|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$209.42 |
| Rate for Payer: Aetna Commercial |
$156.68
|
| Rate for Payer: Aetna Medicare |
$64.41
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$143.54
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$143.54
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$163.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Whirlpool |
$174.09
|
| Rate for Payer: Mclaren Commercial |
$156.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.42
|
| Rate for Payer: Priority Health Narrow Network |
$167.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$174.09 |
| Rate for Payer: Aetna Commercial |
$156.68
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: BCBS Trust/PPO |
$142.96
|
| Rate for Payer: BCN Commercial |
$142.96
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$163.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Whirlpool |
$174.09
|
| Rate for Payer: Mclaren Commercial |
$156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.98
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.44 |
| Max. Negotiated Rate |
$211.25 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: ASR ASR |
$204.91
|
| Rate for Payer: BCBS Trust/PPO |
$173.48
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$198.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$204.91
|
| Rate for Payer: Healthscope Whirlpool |
$211.25
|
| Rate for Payer: Mclaren Commercial |
$190.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Nomi Health Commercial |
$173.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.90
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$233.65 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$78.16
|
| Rate for Payer: ASR ASR |
$204.91
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: BCBS Trust/PPO |
$174.18
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$174.18
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$198.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$204.91
|
| Rate for Payer: Healthscope Whirlpool |
$211.25
|
| Rate for Payer: Mclaren Commercial |
$190.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Nomi Health Commercial |
$173.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.65
|
| Rate for Payer: Priority Health Narrow Network |
$186.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.90
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
IP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.53 |
| Max. Negotiated Rate |
$303.37 |
| Rate for Payer: Aetna Commercial |
$273.03
|
| Rate for Payer: ASR ASR |
$294.27
|
| Rate for Payer: BCBS Trust/PPO |
$249.13
|
| Rate for Payer: BCN Commercial |
$249.13
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$285.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$294.27
|
| Rate for Payer: Healthscope Whirlpool |
$303.37
|
| Rate for Payer: Mclaren Commercial |
$273.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.97
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
OP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.68 |
| Max. Negotiated Rate |
$303.37 |
| Rate for Payer: Aetna Commercial |
$273.03
|
| Rate for Payer: Aetna Medicare |
$112.25
|
| Rate for Payer: ASR ASR |
$294.27
|
| Rate for Payer: BCBS Complete |
$121.35
|
| Rate for Payer: BCBS Trust/PPO |
$250.13
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$250.13
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$285.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$294.27
|
| Rate for Payer: Healthscope Whirlpool |
$303.37
|
| Rate for Payer: Mclaren Commercial |
$273.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.85
|
| Rate for Payer: Priority Health Narrow Network |
$206.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.97
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
IP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.86 |
| Max. Negotiated Rate |
$505.14 |
| Rate for Payer: Aetna Commercial |
$454.63
|
| Rate for Payer: ASR ASR |
$489.99
|
| Rate for Payer: BCBS Trust/PPO |
$414.82
|
| Rate for Payer: BCN Commercial |
$414.82
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$474.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$489.99
|
| Rate for Payer: Healthscope Whirlpool |
$505.14
|
| Rate for Payer: Mclaren Commercial |
$454.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Nomi Health Commercial |
$414.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.52
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
OP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$505.14 |
| Rate for Payer: Aetna Commercial |
$454.63
|
| Rate for Payer: Aetna Medicare |
$186.90
|
| Rate for Payer: ASR ASR |
$489.99
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS Trust/PPO |
$416.49
|
| Rate for Payer: BCN Commercial |
$416.49
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$474.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$489.99
|
| Rate for Payer: Healthscope Whirlpool |
$505.14
|
| Rate for Payer: Mclaren Commercial |
$454.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$404.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.37
|
| Rate for Payer: Nomi Health Commercial |
$414.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$442.60
|
| Rate for Payer: Priority Health Narrow Network |
$354.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.52
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$111.07
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$111.07
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$130.67
|
| Rate for Payer: Healthscope Whirlpool |
$134.71
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| 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 |
$118.54
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.03 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$110.62
|
| Rate for Payer: BCN Commercial |
$110.62
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$130.67
|
| Rate for Payer: Healthscope Whirlpool |
$134.71
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| 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 |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: Aetna Medicare |
$23.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.50
|
| Rate for Payer: ASR ASR |
$74.68
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$63.48
|
| Rate for Payer: BCN Commercial |
$63.48
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Healthscope Commercial |
$74.68
|
| Rate for Payer: Healthscope Whirlpool |
$76.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.60
|
| Rate for Payer: Mclaren Commercial |
$69.29
|
| Rate for Payer: Mclaren Medicaid |
$23.60
|
| Rate for Payer: Mclaren Medicare |
$23.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.78
|
| Rate for Payer: Meridian Medicaid |
$12.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PACE Medicare |
$22.42
|
| Rate for Payer: PACE SWMI |
$23.60
|
| Rate for Payer: PHP Commercial |
$25.96
|
| Rate for Payer: PHP Medicaid |
$12.65
|
| Rate for Payer: PHP Medicare Advantage |
$23.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.46
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health Narrow Network |
$53.97
|
| Rate for Payer: Railroad Medicare Medicare |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.60
|
| Rate for Payer: UHC Exchange |
$36.58
|
| Rate for Payer: UHC Medicaid |
$12.34
|
| Rate for Payer: UHCCP DNSP |
$23.60
|
| Rate for Payer: UHCCP Medicaid |
$12.34
|
