|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$195.84
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$176.26
|
| Rate for Payer: Aetna Medicare |
$106.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
| Rate for Payer: ASR ASR |
$189.96
|
| Rate for Payer: BCBS Complete |
$61.23
|
| Rate for Payer: BCBS MAPPO |
$106.59
|
| Rate for Payer: BCBS Trust/PPO |
$151.83
|
| Rate for Payer: BCN Commercial |
$151.83
|
| Rate for Payer: BCN Medicare Advantage |
$106.59
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
| Rate for Payer: Healthscope Commercial |
$195.84
|
| Rate for Payer: Healthscope Whirlpool |
$189.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$106.59
|
| Rate for Payer: Mclaren Commercial |
$176.26
|
| Rate for Payer: Mclaren Medicaid |
$58.30
|
| Rate for Payer: Mclaren Medicare |
$106.59
|
| Rate for Payer: Meridian Medicaid |
$61.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.46
|
| Rate for Payer: PACE Medicare |
$101.26
|
| Rate for Payer: PACE SWMI |
$106.59
|
| Rate for Payer: PHP Commercial |
$117.25
|
| Rate for Payer: PHP Medicaid |
$58.30
|
| Rate for Payer: PHP Medicare Advantage |
$106.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.21
|
| Rate for Payer: Priority Health Medicare |
$106.59
|
| Rate for Payer: Priority Health Narrow Network |
$139.05
|
| Rate for Payer: Railroad Medicare Medicare |
$106.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.34
|
| Rate for Payer: UHC Medicare Advantage |
$109.79
|
| Rate for Payer: VA VA |
$106.59
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$195.84
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.09 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$176.26
|
| Rate for Payer: ASR ASR |
$189.96
|
| Rate for Payer: BCBS Trust/PPO |
$151.83
|
| Rate for Payer: BCN Commercial |
$151.83
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cofinity Commercial |
$184.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.67
|
| Rate for Payer: Healthscope Commercial |
$195.84
|
| Rate for Payer: Healthscope Whirlpool |
$189.96
|
| Rate for Payer: Mclaren Commercial |
$176.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.34
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,102.66
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,871.86 |
| Max. Negotiated Rate |
$4,102.66 |
| Rate for Payer: Aetna Commercial |
$3,692.39
|
| Rate for Payer: ASR ASR |
$3,979.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,180.79
|
| Rate for Payer: BCN Commercial |
$3,180.79
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cofinity Commercial |
$3,856.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,282.13
|
| Rate for Payer: Healthscope Commercial |
$4,102.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,979.58
|
| Rate for Payer: Mclaren Commercial |
$3,692.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,487.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,610.34
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,102.66
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.06 |
| Max. Negotiated Rate |
$4,102.66 |
| Rate for Payer: Aetna Commercial |
$3,692.39
|
| Rate for Payer: ASR ASR |
$3,979.58
|
| Rate for Payer: BCBS Complete |
$1,641.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,180.79
|
| Rate for Payer: BCN Commercial |
$3,180.79
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cofinity Commercial |
$3,856.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,282.13
|
| Rate for Payer: Healthscope Commercial |
$4,102.66
|
| Rate for Payer: Healthscope Whirlpool |
$3,979.58
|
| Rate for Payer: Mclaren Commercial |
$3,692.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,487.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,733.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,912.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,610.34
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: BCBS Trust/PPO |
$83.42
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$107.60
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$96.84
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$104.37
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$83.42
|
| Rate for Payer: BCN Commercial |
$83.42
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$101.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$107.60
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$96.84
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.28
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$40.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.69
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$175.03
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.01 |
| Max. Negotiated Rate |
$175.03 |
| Rate for Payer: Aetna Commercial |
$157.53
|
| Rate for Payer: ASR ASR |
$169.78
|
| Rate for Payer: BCBS Complete |
$70.01
|
| Rate for Payer: BCBS Trust/PPO |
$135.70
|
| Rate for Payer: BCN Commercial |
$135.70
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cofinity Commercial |
$164.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.02
|
| Rate for Payer: Healthscope Commercial |
$175.03
|
| Rate for Payer: Healthscope Whirlpool |
$169.78
|
