|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$211.92 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| Rate for Payer: ASR ASR |
$204.91
|
| Rate for Payer: ASR Commercial |
$204.91
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: BCBS Trust/PPO |
$172.99
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$163.78
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$198.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$211.25
|
| Rate for Payer: Healthscope Whirlpool |
$204.91
|
| 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: Priority Health Cigna Priority Health |
$137.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.92
|
| Rate for Payer: Priority Health Narrow Network |
$169.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.90
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$211.25 |
| Rate for Payer: Aetna Commercial |
$190.12
|
| Rate for Payer: ASR ASR |
$204.91
|
| Rate for Payer: ASR Commercial |
$204.91
|
| Rate for Payer: BCBS Trust/PPO |
$172.15
|
| Rate for Payer: BCN Commercial |
$163.78
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$198.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$211.25
|
| Rate for Payer: Healthscope Whirlpool |
$204.91
|
| 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: Priority Health Cigna Priority Health |
$137.31
|
| 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 |
$197.19 |
| Max. Negotiated Rate |
$303.37 |
| Rate for Payer: Aetna Commercial |
$273.03
|
| Rate for Payer: ASR ASR |
$294.27
|
| Rate for Payer: ASR Commercial |
$294.27
|
| Rate for Payer: BCBS Trust/PPO |
$247.22
|
| Rate for Payer: BCN Commercial |
$235.20
|
| 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 |
$303.37
|
| Rate for Payer: Healthscope Whirlpool |
$294.27
|
| 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: Priority Health Cigna Priority Health |
$197.19
|
| 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 |
$151.68
|
| Rate for Payer: ASR ASR |
$294.27
|
| Rate for Payer: ASR Commercial |
$294.27
|
| Rate for Payer: BCBS Complete |
$121.35
|
| Rate for Payer: BCBS Trust/PPO |
$248.43
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$235.20
|
| 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 |
$303.37
|
| Rate for Payer: Healthscope Whirlpool |
$294.27
|
| 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: Priority Health Cigna Priority Health |
$197.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.88
|
| Rate for Payer: Priority Health Narrow Network |
$187.10
|
| 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 |
$328.34 |
| Max. Negotiated Rate |
$505.14 |
| Rate for Payer: Aetna Commercial |
$454.63
|
| Rate for Payer: ASR ASR |
$489.99
|
| Rate for Payer: ASR Commercial |
$489.99
|
| Rate for Payer: BCBS Trust/PPO |
$411.64
|
| Rate for Payer: BCN Commercial |
$391.64
|
| 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 |
$505.14
|
| Rate for Payer: Healthscope Whirlpool |
$489.99
|
| 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: Priority Health Cigna Priority Health |
$328.34
|
| 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 |
$202.06 |
| Max. Negotiated Rate |
$505.14 |
| Rate for Payer: Aetna Commercial |
$454.63
|
| Rate for Payer: Aetna Medicare |
$252.57
|
| Rate for Payer: ASR ASR |
$489.99
|
| Rate for Payer: ASR Commercial |
$489.99
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS Trust/PPO |
$413.66
|
| Rate for Payer: BCN Commercial |
$391.64
|
| 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 |
$505.14
|
| Rate for Payer: Healthscope Whirlpool |
$489.99
|
| 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: Priority Health Cigna Priority Health |
$328.34
|
| Rate for Payer: 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 |
$67.36
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$110.31
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$104.44
|
| 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 |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| 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: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| 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 |
$87.56 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$109.78
|
| Rate for Payer: BCN Commercial |
$104.44
|
| 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 |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| 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: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$67.93
|
| Rate for Payer: ASR ASR |
$73.22
|
| Rate for Payer: ASR Commercial |
$73.22
|
| Rate for Payer: BCBS Trust/PPO |
$61.51
|
| Rate for Payer: BCN Commercial |
$58.52
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Healthscope Whirlpool |
$73.22
|
| Rate for Payer: Mclaren Commercial |
$67.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.42
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$67.93
|
| 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 |
$73.22
|
| Rate for Payer: ASR Commercial |
$73.22
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$58.52
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Healthscope Whirlpool |
$73.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.60
|
| Rate for Payer: Mclaren Commercial |
$67.93
|
| Rate for Payer: Mclaren Medicaid |
$12.65
|
| 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 |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| 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 |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.14
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health Narrow Network |
$52.91
|
| Rate for Payer: Railroad Medicare Medicare |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.60
|
| Rate for Payer: UHC Exchange |
$36.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.60
|
| Rate for Payer: UHCCP DNSP |
$23.60
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: VA VA |
$23.60
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Medicare |
$137.50
|
| Rate for Payer: ASR ASR |
$266.75
|
| Rate for Payer: ASR Commercial |
$266.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$225.20
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$258.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$275.00
|
| Rate for Payer: Healthscope Whirlpool |
$266.75
|
| Rate for Payer: Mclaren Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: Nomi Health Commercial |
$225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.96
|
| Rate for Payer: Priority Health Narrow Network |
$192.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.00
|
|
|
HC OR LEVEL 1 BASE CHARGE
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
36000126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: ASR ASR |
$266.75
|
| Rate for Payer: ASR Commercial |
$266.75
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$258.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$275.00
|
| Rate for Payer: Healthscope Whirlpool |
$266.75
|
