|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$119.87
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.90 |
| Max. Negotiated Rate |
$119.87 |
| Rate for Payer: Aetna Commercial |
$107.88
|
| Rate for Payer: ASR ASR |
$116.27
|
| Rate for Payer: BCBS Trust/PPO |
$98.44
|
| Rate for Payer: BCN Commercial |
$98.44
|
| Rate for Payer: Cash Price |
$95.90
|
| Rate for Payer: Cofinity Commercial |
$112.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.90
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Whirlpool |
$119.87
|
| Rate for Payer: Mclaren Commercial |
$107.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.89
|
| Rate for Payer: Nomi Health Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.49
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.23 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$100.28
|
| Rate for Payer: Aetna Medicare |
$41.23
|
| Rate for Payer: ASR ASR |
$108.08
|
| Rate for Payer: BCBS Complete |
$44.57
|
| Rate for Payer: BCBS Trust/PPO |
$91.87
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$108.08
|
| Rate for Payer: Healthscope Whirlpool |
$111.42
|
| Rate for Payer: Mclaren Commercial |
$100.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$91.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.10
|
| Rate for Payer: Priority Health Narrow Network |
$86.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.05
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$100.28
|
| Rate for Payer: ASR ASR |
$108.08
|
| Rate for Payer: BCBS Trust/PPO |
$91.50
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$108.08
|
| Rate for Payer: Healthscope Whirlpool |
$111.42
|
| Rate for Payer: Mclaren Commercial |
$100.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$91.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.05
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$52.63
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$52.63 |
| Rate for Payer: Aetna Commercial |
$47.37
|
| Rate for Payer: Aetna Medicare |
$19.47
|
| Rate for Payer: ASR ASR |
$51.05
|
| Rate for Payer: BCBS Complete |
$21.05
|
| Rate for Payer: BCBS Trust/PPO |
$43.39
|
| Rate for Payer: BCN Commercial |
$43.39
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$49.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Healthscope Commercial |
$51.05
|
| Rate for Payer: Healthscope Whirlpool |
$52.63
|
| Rate for Payer: Mclaren Commercial |
$47.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Nomi Health Commercial |
$43.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.11
|
| Rate for Payer: Priority Health Narrow Network |
$36.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.31
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$52.63
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$52.63 |
| Rate for Payer: Aetna Commercial |
$47.37
|
| Rate for Payer: ASR ASR |
$51.05
|
| Rate for Payer: BCBS Trust/PPO |
$43.22
|
| Rate for Payer: BCN Commercial |
$43.22
|
| Rate for Payer: Cash Price |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$49.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Healthscope Commercial |
$51.05
|
| Rate for Payer: Healthscope Whirlpool |
$52.63
|
| Rate for Payer: Mclaren Commercial |
$47.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Nomi Health Commercial |
$43.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.31
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$61.74
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Aetna Commercial |
$55.57
|
| Rate for Payer: ASR ASR |
$59.89
|
| Rate for Payer: BCBS Trust/PPO |
$50.70
|
| Rate for Payer: BCN Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cofinity Commercial |
$58.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.39
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Healthscope Whirlpool |
$61.74
|
| Rate for Payer: Mclaren Commercial |
$55.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.48
|
| Rate for Payer: Nomi Health Commercial |
$50.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.33
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$61.74
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Aetna Commercial |
$55.57
|
| Rate for Payer: Aetna Medicare |
$22.84
|
| Rate for Payer: ASR ASR |
$59.89
|
| Rate for Payer: BCBS Complete |
$24.70
|
| Rate for Payer: BCBS Trust/PPO |
$50.90
|
| Rate for Payer: BCN Commercial |
$50.90
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cofinity Commercial |
$58.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.39
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Healthscope Whirlpool |
$61.74
|
| Rate for Payer: Mclaren Commercial |
$55.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.48
|
| Rate for Payer: Nomi Health Commercial |
$50.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.10
|
| Rate for Payer: Priority Health Narrow Network |
$43.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.33
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$141.43
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$141.43 |
| Rate for Payer: Aetna Commercial |
$127.29
|
| Rate for Payer: ASR ASR |
$137.19
|
| Rate for Payer: BCBS Trust/PPO |
$116.14
|
| Rate for Payer: BCN Commercial |
$116.14
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cofinity Commercial |
$132.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.14
|
| Rate for Payer: Healthscope Commercial |
$137.19
|
| Rate for Payer: Healthscope Whirlpool |
$141.43
|
| Rate for Payer: Mclaren Commercial |
$127.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.22
|
| Rate for Payer: Nomi Health Commercial |
$115.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.46
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$141.43
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$141.43 |
| Rate for Payer: Aetna Commercial |
$127.29
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: ASR ASR |
$137.19
|
| Rate for Payer: BCBS Complete |
