/PPO |
$100.04
|
| Rate for Payer: BCN Commercial |
$100.04
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.03
|
| Rate for Payer: Healthscope Whirlpool |
$125.16
|
| Rate for Payer: Mclaren Commercial |
$116.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.42
|
| Rate for Payer: Priority Health Narrow Network |
$91.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.55
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
OP
|
$29.33
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: BCBS Complete |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$22.74
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Narrow Network |
$20.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$22.74
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| 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 |
$30.67
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| 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 |
$26.88
|
| 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 |
$22.13
|
| 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 |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$229.87 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| 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 |
$30.67
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| 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 |
$26.88
|
| 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 |
$22.13
|
| 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 |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: ASR ASR |
$284.21
|
| Rate for Payer: BCBS Trust/PPO |
$227.16
|
| Rate for Payer: BCN Commercial |
$227.16
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Healthscope Commercial |
$293.00
|
| Rate for Payer: Healthscope Whirlpool |
$284.21
|
| Rate for Payer: Mclaren Commercial |
$263.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.84
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$284.21
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$227.16
|
| Rate for Payer: BCN Commercial |
$227.16
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$293.00
|
| Rate for Payer: Healthscope Whirlpool |
$284.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$263.70
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$13.18
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.63
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$208.03
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.84
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
IP
|
$117.68
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: ASR ASR |
$114.15
|
| Rate for Payer: BCBS Trust/PPO |
$91.24
|
| Rate for Payer: BCN Commercial |
$91.24
|
| Rate for Payer: Cash Price |
$94.14
|
| Rate for Payer: Cofinity Commercial |
$110.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Healthscope Whirlpool |
$114.15
|
| Rate for Payer: Mclaren Commercial |
$105.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.56
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
OP
|
$117.68
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: ASR ASR |
$114.15
|
| Rate for Payer: BCBS Complete |
$47.07
|
| Rate for Payer: BCBS Trust/PPO |
$91.24
|
| Rate for Payer: BCN Commercial |
$91.24
|
| Rate for Payer: Cash Price |
$94.14
|
| Rate for Payer: Cash Price |
$94.14
|
| Rate for Payer: Cofinity Commercial |
$110.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Healthscope Whirlpool |
$114.15
|
| Rate for Payer: Mclaren Commercial |
$105.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.60
|
| Rate for Payer: Priority Health Narrow Network |
$50.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.56
|
|
|
HC PROTEGE RX STENT
|
Facility
|
OP
|
$4,482.37
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.95 |
| Max. Negotiated Rate |
$4,482.37 |
| Rate for Payer: Aetna Commercial |
$4,034.13
|
| Rate for Payer: ASR ASR |
$4,347.90
|
| Rate for Payer: BCBS Complete |
$1,792.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,475.18
|
| Rate for Payer: BCN Commercial |
$3,475.18
|
| Rate for Payer: Cash Price |
$3,585.90
|
| Rate for Payer: Cofinity Commercial |
$4,213.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,585.90
|
| Rate for Payer: Healthscope Commercial |
$4,482.37
|
| Rate for Payer: Healthscope Whirlpool |
$4,347.90
|
| Rate for Payer: Mclaren Commercial |
$4,034.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,810.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,078.96
|
| Rate for Payer: Priority Health Narrow Network |
$3,182.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,944.49
|
|
|
HC PROTEGE RX STENT
|
Facility
|
IP
|
$4,482.37
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,137.66 |
| Max. Negotiated Rate |
$4,482.37 |
| Rate for Payer: Aetna Commercial |
$4,034.13
|
| Rate for Payer: ASR ASR |
$4,347.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,475.18
|
| Rate for Payer: BCN Commercial |
$3,475.18
|
| Rate for Payer: Cash Price |
$3,585.90
|
| Rate for Payer: Cofinity Commercial |
$4,213.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,585.90
|
| Rate for Payer: Healthscope Commercial |
$4,482.37
|
| Rate for Payer: Healthscope Whirlpool |
$4,347.90
|
| Rate for Payer: Mclaren Commercial |
$4,034.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,810.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,944.49
|
|
