|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: ASR ASR |
$104.76
|
| Rate for Payer: BCBS Trust/PPO |
$88.69
|
| Rate for Payer: BCN Commercial |
$88.69
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$95.04
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
IP
|
$1,372.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna Commercial |
$1,234.80
|
| Rate for Payer: ASR ASR |
$1,330.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.69
|
| Rate for Payer: BCN Commercial |
$1,126.69
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,289.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,330.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,372.00
|
| Rate for Payer: Mclaren Commercial |
$1,234.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.20
|
| Rate for Payer: Nomi Health Commercial |
$1,125.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,207.36
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
OP
|
$1,372.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.64 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna Commercial |
$1,234.80
|
| Rate for Payer: Aetna Medicare |
$507.64
|
| Rate for Payer: ASR ASR |
$1,330.84
|
| Rate for Payer: BCBS Complete |
$548.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.21
|
| Rate for Payer: BCN Commercial |
$1,131.21
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,289.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,330.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,372.00
|
| Rate for Payer: Mclaren Commercial |
$1,234.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,097.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.20
|
| Rate for Payer: Nomi Health Commercial |
$1,125.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,202.15
|
| Rate for Payer: Priority Health Narrow Network |
$961.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,207.36
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
OP
|
$118.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.66 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Medicare |
$43.66
|
| Rate for Payer: ASR ASR |
$114.46
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS Trust/PPO |
$97.29
|
| Rate for Payer: BCN Commercial |
$97.29
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$114.46
|
| Rate for Payer: Healthscope Whirlpool |
$118.00
|
| Rate for Payer: Mclaren Commercial |
$106.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.30
|
| Rate for Payer: Nomi Health Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.39
|
| Rate for Payer: Priority Health Narrow Network |
$82.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.84
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
IP
|
$118.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: ASR ASR |
$114.46
|
| Rate for Payer: BCBS Trust/PPO |
$96.90
|
| Rate for Payer: BCN Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.40
|
| Rate for Payer: Healthscope Commercial |
$114.46
|
| Rate for Payer: Healthscope Whirlpool |
$118.00
|
| Rate for Payer: Mclaren Commercial |
$106.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.30
|
| Rate for Payer: Nomi Health Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.84
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
IP
|
$2,188.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,641.00 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$1,969.20
|
| Rate for Payer: ASR ASR |
$2,122.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.79
|
| Rate for Payer: BCN Commercial |
$1,796.79
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$2,056.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,750.40
|
| Rate for Payer: Healthscope Commercial |
$2,122.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,188.00
|
| Rate for Payer: Mclaren Commercial |
$1,969.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,859.80
|
| Rate for Payer: Nomi Health Commercial |
$1,794.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,925.44
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
OP
|
$2,188.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$809.56 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$1,969.20
|
| Rate for Payer: Aetna Medicare |
$809.56
|
| Rate for Payer: ASR ASR |
$2,122.36
|
| Rate for Payer: BCBS Complete |
$875.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.01
|
| Rate for Payer: BCN Commercial |
$1,804.01
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$2,056.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,750.40
|
| Rate for Payer: Healthscope Commercial |
$2,122.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,188.00
|
| Rate for Payer: Mclaren Commercial |
$1,969.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,859.80
|
| Rate for Payer: Nomi Health Commercial |
$1,794.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,917.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,925.44
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$123.67
|
| Rate for Payer: BCN Commercial |
$123.67
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$145.50
|
| Rate for Payer: Healthscope Whirlpool |
$150.00
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.50
|
| Rate for Payer: Nomi Health Commercial |
$123.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.43
|
| Rate for Payer: Priority Health Narrow Network |
$105.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$123.18
|
| Rate for Payer: BCN Commercial |
$123.18
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$145.50
|
| Rate for Payer: Healthscope Whirlpool |
$150.00
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.50
|
| Rate for Payer: Nomi Health Commercial |
$123.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$30.77
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: ASR ASR |
$29.85