| Rate for Payer: Mclaren Commercial |
$157.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.28
|
| Rate for Payer: Priority Health Narrow Network |
$124.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.03
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$175.03
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.52 |
| Max. Negotiated Rate |
$175.03 |
| Rate for Payer: Aetna Commercial |
$157.53
|
| Rate for Payer: ASR ASR |
$169.78
|
| Rate for Payer: BCBS Trust/PPO |
$135.70
|
| Rate for Payer: BCN Commercial |
$135.70
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cofinity Commercial |
$164.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.02
|
| Rate for Payer: Healthscope Commercial |
$175.03
|
| Rate for Payer: Healthscope Whirlpool |
$169.78
|
| Rate for Payer: Mclaren Commercial |
$157.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.03
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$75.89
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$75.89 |
| Rate for Payer: Aetna Commercial |
$68.30
|
| Rate for Payer: ASR ASR |
$73.61
|
| Rate for Payer: BCBS Complete |
$30.36
|
| Rate for Payer: BCBS Trust/PPO |
$58.84
|
| Rate for Payer: BCN Commercial |
$58.84
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$71.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.71
|
| Rate for Payer: Healthscope Commercial |
$75.89
|
| Rate for Payer: Healthscope Whirlpool |
$73.61
|
| Rate for Payer: Mclaren Commercial |
$68.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.06
|
| Rate for Payer: Priority Health Narrow Network |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.78
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$75.89
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$75.89 |
| Rate for Payer: Aetna Commercial |
$68.30
|
| Rate for Payer: ASR ASR |
$73.61
|
| Rate for Payer: BCBS Trust/PPO |
$58.84
|
| Rate for Payer: BCN Commercial |
$58.84
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$71.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.71
|
| Rate for Payer: Healthscope Commercial |
$75.89
|
| Rate for Payer: Healthscope Whirlpool |
$73.61
|
| Rate for Payer: Mclaren Commercial |
$68.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.78
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$511.02
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$357.71 |
| Max. Negotiated Rate |
$511.02 |
| Rate for Payer: Aetna Commercial |
$459.92
|
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: ASR ASR |
$495.69
|
| Rate for Payer: ASR ASR |
$154.23
|
| Rate for Payer: BCBS Trust/PPO |
$123.27
|
| Rate for Payer: BCBS Trust/PPO |
$396.19
|
| Rate for Payer: BCN Commercial |
$396.19
|
| Rate for Payer: BCN Commercial |
$123.27
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cofinity Commercial |
$480.36
|
| Rate for Payer: Cofinity Commercial |
$149.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.82
|
| Rate for Payer: Healthscope Commercial |
$159.00
|
| Rate for Payer: Healthscope Commercial |
$511.02
|
| Rate for Payer: Healthscope Whirlpool |
$495.69
|
| Rate for Payer: Healthscope Whirlpool |
$154.23
|
| Rate for Payer: Mclaren Commercial |
$143.10
|
| Rate for Payer: Mclaren Commercial |
$459.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.92
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$511.02
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$511.02 |
| Rate for Payer: Aetna Commercial |
$459.92
|
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$154.23
|
| Rate for Payer: ASR ASR |
$495.69
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$396.19
|
| Rate for Payer: BCBS Trust/PPO |
$123.27
|
| Rate for Payer: BCN Commercial |
$396.19
|
| Rate for Payer: BCN Commercial |
$123.27
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cofinity Commercial |
$480.36
|
| Rate for Payer: Cofinity Commercial |
$149.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$511.02
|
| Rate for Payer: Healthscope Commercial |
$159.00
|
| Rate for Payer: Healthscope Whirlpool |
$154.23
|
| Rate for Payer: Healthscope Whirlpool |
$495.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$459.92
|
| Rate for Payer: Mclaren Commercial |
$143.10
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$112.89
|
| Rate for Payer: Priority Health Narrow Network |
$362.82
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.70
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$405.96
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$405.96 |
| Rate for Payer: Aetna Commercial |
$365.36
|
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$328.83
|
| Rate for Payer: ASR ASR |
$393.78
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$262.83
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$262.83
|
| Rate for Payer: BCN Commercial |
$314.74
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$318.66
|
| Rate for Payer: Cofinity Commercial |
$381.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$339.00
|
| Rate for Payer: Healthscope Commercial |
$405.96
|
| Rate for Payer: Healthscope Whirlpool |
$393.78
|
| Rate for Payer: Healthscope Whirlpool |
$328.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$365.36
|
| Rate for Payer: Mclaren Commercial |
