|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.66 |
| Max. Negotiated Rate |
$1,237.94 |
| Rate for Payer: Aetna Commercial |
$1,114.15
|
| Rate for Payer: ASR ASR |
$1,200.80
|
| Rate for Payer: ASR Commercial |
$1,200.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.80
|
| Rate for Payer: BCN Commercial |
$959.77
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Commercial |
$1,163.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,237.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.80
|
| Rate for Payer: Mclaren Commercial |
$1,114.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.39
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$495.18 |
| Max. Negotiated Rate |
$1,237.94 |
| Rate for Payer: Aetna Commercial |
$1,114.15
|
| Rate for Payer: Aetna Medicare |
$618.97
|
| Rate for Payer: ASR ASR |
$1,200.80
|
| Rate for Payer: ASR Commercial |
$1,200.80
|
| Rate for Payer: BCBS Complete |
$495.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.75
|
| Rate for Payer: BCN Commercial |
$959.77
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Commercial |
$1,163.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,237.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,200.80
|
| Rate for Payer: Mclaren Commercial |
$1,114.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,084.68
|
| Rate for Payer: Priority Health Narrow Network |
$867.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.39
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,530.93 |
| Max. Negotiated Rate |
$3,827.33 |
| Rate for Payer: Aetna Commercial |
$3,444.60
|
| Rate for Payer: Aetna Medicare |
$1,913.66
|
| Rate for Payer: ASR ASR |
$3,712.51
|
| Rate for Payer: ASR Commercial |
$3,712.51
|
| Rate for Payer: BCBS Complete |
$1,530.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,134.20
|
| Rate for Payer: BCN Commercial |
$2,967.33
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Commercial |
$3,597.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,827.33
|
| Rate for Payer: Healthscope Whirlpool |
$3,712.51
|
| Rate for Payer: Mclaren Commercial |
$3,444.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Nomi Health Commercial |
$3,138.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,353.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,682.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,368.05
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,487.76 |
| Max. Negotiated Rate |
$3,827.33 |
| Rate for Payer: Aetna Commercial |
$3,444.60
|
| Rate for Payer: ASR ASR |
$3,712.51
|
| Rate for Payer: ASR Commercial |
$3,712.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,118.89
|
| Rate for Payer: BCN Commercial |
$2,967.33
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Commercial |
$3,597.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,827.33
|
| Rate for Payer: Healthscope Whirlpool |
$3,712.51
|
| Rate for Payer: Mclaren Commercial |
$3,444.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Nomi Health Commercial |
$3,138.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,487.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,368.05
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$967.13 |
| Max. Negotiated Rate |
$1,487.89 |
| Rate for Payer: Aetna Commercial |
$1,339.10
|
| Rate for Payer: ASR ASR |
$1,443.25
|
| Rate for Payer: ASR Commercial |
$1,443.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.48
|
| Rate for Payer: BCN Commercial |
$1,153.56
|
| 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 |
$1,487.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.25
|
| Rate for Payer: Mclaren Commercial |
$1,339.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Nomi Health Commercial |
$1,220.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.34
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.16 |
| Max. Negotiated Rate |
$1,487.89 |
| Rate for Payer: Aetna Commercial |
$1,339.10
|
| Rate for Payer: Aetna Medicare |
$743.95
|
| Rate for Payer: ASR ASR |
$1,443.25
|
| Rate for Payer: ASR Commercial |
$1,443.25
|
| Rate for Payer: BCBS Complete |
$595.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.43
|
| Rate for Payer: BCN Commercial |
$1,153.56
|
| 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 |
$1,487.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,443.25
|
| Rate for Payer: Mclaren Commercial |
$1,339.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Nomi Health Commercial |
$1,220.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.13
|
| Rate for Payer: 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
|
IP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,961.72 |
| 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: ASR Commercial |
$4,419.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,713.09
|
| Rate for Payer: BCN Commercial |
$3,532.65
|
| 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 |
$4,556.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,419.81
|
| 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: Priority Health Cigna Priority Health |
$2,961.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,009.72
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,556.50
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,822.60 |
| Max. Negotiated Rate |
$4,556.50 |
| Rate for Payer: Aetna Commercial |
$4,100.85
|
| Rate for Payer: Aetna Medicare |
$2,278.25
|
| Rate for Payer: ASR ASR |
$4,419.81
|
| Rate for Payer: ASR Commercial |
$4,419.81
|
| Rate for Payer: BCBS Complete |
$1,822.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,731.32
|
| Rate for Payer: BCN Commercial |
$3,532.65
|