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$25.37
|
| Rate for Payer: BCN Commercial |
$25.37
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$28.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$30.77
|
| Rate for Payer: Mclaren Commercial |
$27.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.63
|
| Rate for Payer: Priority Health Narrow Network |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.08
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
IP
|
$30.77
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: Aetna Commercial |
$27.69
|
| Rate for Payer: ASR ASR |
$29.85
|
| Rate for Payer: BCBS Trust/PPO |
$25.27
|
| Rate for Payer: BCN Commercial |
$25.27
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$28.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$30.77
|
| Rate for Payer: Mclaren Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.08
|
|
|
HC OR SEDATION PER MINUTE
|
Facility
|
OP
|
$14.28
|
|
| Hospital Charge Code |
37000026
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: BCN Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Whirlpool |
$14.28
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.51
|
| Rate for Payer: Priority Health Narrow Network |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
|
|
HC OR SEDATION PER MINUTE
|
Facility
|
IP
|
$14.28
|
|
| Hospital Charge Code |
37000026
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.73
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Whirlpool |
$14.28
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$125.74
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$125.74 |
| Rate for Payer: Aetna Commercial |
$113.17
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: ASR ASR |
$121.97
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$103.67
|
| Rate for Payer: BCN Commercial |
$103.67
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$100.59
|
| Rate for Payer: Cash Price |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$118.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$121.97
|
| Rate for Payer: Healthscope Whirlpool |
$125.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$113.17
|
| Rate for Payer: Mclaren Medicaid |
$51.31
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.88
|
| Rate for Payer: Nomi Health Commercial |
$103.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.31
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: PHP Medicaid |
$27.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$110.17
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$88.14
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$79.53
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP DNSP |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
IP
|
$125.74
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$125.74 |
| Rate for Payer: Aetna Commercial |
$113.17
|
| Rate for Payer: ASR ASR |
$121.97
|
| Rate for Payer: BCBS Trust/PPO |
$103.26
|
| Rate for Payer: BCN Commercial |
$103.26
|
| Rate for Payer: Cash Price |
$100.59
|
| Rate for Payer: Cofinity Commercial |
$118.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.59
|
| Rate for Payer: Healthscope Commercial |
$121.97
|
| Rate for Payer: Healthscope Whirlpool |
$125.74
|
| Rate for Payer: Mclaren Commercial |
$113.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.88
|
| Rate for Payer: Nomi Health Commercial |
$103.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.65
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.52 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$64.08
|
| Rate for Payer: BCN Commercial |
$64.08
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$75.69
|
| Rate for Payer: Healthscope Whirlpool |
$78.03
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$64.34
|
| Rate for Payer: BCN Commercial |
$64.34
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$75.69
|
| Rate for Payer: Healthscope Whirlpool |
$78.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$51.31
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: PHP Medicaid |
$27.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.37
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$79.53
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP DNSP |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
OP
|
$149.64
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$149.64 |
| Rate for Payer: Aetna Commercial |
$134.68
|
| Rate for Payer: Aetna Medicare |
$55.37
|
| Rate for Payer: ASR ASR |
$145.15
|
| Rate for Payer: BCBS Complete |
$59.86
|
| Rate for Payer: BCBS Trust/PPO |
$123.38
|
| Rate for Payer: BCN Commercial |
$123.38
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.71
|
| Rate for Payer: Healthscope Commercial |
$145.15
|
| Rate for Payer: Healthscope Whirlpool |
$149.64
|
| Rate for Payer: Mclaren Commercial |
$134.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.19
|
| Rate for Payer: Nomi Health Commercial |
$122.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.53
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.68
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
IP
|
$149.64
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$149.64 |
| Rate for Payer: Aetna Commercial |
$134.68
|
| Rate for Payer: ASR ASR |
$145.15
|
| Rate for Payer: BCBS Trust/PPO |
$122.88
|
| Rate for Payer: BCN Commercial |
$122.88
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.71
|
| Rate for Payer: Healthscope Commercial |
$145.15
|
| Rate for Payer: Healthscope Whirlpool |
$149.64
|
| Rate for Payer: Mclaren Commercial |
$134.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.19
|
| Rate for Payer: Nomi Health Commercial |
$122.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.68
|
|
|
HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN
|
Facility
|
OP
|