$305.10
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.49
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$240.69
|
| Rate for Payer: Priority Health Narrow Network |
$288.23
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.24
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$237.30 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Commercial |
$365.36
|
| Rate for Payer: ASR ASR |
$328.83
|
| Rate for Payer: ASR ASR |
$393.78
|
| Rate for Payer: BCBS Trust/PPO |
$262.83
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$314.74
|
| Rate for Payer: BCN Commercial |
$262.83
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cofinity Commercial |
$381.60
|
| Rate for Payer: Cofinity Commercial |
$318.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.77
|
| Rate for Payer: Healthscope Commercial |
$339.00
|
| Rate for Payer: Healthscope Commercial |
$405.96
|
| Rate for Payer: Healthscope Whirlpool |
$393.78
|
| Rate for Payer: Healthscope Whirlpool |
$328.83
|
| Rate for Payer: Mclaren Commercial |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$365.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.24
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.67 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Commercial |
$618.73
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
| Rate for Payer: ASR ASR |
$833.23
|
| Rate for Payer: ASR ASR |
$666.86
|
| Rate for Payer: BCBS Complete |
$137.21
|
| Rate for Payer: BCBS Complete |
$137.21
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$533.00
|
| Rate for Payer: BCBS Trust/PPO |
$665.98
|
| Rate for Payer: BCN Commercial |
$665.98
|
| Rate for Payer: BCN Commercial |
$533.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$807.46
|
| Rate for Payer: Cofinity Commercial |
$646.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Healthscope Commercial |
$859.00
|
| Rate for Payer: Healthscope Commercial |
$687.48
|
| Rate for Payer: Healthscope Whirlpool |
$666.86
|
| Rate for Payer: Healthscope Whirlpool |
$833.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.88
|
| Rate for Payer: Mclaren Commercial |
$773.10
|
| Rate for Payer: Mclaren Commercial |
$618.73
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Mclaren Medicare |
$238.88
|
| Rate for Payer: Mclaren Medicare |
$238.88
|
| Rate for Payer: Meridian Medicaid |
$137.21
|
| Rate for Payer: Meridian Medicaid |
$137.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PACE Medicare |
$226.94
|
| Rate for Payer: PACE Medicare |
$226.94
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Commercial |
$262.77
|
| Rate for Payer: PHP Commercial |
$262.77
|
| Rate for Payer: PHP Medicaid |
$130.67
|
| Rate for Payer: PHP Medicaid |
$130.67
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$781.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$625.61
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow Network |
$488.11
|
| Rate for Payer: Priority Health Narrow Network |
$609.89
|
| Rate for Payer: Railroad Medicare Medicare |
$238.88
|
| Rate for Payer: Railroad Medicare Medicare |
$238.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.92
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
| Rate for Payer: VA VA |
$238.88
|
| Rate for Payer: VA VA |
$238.88
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$601.30 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Commercial |
$618.73
|
| Rate for Payer: ASR ASR |
$666.86
|
| Rate for Payer: ASR ASR |
$833.23
|
| Rate for Payer: BCBS Trust/PPO |
$665.98
|
| Rate for Payer: BCBS Trust/PPO |
$533.00
|
| Rate for Payer: BCN Commercial |
$533.00
|
| Rate for Payer: BCN Commercial |
$665.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$646.23
|
| Rate for Payer: Cofinity Commercial |
$807.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Healthscope Commercial |
$859.00
|
| Rate for Payer: Healthscope Commercial |
$687.48
|
| Rate for Payer: Healthscope Whirlpool |
$666.86
|
| Rate for Payer: Healthscope Whirlpool |
$833.23
|
| Rate for Payer: Mclaren Commercial |
$773.10
|
| Rate for Payer: Mclaren Commercial |
$618.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.92
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$413.27
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.67 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.60
|
| Rate for Payer: ASR ASR |
$400.87
|
| Rate for Payer: BCBS Complete |
$137.21
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$320.41
|
| Rate for Payer: BCN Commercial |
$320.41
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$388.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Healthscope Commercial |
$413.27
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.88
|
| Rate for Payer: Mclaren Commercial |
$371.94
|
| Rate for Payer: Mclaren Medicaid |
$130.67
|
| Rate for Payer: Mclaren Medicare |
$238.88
|
| Rate for Payer: Meridian Medicaid |
$137.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PACE Medicare |
$226.94
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Commercial |
$262.77
|
| Rate for Payer: PHP Medicaid |
$130.67
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.08