| Rate for Payer: VA VA |
$23.60
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: ASR ASR |
$74.68
|
| Rate for Payer: BCBS Trust/PPO |
$63.22
|
| Rate for Payer: BCN Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Healthscope Commercial |
$74.68
|
| Rate for Payer: Healthscope Whirlpool |
$76.99
|
| Rate for Payer: Mclaren Commercial |
$69.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.75
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
IP
|
$219.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: ASR ASR |
$212.43
|
| Rate for Payer: BCBS Trust/PPO |
$179.84
|
| Rate for Payer: BCN Commercial |
$179.84
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$205.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.20
|
| Rate for Payer: Healthscope Commercial |
$212.43
|
| Rate for Payer: Healthscope Whirlpool |
$219.00
|
| Rate for Payer: Mclaren Commercial |
$197.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.15
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.72
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
OP
|
$219.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Medicare |
$81.03
|
| Rate for Payer: ASR ASR |
$212.43
|
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: BCBS Trust/PPO |
$180.57
|
| Rate for Payer: BCN Commercial |
$180.57
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$205.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.20
|
| Rate for Payer: Healthscope Commercial |
$212.43
|
| Rate for Payer: Healthscope Whirlpool |
$219.00
|
| Rate for Payer: Mclaren Commercial |
$197.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.15
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.89
|
| Rate for Payer: Priority Health Narrow Network |
$153.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.72
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
OP
|
$65.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$24.05
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$53.59
|
| Rate for Payer: BCN Commercial |
$53.59
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$63.05
|
| Rate for Payer: Healthscope Whirlpool |
$65.00
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.95
|
| Rate for Payer: Priority Health Narrow Network |
$45.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
IP
|
$65.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$53.38
|
| Rate for Payer: BCN Commercial |
$53.38
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$63.05
|
| Rate for Payer: Healthscope Whirlpool |
$65.00
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
IP
|
$643.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$482.25 |
| Max. Negotiated Rate |
$643.00 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: ASR ASR |
$623.71
|
| Rate for Payer: BCBS Trust/PPO |
$528.03
|
| Rate for Payer: BCN Commercial |
$528.03
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$604.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.40
|
| Rate for Payer: Healthscope Commercial |
$623.71
|
| Rate for Payer: Healthscope Whirlpool |
$643.00
|
| Rate for Payer: Mclaren Commercial |
$578.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.55
|
| Rate for Payer: Nomi Health Commercial |
$527.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.84
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
OP
|
$643.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$643.00 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Aetna Medicare |
$237.91
|
| Rate for Payer: ASR ASR |
$623.71
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS Trust/PPO |
$530.15
|
| Rate for Payer: BCN Commercial |
$530.15
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$604.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.40
|
| Rate for Payer: Healthscope Commercial |
$623.71
|
| Rate for Payer: Healthscope Whirlpool |
$643.00
|
| Rate for Payer: Mclaren Commercial |
$578.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.55
|
| Rate for Payer: Nomi Health Commercial |
$527.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$563.40
|
| Rate for Payer: Priority Health Narrow Network |
$450.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$565.84
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.89 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Medicare |
$35.89
|
| Rate for Payer: ASR ASR |
$94.09
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Trust/PPO |
$79.98
|
| Rate for Payer: BCN Commercial |
$79.98
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$94.09
|
| Rate for Payer: Healthscope Whirlpool |
$97.00
|
| Rate for Payer: Mclaren Commercial |
$87.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$84.99
|
| Rate for Payer: Priority Health Narrow Network |
$68.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.36
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: ASR ASR |
$94.09
|
| Rate for Payer: BCBS Trust/PPO |
$79.66
|
| Rate for Payer: BCN Commercial |
$79.66
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$94.09
|
| Rate for Payer: Healthscope Whirlpool |
$97.00
|
| Rate for Payer: Mclaren Commercial |
$87.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.36
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.09 |
| Max. Negotiated Rate |
$857.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Medicare |
$317.09
|
| Rate for Payer: ASR ASR |
$831.29
|
| Rate for Payer: BCBS Complete |
$342.80
|
| Rate for Payer: BCBS Trust/PPO |
$706.60
|
| Rate for Payer: BCN Commercial |
$706.60
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$805.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$831.29
|
| Rate for Payer: Healthscope Whirlpool |
$857.00
|
| Rate for Payer: Mclaren Commercial |
$771.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$685.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Nomi Health Commercial |
$702.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$750.90
|
| Rate for Payer: Priority Health Narrow Network |
$600.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.16
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$642.75 |
| Max. Negotiated Rate |
$857.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: ASR ASR |
$831.29
|
| Rate for Payer: BCBS Trust/PPO |
$703.77
|
| Rate for Payer: BCN Commercial |
$703.77
|
| Rate for Payer: Cash Price |
$685.60
|
| Rate for Payer: Cofinity Commercial |
$805.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.60
|
| Rate for Payer: Healthscope Commercial |
$831.29
|
| Rate for Payer: Healthscope Whirlpool |
$857.00
|
| Rate for Payer: Mclaren Commercial |
$771.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.45
|
| Rate for Payer: Nomi Health Commercial |
$702.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.16
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Medicare |
$39.96
|
| Rate for Payer: ASR ASR |
$104.76
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Trust/PPO |
$89.05
|
| Rate for Payer: BCN Commercial |
$89.05
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$101.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$104.76
|
| Rate for Payer: Healthscope Whirlpool |
$108.00
|
| Rate for Payer: Mclaren Commercial |
$97.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.80
|
| Rate for Payer: Nomi Health Commercial |
$88.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.63
|
| Rate for Payer: Priority Health Narrow Network |
$75.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.04
|
|