$56.57
|
| Rate for Payer: BCBS Trust/PPO |
$116.61
|
| Rate for Payer: BCN Commercial |
$116.61
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cofinity Commercial |
$132.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.14
|
| Rate for Payer: Healthscope Commercial |
$137.19
|
| Rate for Payer: Healthscope Whirlpool |
$141.43
|
| Rate for Payer: Mclaren Commercial |
$127.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.22
|
| Rate for Payer: Nomi Health Commercial |
$115.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.43
|
| Rate for Payer: Priority Health Narrow Network |
$38.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.46
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$125.01
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Aetna Commercial |
$112.51
|
| Rate for Payer: Aetna Medicare |
$46.25
|
| Rate for Payer: ASR ASR |
$121.26
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$103.07
|
| Rate for Payer: BCN Commercial |
$103.07
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cofinity Commercial |
$117.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$121.26
|
| Rate for Payer: Healthscope Whirlpool |
$125.01
|
| Rate for Payer: Mclaren Commercial |
$112.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.26
|
| Rate for Payer: Nomi Health Commercial |
$102.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.31
|
| Rate for Payer: Priority Health Narrow Network |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.01
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$125.01
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$93.76 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Aetna Commercial |
$112.51
|
| Rate for Payer: ASR ASR |
$121.26
|
| Rate for Payer: BCBS Trust/PPO |
$102.66
|
| Rate for Payer: BCN Commercial |
$102.66
|
| Rate for Payer: Cash Price |
$100.01
|
| Rate for Payer: Cofinity Commercial |
$117.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.01
|
| Rate for Payer: Healthscope Commercial |
$121.26
|
| Rate for Payer: Healthscope Whirlpool |
$125.01
|
| Rate for Payer: Mclaren Commercial |
$112.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.26
|
| Rate for Payer: Nomi Health Commercial |
$102.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.01
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$546.21
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$409.66 |
| Max. Negotiated Rate |
$546.21 |
| Rate for Payer: Aetna Commercial |
$491.59
|
| Rate for Payer: ASR ASR |
$529.82
|
| Rate for Payer: BCBS Trust/PPO |
$448.55
|
| Rate for Payer: BCN Commercial |
$448.55
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$513.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Healthscope Commercial |
$529.82
|
| Rate for Payer: Healthscope Whirlpool |
$546.21
|
| Rate for Payer: Mclaren Commercial |
$491.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$447.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.66
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$546.21
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$546.21 |
| Rate for Payer: Aetna Commercial |
$491.59
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$529.82
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$450.35
|
| Rate for Payer: BCN Commercial |
$450.35
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cash Price |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$513.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$529.82
|
| Rate for Payer: Healthscope Whirlpool |
$546.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$491.59
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.28
|
| Rate for Payer: Nomi Health Commercial |
$447.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.66
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$64.34
|
| Rate for Payer: BCN Commercial |
$64.34
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$75.69
|
| Rate for Payer: Healthscope Whirlpool |
$78.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.06
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$170.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.52 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$64.08
|
| Rate for Payer: BCN Commercial |
$64.08
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$75.69
|
| Rate for Payer: Healthscope Whirlpool |
$78.03
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$771.07
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$578.30 |
| Max. Negotiated Rate |
$771.07 |
| Rate for Payer: Aetna Commercial |
$693.96
|
| Rate for Payer: ASR ASR |
$747.94
|
| Rate for Payer: BCBS Trust/PPO |
$633.20
|
| Rate for Payer: BCN Commercial |
$633.20
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cofinity Commercial |
$724.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.86
|
| Rate for Payer: Healthscope Commercial |
$747.94
|
| Rate for Payer: Healthscope Whirlpool |
$771.07
|
| Rate for Payer: Mclaren Commercial |
$693.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.41
|
| Rate for Payer: Nomi Health Commercial |
$632.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.54
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$771.07
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$771.07 |
| Rate for Payer: Aetna Commercial |
$693.96
|
| Rate for Payer: Aetna Medicare |
$128.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: ASR ASR |
$747.94
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$635.75
|
| Rate for Payer: BCN Commercial |
$635.75
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cash Price |
$616.86
|
| Rate for Payer: Cofinity Commercial |
$724.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$747.94
|
| Rate for Payer: Healthscope Whirlpool |
$771.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$693.96
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$70.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.41
|
| Rate for Payer: Nomi Health Commercial |