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow Network |
$293.42
|
| Rate for Payer: Railroad Medicare Medicare |
$238.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.68
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
| Rate for Payer: VA VA |
$238.88
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$413.27
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$289.29 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: ASR ASR |
$400.87
|
| Rate for Payer: BCBS Trust/PPO |
$320.41
|
| Rate for Payer: BCN Commercial |
$320.41
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$388.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$413.27
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Mclaren Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.68
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$859.00 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Commercial |
$204.04
|
| Rate for Payer: Aetna Medicare |
$106.59
|
| Rate for Payer: Aetna Medicare |
$106.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.24
|
| Rate for Payer: ASR ASR |
$219.91
|
| Rate for Payer: ASR ASR |
$833.23
|
| Rate for Payer: BCBS Complete |
$61.23
|
| Rate for Payer: BCBS Complete |
$61.23
|
| Rate for Payer: BCBS MAPPO |
$106.59
|
| Rate for Payer: BCBS MAPPO |
$106.59
|
| Rate for Payer: BCBS Trust/PPO |
$175.77
|
| Rate for Payer: BCBS Trust/PPO |
$665.98
|
| Rate for Payer: BCN Commercial |
$175.77
|
| Rate for Payer: BCN Commercial |
$665.98
|
| Rate for Payer: BCN Medicare Advantage |
$106.59
|
| Rate for Payer: BCN Medicare Advantage |
$106.59
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cofinity Commercial |
$213.11
|
| Rate for Payer: Cofinity Commercial |
$807.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.59
|
| Rate for Payer: Healthscope Commercial |
$226.71
|
| Rate for Payer: Healthscope Commercial |
$859.00
|
| Rate for Payer: Healthscope Whirlpool |
$833.23
|
| Rate for Payer: Healthscope Whirlpool |
$219.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$106.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$106.59
|
| Rate for Payer: Mclaren Commercial |
$773.10
|
| Rate for Payer: Mclaren Commercial |
$204.04
|
| Rate for Payer: Mclaren Medicaid |
$58.30
|
| Rate for Payer: Mclaren Medicaid |
$58.30
|
| Rate for Payer: Mclaren Medicare |
$106.59
|
| Rate for Payer: Mclaren Medicare |
$106.59
|
| Rate for Payer: Meridian Medicaid |
$61.23
|
| Rate for Payer: Meridian Medicaid |
$61.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: PACE Medicare |
$101.26
|
| Rate for Payer: PACE Medicare |
$101.26
|
| Rate for Payer: PACE SWMI |
$106.59
|
| Rate for Payer: PACE SWMI |
$106.59
|
| Rate for Payer: PHP Commercial |
$117.25
|
| Rate for Payer: PHP Commercial |
$117.25
|
| Rate for Payer: PHP Medicaid |
$58.30
|
| Rate for Payer: PHP Medicaid |
$58.30
|
| Rate for Payer: PHP Medicare Advantage |
$106.59
|
| Rate for Payer: PHP Medicare Advantage |
$106.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$781.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.31
|
| Rate for Payer: Priority Health Medicare |
$106.59
|
| Rate for Payer: Priority Health Medicare |
$106.59
|
| Rate for Payer: Priority Health Narrow Network |
$609.89
|
| Rate for Payer: Priority Health Narrow Network |
$160.96
|
| Rate for Payer: Railroad Medicare Medicare |
$106.59
|
| Rate for Payer: Railroad Medicare Medicare |
$106.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.50
|
| Rate for Payer: UHC Medicare Advantage |
$109.79
|
| Rate for Payer: UHC Medicare Advantage |
$109.79
|
| Rate for Payer: VA VA |
$106.59
|
| Rate for Payer: VA VA |
$106.59
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$226.71
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$158.70 |
| Max. Negotiated Rate |
$226.71 |
| Rate for Payer: Aetna Commercial |
$204.04
|
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: ASR ASR |
$219.91
|
| Rate for Payer: ASR ASR |
$833.23
|
| Rate for Payer: BCBS Trust/PPO |
$665.98
|
| Rate for Payer: BCBS Trust/PPO |
$175.77
|
| Rate for Payer: BCN Commercial |
$665.98
|
| Rate for Payer: BCN Commercial |
$175.77
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$807.46
|
| Rate for Payer: Cofinity Commercial |
$213.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.37
|
| Rate for Payer: Healthscope Commercial |
$226.71
|
| Rate for Payer: Healthscope Commercial |
$859.00
|
| Rate for Payer: Healthscope Whirlpool |
$219.91
|
| Rate for Payer: Healthscope Whirlpool |
$833.23
|
| Rate for Payer: Mclaren Commercial |
$773.10
|
| Rate for Payer: Mclaren Commercial |
$204.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.92
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$37.96 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.96
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$30.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$2.53
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.40
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.41
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Medicaid |
$2.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Medicaid |
$2.41
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.53
|
| Rate for Payer: VA VA |
$4.40
|
|