| Rate for Payer: Mclaren Commercial |
$247.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.75
|
| Rate for Payer: Nomi Health Commercial |
$225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.00
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: ASR Commercial |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$48.89
|
| Rate for Payer: BCN Commercial |
$46.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$60.00
|
| Rate for Payer: Healthscope Whirlpool |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC OR LEVEL 1 PER MINUTE
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
36000127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: ASR Commercial |
$58.20
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.13
|
| Rate for Payer: BCN Commercial |
$46.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$60.00
|
| Rate for Payer: Healthscope Whirlpool |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.57
|
| Rate for Payer: Priority Health Narrow Network |
$42.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
OP
|
$737.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.80 |
| Max. Negotiated Rate |
$737.00 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Aetna Medicare |
$368.50
|
| Rate for Payer: ASR ASR |
$714.89
|
| Rate for Payer: ASR Commercial |
$714.89
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS Trust/PPO |
$603.53
|
| Rate for Payer: BCN Commercial |
$571.40
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$692.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Healthscope Commercial |
$737.00
|
| Rate for Payer: Healthscope Whirlpool |
$714.89
|
| Rate for Payer: Mclaren Commercial |
$663.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$645.76
|
| Rate for Payer: Priority Health Narrow Network |
$516.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.56
|
|
|
HC OR LEVEL 2 BASE CHARGE
|
Facility
|
IP
|
$737.00
|
|
| Hospital Charge Code |
36000128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.05 |
| Max. Negotiated Rate |
$737.00 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: ASR ASR |
$714.89
|
| Rate for Payer: ASR Commercial |
$714.89
|
| Rate for Payer: BCBS Trust/PPO |
$600.58
|
| Rate for Payer: BCN Commercial |
$571.40
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$692.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.60
|
| Rate for Payer: Healthscope Commercial |
$737.00
|
| Rate for Payer: Healthscope Whirlpool |
$714.89
|
| Rate for Payer: Mclaren Commercial |
$663.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.45
|
| Rate for Payer: Nomi Health Commercial |
$604.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.56
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: ASR Commercial |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$67.64
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: Nomi Health Commercial |
$68.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
HC OR LEVEL 2 PER MINUTE
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
36000129
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: ASR ASR |
$80.51
|
| Rate for Payer: ASR Commercial |
$80.51
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$67.97
|
| Rate for Payer: BCN Commercial |
$64.35
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$83.00
|
| Rate for Payer: Healthscope Whirlpool |
$80.51
|
| Rate for Payer: Mclaren Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.55
|
| Rate for Payer: Nomi Health Commercial |
$68.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.72
|
| Rate for Payer: Priority Health Narrow Network |
$58.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.04
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$857.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: ASR ASR |
$831.29
|
| Rate for Payer: ASR Commercial |
$831.29
|
| Rate for Payer: BCBS Trust/PPO |
$698.37
|
| Rate for Payer: BCN Commercial |
$664.43
|
| 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 |
$857.00
|
| Rate for Payer: Healthscope Whirlpool |
$831.29
|
| 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: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.16
|
|
|
HC OR LEVEL 3 BASE CHARGE
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
36000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.80 |
| Max. Negotiated Rate |
$857.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Medicare |
$428.50
|
| Rate for Payer: ASR ASR |
$831.29
|
| Rate for Payer: ASR Commercial |
$831.29
|
| Rate for Payer: BCBS Complete |
$342.80
|
| Rate for Payer: BCBS Trust/PPO |
$701.80
|
| Rate for Payer: BCN Commercial |
$664.43
|
| 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 |
$857.00
|
| Rate for Payer: Healthscope Whirlpool |
$831.29
|
| 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: Priority Health Cigna Priority Health |
$557.05
|
| Rate for Payer: 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 PER MINUTE
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: ASR ASR |
$96.03
|
| Rate for Payer: ASR Commercial |
$96.03
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Trust/PPO |
$81.07
|
| Rate for Payer: BCN Commercial |
$76.75
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$93.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Healthscope Whirlpool |
$96.03
|
| Rate for Payer: Mclaren Commercial |
$89.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: Nomi Health Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.74
|
| Rate for Payer: Priority Health Narrow Network |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.12
|
|
|
HC OR LEVEL 3 PER MINUTE
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
36000131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: ASR ASR |
$96.03
|
| Rate for Payer: ASR Commercial |
$96.03
|
| Rate for Payer: BCBS Trust/PPO |
$80.68
|
| Rate for Payer: BCN Commercial |
$76.75
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$93.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Healthscope Whirlpool |
$96.03
|
| Rate for Payer: Mclaren Commercial |
$89.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: Nomi Health Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.12
|
|
|
HC OR LEVEL 4 BASE CHARGE
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.90 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: Aetna Commercial |
$1,103.40
|
| Rate for Payer: ASR ASR |
$1,189.22
|
| Rate for Payer: ASR Commercial |
$1,189.22
|
| Rate for Payer: BCBS Trust/PPO |
$999.07
|
| Rate for Payer: BCN Commercial |
$950.52
|
| Rate for Payer: Cash Price |
$980.80
|
| Rate for Payer: Cofinity Commercial |
$1,152.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.80
|
| Rate for Payer: Healthscope Commercial |
$1,226.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.22
|
| Rate for Payer: Mclaren Commercial |
$1,103.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.10
|
| Rate for Payer: Nomi Health Commercial |
$1,005.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,078.88
|
|