| 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 |
$4,556.50
|
| Rate for Payer: Healthscope Whirlpool |
$4,419.81
|
| 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: Priority Health Cigna Priority Health |
$2,961.72
|
| Rate for Payer: 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 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,077.75 |
| 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: ASR Commercial |
$1,608.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.16
|
| Rate for Payer: BCN Commercial |
$1,285.50
|
| 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 |
$1,658.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,608.33
|
| 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: Priority Health Cigna Priority Health |
$1,077.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,459.10
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,658.07
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.23 |
| Max. Negotiated Rate |
$1,658.07 |
| Rate for Payer: Aetna Commercial |
$1,492.26
|
| Rate for Payer: Aetna Medicare |
$829.03
|
| Rate for Payer: ASR ASR |
$1,608.33
|
| Rate for Payer: ASR Commercial |
$1,608.33
|
| Rate for Payer: BCBS Complete |
$663.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.79
|
| Rate for Payer: BCN Commercial |
$1,285.50
|
| 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 |
$1,658.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,608.33
|
| 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: Priority Health Cigna Priority Health |
$1,077.75
|
| Rate for Payer: 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 5 INIT 30 MIN
|
Facility
|
OP
|
$5,084.43
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,033.77 |
| Max. Negotiated Rate |
$5,084.43 |
| Rate for Payer: Aetna Commercial |
$4,575.99
|
| Rate for Payer: Aetna Medicare |
$2,542.22
|
| Rate for Payer: ASR ASR |
$4,931.90
|
| Rate for Payer: ASR Commercial |
$4,931.90
|
| Rate for Payer: BCBS Complete |
$2,033.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,163.64
|
| Rate for Payer: BCN Commercial |
$3,941.96
|
| 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 |
$5,084.43
|
| Rate for Payer: Healthscope Whirlpool |
$4,931.90
|
| 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: Priority Health Cigna Priority Health |
$3,304.88
|
| Rate for Payer: 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 |
$3,304.88 |
| 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: ASR Commercial |
$4,931.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,143.30
|
| Rate for Payer: BCN Commercial |
$3,941.96
|
| 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 |
$5,084.43
|
| Rate for Payer: Healthscope Whirlpool |
$4,931.90
|
| 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: Priority Health Cigna Priority Health |
$3,304.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,474.30
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.41 |
| Max. Negotiated Rate |
$2,078.52 |
| Rate for Payer: Aetna Commercial |
$1,870.67
|
| Rate for Payer: Aetna Medicare |
$1,039.26
|
| Rate for Payer: ASR ASR |
$2,016.16
|
| Rate for Payer: ASR Commercial |
$2,016.16
|
| Rate for Payer: BCBS Complete |
$831.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,702.10
|
| Rate for Payer: BCN Commercial |
$1,611.48
|
| 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 |
$2,078.52
|
| Rate for Payer: Healthscope Whirlpool |
$2,016.16
|
| 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: Priority Health Cigna Priority Health |
$1,351.04
|
| Rate for Payer: 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 LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$2,078.52
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,351.04 |
| 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: ASR Commercial |
$2,016.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.79
|
| Rate for Payer: BCN Commercial |
$1,611.48
|
| 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 |
$2,078.52
|
| Rate for Payer: Healthscope Whirlpool |
$2,016.16
|
| 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: Priority Health Cigna Priority Health |
$1,351.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,829.10
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$69.11
|
| 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 |
$74.49
|
| Rate for Payer: ASR Commercial |
$74.49
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$62.88
|
| Rate for Payer: BCN Commercial |
$59.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$72.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$76.79
|
| Rate for Payer: Healthscope Whirlpool |
$74.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$69.11
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: Nomi Health Commercial |
$62.97
|
| 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 |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.28
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$53.83
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.91 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$69.11
|
| Rate for Payer: ASR ASR |
$74.49
|
| Rate for Payer: ASR Commercial |
$74.49
|
| Rate for Payer: BCBS Trust/PPO |
$62.58
|
| Rate for Payer: BCN Commercial |
$59.54
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$72.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$76.79
|
| Rate for Payer: Healthscope Whirlpool |
$74.49
|
| Rate for Payer: Mclaren Commercial |
$69.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: Nomi Health Commercial |
$62.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.58
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,500.37 |