$137.09
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$137.09 |
| Rate for Payer: Aetna Commercial |
$123.38
|
| Rate for Payer: Aetna Medicare |
$50.72
|
| Rate for Payer: ASR ASR |
$132.98
|
| Rate for Payer: BCBS Complete |
$54.84
|
| Rate for Payer: BCBS Trust/PPO |
$113.03
|
| Rate for Payer: BCN Commercial |
$113.03
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Commercial |
$128.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| Rate for Payer: Healthscope Whirlpool |
$137.09
|
| Rate for Payer: Mclaren Commercial |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Nomi Health Commercial |
$112.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.62
|
| Rate for Payer: Priority Health Narrow Network |
$76.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.64
|
|
|
HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN
|
Facility
|
IP
|
$137.09
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$137.09 |
| Rate for Payer: Aetna Commercial |
$123.38
|
| Rate for Payer: ASR ASR |
$132.98
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Commercial |
$128.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$132.98
|
| Rate for Payer: Healthscope Whirlpool |
$137.09
|
| Rate for Payer: Mclaren Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Nomi Health Commercial |
$112.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.64
|
|
|
HC OSCILLATOR INIT DAY
|
Facility
|
IP
|
$2,458.59
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,843.94 |
| Max. Negotiated Rate |
$2,458.59 |
| Rate for Payer: Aetna Commercial |
$2,212.73
|
| Rate for Payer: ASR ASR |
$2,384.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,018.99
|
| Rate for Payer: BCN Commercial |
$2,018.99
|
| Rate for Payer: Cash Price |
$1,966.87
|
| Rate for Payer: Cofinity Commercial |
$2,311.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.87
|
| Rate for Payer: Healthscope Commercial |
$2,384.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,458.59
|
| Rate for Payer: Mclaren Commercial |
$2,212.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.80
|
| Rate for Payer: Nomi Health Commercial |
$2,016.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,843.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,163.56
|
|
|
HC OSCILLATOR INIT DAY
|
Facility
|
OP
|
$2,458.59
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$4,454.85 |
| Rate for Payer: Aetna Commercial |
$2,212.73
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: ASR ASR |
$2,384.83
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,027.11
|
| Rate for Payer: BCN Commercial |
$2,027.11
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,966.87
|
| Rate for Payer: Cash Price |
$1,966.87
|
| Rate for Payer: Cofinity Commercial |
$2,311.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$2,384.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,458.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$615.57
|
| Rate for Payer: Mclaren Commercial |
$2,212.73
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.80
|
| Rate for Payer: Nomi Health Commercial |
$2,016.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,843.94
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$677.13
|
| Rate for Payer: PHP Medicaid |
$329.95
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,454.85
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,563.88
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,163.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$954.13
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC OSCILLATOR SUB DAY
|
Facility
|
OP
|
$1,375.25
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$3,898.00 |
| Rate for Payer: Aetna Commercial |
$1,237.72
|
| Rate for Payer: Aetna Medicare |
$615.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: ASR ASR |
$1,333.99
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.89
|
| Rate for Payer: BCN Commercial |
$1,133.89
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,100.20
|
| Rate for Payer: Cash Price |
$1,100.20
|
| Rate for Payer: Cofinity Commercial |
$1,292.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,333.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$615.57
|
| Rate for Payer: Mclaren Commercial |
$1,237.72
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$338.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,168.96
|
| Rate for Payer: Nomi Health Commercial |
$1,127.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,031.44
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$677.13
|
| Rate for Payer: PHP Medicaid |
$329.95
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,898.00
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,118.40
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,210.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$954.13
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP DNSP |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC OSCILLATOR SUB DAY
|
Facility
|
IP
|
$1,375.25
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,031.44 |
| Max. Negotiated Rate |
$1,375.25 |
| Rate for Payer: Aetna Commercial |
$1,237.72
|
| Rate for Payer: ASR ASR |
$1,333.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.36
|
| Rate for Payer: BCN Commercial |
$1,129.36
|
| Rate for Payer: Cash Price |
$1,100.20
|
| Rate for Payer: Cofinity Commercial |
$1,292.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.20
|
| Rate for Payer: Healthscope Commercial |
$1,333.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,375.25
|
| Rate for Payer: Mclaren Commercial |
$1,237.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,168.96
|
| Rate for Payer: Nomi Health Commercial |
$1,127.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,031.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,210.22
|
|
