|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$197.13
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$177.42
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: ASR ASR |
$191.22
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Trust/PPO |
$162.53
|
| Rate for Payer: BCN Commercial |
$162.53
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Commercial |
$185.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$191.22
|
| Rate for Payer: Healthscope Whirlpool |
$197.13
|
| Rate for Payer: Mclaren Commercial |
$177.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Nomi Health Commercial |
$161.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.73
|
| Rate for Payer: Priority Health Narrow Network |
$138.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.47
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$988.38
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$357.65 |
| Max. Negotiated Rate |
$1,059.97 |
| Rate for Payer: Aetna Commercial |
$889.54
|
| Rate for Payer: Aetna Medicare |
$683.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$854.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$854.81
|
| Rate for Payer: ASR ASR |
$958.73
|
| Rate for Payer: BCBS Complete |
$375.57
|
| Rate for Payer: BCBS MAPPO |
$683.85
|
| Rate for Payer: BCBS Trust/PPO |
$814.92
|
| Rate for Payer: BCN Commercial |
$814.92
|
| Rate for Payer: BCN Medicare Advantage |
$683.85
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Commercial |
$929.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.85
|
| Rate for Payer: Healthscope Commercial |
$958.73
|
| Rate for Payer: Healthscope Whirlpool |
$988.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$683.85
|
| Rate for Payer: Mclaren Commercial |
$889.54
|
| Rate for Payer: Mclaren Medicaid |
$683.85
|
| Rate for Payer: Mclaren Medicare |
$683.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.04
|
| Rate for Payer: Meridian Medicaid |
$375.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$786.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$752.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Nomi Health Commercial |
$810.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: PACE Medicare |
$649.66
|
| Rate for Payer: PACE SWMI |
$683.85
|
| Rate for Payer: PHP Commercial |
$752.24
|
| Rate for Payer: PHP Medicaid |
$366.54
|
| Rate for Payer: PHP Medicare Advantage |
$683.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$866.02
|
| Rate for Payer: Priority Health Medicare |
$683.85
|
| Rate for Payer: Priority Health Narrow Network |
$692.85
|
| Rate for Payer: Railroad Medicare Medicare |
$683.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$869.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$683.85
|
| Rate for Payer: UHC Exchange |
$1,059.97
|
| Rate for Payer: UHC Medicaid |
$357.65
|
| Rate for Payer: UHCCP DNSP |
$683.85
|
| Rate for Payer: UHCCP Medicaid |
$357.65
|
| Rate for Payer: VA VA |
$683.85
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$988.38
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$741.28 |
| Max. Negotiated Rate |
$988.38 |
| Rate for Payer: Aetna Commercial |
$889.54
|
| Rate for Payer: ASR ASR |
$958.73
|
| Rate for Payer: BCBS Trust/PPO |
$811.66
|
| Rate for Payer: BCN Commercial |
$811.66
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Commercial |
$929.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Healthscope Commercial |
$958.73
|
| Rate for Payer: Healthscope Whirlpool |
$988.38
|
| Rate for Payer: Mclaren Commercial |
$889.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Nomi Health Commercial |
$810.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$869.77
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.38 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.97
|
| Rate for Payer: BCN Commercial |
$52.97
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$62.56
|
| Rate for Payer: Healthscope Whirlpool |
$64.50
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$53.18
|
| Rate for Payer: BCN Commercial |
$53.18
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$62.56
|
| Rate for Payer: Healthscope Whirlpool |
$64.50
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.51
|
| Rate for Payer: Priority Health Narrow Network |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.89
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$22.31
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$77.99
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$100.12
|
| Rate for Payer: ASR ASR |
$107.91
|
| Rate for Payer: BCBS Trust/PPO |
$91.36
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$104.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Healthscope Whirlpool |
$111.25
|
| Rate for Payer: Mclaren Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.90
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$93.53
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.50
|
| Rate for Payer: BCN Commercial |
$79.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Healthscope Whirlpool |
$96.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$86.78
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.48
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$67.59