| Max. Negotiated Rate |
$3,846.72 |
| Rate for Payer: Aetna Commercial |
$3,462.05
|
| Rate for Payer: ASR ASR |
$3,731.32
|
| Rate for Payer: ASR Commercial |
$3,731.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,134.69
|
| Rate for Payer: BCN Commercial |
$2,982.36
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$3,615.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,846.72
|
| Rate for Payer: Healthscope Whirlpool |
$3,731.32
|
| Rate for Payer: Mclaren Commercial |
$3,462.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: Nomi Health Commercial |
$3,154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,385.11
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,538.69 |
| Max. Negotiated Rate |
$3,846.72 |
| Rate for Payer: Aetna Commercial |
$3,462.05
|
| Rate for Payer: Aetna Medicare |
$1,923.36
|
| Rate for Payer: ASR ASR |
$3,731.32
|
| Rate for Payer: ASR Commercial |
$3,731.32
|
| Rate for Payer: BCBS Complete |
$1,538.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,150.08
|
| Rate for Payer: BCN Commercial |
$2,982.36
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$3,615.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,846.72
|
| Rate for Payer: Healthscope Whirlpool |
$3,731.32
|
| Rate for Payer: Mclaren Commercial |
$3,462.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: Nomi Health Commercial |
$3,154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,370.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,696.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,385.11
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| 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 |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| 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: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| 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 |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| 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 |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| 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 |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| 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 |
$178.09
|
| Rate for Payer: ASR Commercial |
$178.09
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$150.35
|
| Rate for Payer: BCN Commercial |
$142.35
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$165.24
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| 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 |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.87
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$128.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.34 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: ASR ASR |
$178.09
|
| Rate for Payer: ASR Commercial |
$178.09
|
| Rate for Payer: BCBS Trust/PPO |
$149.62
|
| Rate for Payer: BCN Commercial |
$142.35
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$172.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Healthscope Whirlpool |
$178.09
|
| Rate for Payer: Mclaren Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: Nomi Health Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.57
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$79.07
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$79.07 |
| Rate for Payer: Aetna Commercial |
$71.16
|
| Rate for Payer: ASR ASR |
$76.70
|
| Rate for Payer: ASR Commercial |
$76.70
|
| Rate for Payer: BCBS Trust/PPO |
$64.43
|
| Rate for Payer: BCN Commercial |
$61.30
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Healthscope Commercial |
$79.07
|
| Rate for Payer: Healthscope Whirlpool |
$76.70
|
| Rate for Payer: Mclaren Commercial |
$71.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: Nomi Health Commercial |
$64.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.58
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$79.07
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$79.07 |
| Rate for Payer: Aetna Commercial |
$71.16
|
| 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 |
$76.70
|
| Rate for Payer: ASR Commercial |
$76.70
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$64.75
|
| Rate for Payer: BCN Commercial |
$61.30
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$74.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$79.07
|
| Rate for Payer: Healthscope Whirlpool |
$76.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.52
|
| Rate for Payer: Mclaren Commercial |
$71.16
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: Nomi Health Commercial |
$64.84
|
| 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 |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.28
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health Narrow Network |
$55.43
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP DNSP |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| 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 |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$54.29
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.69
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| 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 |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| 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 |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.09
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health Narrow Network |
$46.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Exchange |
$22.77
|
| Rate for Payer: UHC Medicare Advantage |
$14.69
|
| Rate for Payer: UHCCP DNSP |
$14.69
|
| Rate for Payer: UHCCP Medicaid |
$7.87
|
| Rate for Payer: VA VA |
$14.69
|
|