$632.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$578.30
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$141.03
|
| Rate for Payer: PHP Medicaid |
$68.72
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$675.61
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$540.52
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$678.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$198.73
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP DNSP |
$128.21
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$249.83
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$187.37 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna Commercial |
$224.85
|
| Rate for Payer: ASR ASR |
$242.34
|
| Rate for Payer: BCBS Trust/PPO |
$205.16
|
| Rate for Payer: BCN Commercial |
$205.16
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Commercial |
$234.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Healthscope Commercial |
$242.34
|
| Rate for Payer: Healthscope Whirlpool |
$249.83
|
| Rate for Payer: Mclaren Commercial |
$224.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$204.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.85
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$249.83
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$250.58 |
| Rate for Payer: Aetna Commercial |
$224.85
|
| Rate for Payer: Aetna Medicare |
$128.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.55
|
| Rate for Payer: ASR ASR |
$242.34
|
| Rate for Payer: BCBS Complete |
$70.54
|
| Rate for Payer: BCBS MAPPO |
$128.44
|
| Rate for Payer: BCBS Trust/PPO |
$205.98
|
| Rate for Payer: BCN Commercial |
$205.98
|
| Rate for Payer: BCN Medicare Advantage |
$128.44
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cash Price |
$199.86
|
| Rate for Payer: Cofinity Commercial |
$234.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.44
|
| Rate for Payer: Healthscope Commercial |
$242.34
|
| Rate for Payer: Healthscope Whirlpool |
$249.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.44
|
| Rate for Payer: Mclaren Commercial |
$224.85
|
| Rate for Payer: Mclaren Medicaid |
$128.44
|
| Rate for Payer: Mclaren Medicare |
$128.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.86
|
| Rate for Payer: Meridian Medicaid |
$70.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.36
|
| Rate for Payer: Nomi Health Commercial |
$204.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.37
|
| Rate for Payer: PACE Medicare |
$122.02
|
| Rate for Payer: PACE SWMI |
$128.44
|
| Rate for Payer: PHP Commercial |
$141.28
|
| Rate for Payer: PHP Medicaid |
$68.84
|
| Rate for Payer: PHP Medicare Advantage |
$128.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$128.44
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$128.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.44
|
| Rate for Payer: UHC Exchange |
$199.08
|
| Rate for Payer: UHC Medicaid |
$67.17
|
| Rate for Payer: UHCCP DNSP |
$128.44
|
| Rate for Payer: UHCCP Medicaid |
$67.17
|
| Rate for Payer: VA VA |
$128.44
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
IP
|
$446.25
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$334.69 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Aetna Commercial |
$401.62
|
| Rate for Payer: ASR ASR |
$432.86
|
| Rate for Payer: BCBS Trust/PPO |
$366.46
|
| Rate for Payer: BCN Commercial |
$366.46
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$419.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$432.86
|
| Rate for Payer: Healthscope Whirlpool |
$446.25
|
| Rate for Payer: Mclaren Commercial |
$401.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Nomi Health Commercial |
$365.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.70
|
|
|
HC MONITOR SET QUICK PRESSURE
|
Facility
|
OP
|
$446.25
|
|
| Hospital Charge Code |
27000707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Aetna Commercial |
$401.62
|
| Rate for Payer: Aetna Medicare |
$165.11
|
| Rate for Payer: ASR ASR |
$432.86
|
| Rate for Payer: BCBS Complete |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$367.93
|
| Rate for Payer: BCN Commercial |
$367.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$419.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$432.86
|
| Rate for Payer: Healthscope Whirlpool |
$446.25
|
| Rate for Payer: Mclaren Commercial |
$401.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.31
|
| Rate for Payer: Nomi Health Commercial |
$365.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$391.00
|
| Rate for Payer: Priority Health Narrow Network |
$312.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.70
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$43.60 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.18
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$5.18
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$109.56
|
| Rate for Payer: ASR ASR |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$99.96
|
| Rate for Payer: BCN Commercial |
$99.96
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$118.08
|
| Rate for Payer: Healthscope Whirlpool |
$121.73
|
| Rate for Payer: Mclaren Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.12
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.04 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$109.56
|
| Rate for Payer: Aetna Medicare |
$45.04
|
| Rate for Payer: ASR ASR |
$118.08
|
| Rate for Payer: BCBS Complete |
$48.69
|
| Rate for Payer: BCBS Trust/PPO |
$100.37
|
| Rate for Payer: BCN Commercial |
$100.37
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$118.08
|
| Rate for Payer: Healthscope Whirlpool |
$121.73
|
| Rate for Payer: Mclaren Commercial |
$109.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: Nomi Health Commercial |
$99.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.66
|
| Rate for Payer: Priority Health Narrow Network |
$85.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.12
|
|