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$96.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.31 |
| Max. Negotiated Rate |
$96.42 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: ASR ASR |
$93.53
|
| Rate for Payer: BCBS Trust/PPO |
$79.18
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$77.14
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$93.53
|
| Rate for Payer: Healthscope Whirlpool |
$96.42
|
| Rate for Payer: Mclaren Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.96
|
| Rate for Payer: Nomi Health Commercial |
$79.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.85
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,568.25 |
| Max. Negotiated Rate |
$2,091.00 |
| Rate for Payer: Aetna Commercial |
$1,881.90
|
| Rate for Payer: ASR ASR |
$2,028.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,717.13
|
| Rate for Payer: BCN Commercial |
$1,717.13
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,965.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$2,028.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,091.00
|
| Rate for Payer: Mclaren Commercial |
$1,881.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Nomi Health Commercial |
$1,714.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.08
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$773.67 |
| Max. Negotiated Rate |
$2,091.00 |
| Rate for Payer: Aetna Commercial |
$1,881.90
|
| Rate for Payer: Aetna Medicare |
$773.67
|
| Rate for Payer: ASR ASR |
$2,028.27
|
| Rate for Payer: BCBS Complete |
$836.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,724.03
|
| Rate for Payer: BCN Commercial |
$1,724.03
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,965.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$2,028.27
|
| Rate for Payer: Healthscope Whirlpool |
$2,091.00
|
| Rate for Payer: Mclaren Commercial |
$1,881.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,672.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Nomi Health Commercial |
$1,714.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,832.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,465.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,840.08
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$63.16
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$63.16 |
| Rate for Payer: Aetna Commercial |
$56.84
|
| Rate for Payer: Aetna Medicare |
$23.37
|
| Rate for Payer: ASR ASR |
$61.27
|
| Rate for Payer: BCBS Complete |
$25.26
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$59.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.53
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Healthscope Whirlpool |
$63.16
|
| Rate for Payer: Mclaren Commercial |
$56.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.69
|
| Rate for Payer: Nomi Health Commercial |
$51.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.34
|
| Rate for Payer: Priority Health Narrow Network |
$44.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.58
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$63.16
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$63.16 |
| Rate for Payer: Aetna Commercial |
$56.84
|
| Rate for Payer: ASR ASR |
$61.27
|
| Rate for Payer: BCBS Trust/PPO |
$51.87
|
| Rate for Payer: BCN Commercial |
$51.87
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$59.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.53
|
| Rate for Payer: Healthscope Commercial |
$61.27
|
| Rate for Payer: Healthscope Whirlpool |
$63.16
|
| Rate for Payer: Mclaren Commercial |
$56.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.69
|
| Rate for Payer: Nomi Health Commercial |
$51.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.58
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.69
|
| Rate for Payer: BCN Commercial |
$76.69
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: Aetna Medicare |
$34.55
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: Aetna Medicare |
$34.55
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.69
|
| Rate for Payer: BCN Commercial |
$76.69
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: Aetna Medicare |
$34.55
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$33.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.69
|
| Rate for Payer: BCN Commercial |
$76.69
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.99 |
| Max. Negotiated Rate |
$154.65 |
| Rate for Payer: Aetna Commercial |
$139.19
|
| Rate for Payer: ASR ASR |
$150.01
|
| Rate for Payer: BCBS Trust/PPO |
$127.00
|
| Rate for Payer: BCN Commercial |
$127.00
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$150.01
|
| Rate for Payer: Healthscope Whirlpool |
$154.65
|
| Rate for Payer: Mclaren Commercial |
$139.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.09
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$154.65 |
| Rate for Payer: Aetna Commercial |
$139.19
|
| Rate for Payer: Aetna Medicare |
$57.22
|
| Rate for Payer: ASR ASR |
$150.01
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: BCBS Trust/PPO |
$127.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$127.51
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$150.01
|
| Rate for Payer: Healthscope Whirlpool |
$154.65
|
| Rate for Payer: Mclaren Commercial |
$139.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.09
|
|
