|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$96.32 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$91.69
|
| Rate for Payer: ASR Commercial |
$91.69
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCN Commercial |
$73.29
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$88.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$94.53
|
| Rate for Payer: Healthscope Whirlpool |
$91.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$77.51
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.83
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$66.27
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$820.00 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: Aetna Medicare |
$1,025.00
|
| Rate for Payer: ASR ASR |
$1,988.50
|
| Rate for Payer: ASR Commercial |
$1,988.50
|
| Rate for Payer: BCBS Complete |
$820.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,678.74
|
| Rate for Payer: BCN Commercial |
$1,589.37
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,927.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$2,050.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,988.50
|
| Rate for Payer: Mclaren Commercial |
$1,845.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.50
|
| Rate for Payer: Nomi Health Commercial |
$1,681.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,796.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,437.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,804.00
|
|
|
HC OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
CPT 34715
|
| Hospital Charge Code |
36000123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,332.50 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: ASR ASR |
$1,988.50
|
| Rate for Payer: ASR Commercial |
$1,988.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.55
|
| Rate for Payer: BCN Commercial |
$1,589.37
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cofinity Commercial |
$1,927.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.00
|
| Rate for Payer: Healthscope Commercial |
$2,050.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,988.50
|
| Rate for Payer: Mclaren Commercial |
$1,845.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.50
|
| Rate for Payer: Nomi Health Commercial |
$1,681.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,804.00
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$61.92
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$61.92 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: ASR ASR |
$60.06
|
| Rate for Payer: ASR Commercial |
$60.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.46
|
| Rate for Payer: BCN Commercial |
$48.01
|
| Rate for Payer: Cash Price |
$49.54
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.54
|
| Rate for Payer: Healthscope Commercial |
$61.92
|
| Rate for Payer: Healthscope Whirlpool |
$60.06
|
| Rate for Payer: Mclaren Commercial |
$55.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.63
|
| Rate for Payer: Nomi Health Commercial |
$50.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.49
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$61.92
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.77 |
| Max. Negotiated Rate |
$61.92 |
| Rate for Payer: Aetna Commercial |
$55.73
|
| Rate for Payer: Aetna Medicare |
$30.96
|
| Rate for Payer: ASR ASR |
$60.06
|
| Rate for Payer: ASR Commercial |
$60.06
|
| Rate for Payer: BCBS Complete |
$24.77
|
| Rate for Payer: BCBS Trust/PPO |
$50.71
|
| Rate for Payer: BCN Commercial |
$48.01
|
| Rate for Payer: Cash Price |
$49.54
|
| Rate for Payer: Cofinity Commercial |
$58.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.54
|
| Rate for Payer: Healthscope Commercial |
$61.92
|
| Rate for Payer: Healthscope Whirlpool |
$60.06
|
| Rate for Payer: Mclaren Commercial |
$55.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.63
|
| Rate for Payer: Nomi Health Commercial |
$50.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.25
|
| Rate for Payer: Priority Health Narrow Network |
$43.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.49
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Narrow Network |
$64.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Narrow Network |
$64.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Narrow Network |
$64.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OPTISON 3RD ML
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$154.65 |
| Rate for Payer: Aetna Commercial |
$139.19
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: ASR ASR |
$150.01
|
| Rate for Payer: ASR Commercial |
$150.01
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: BCBS Trust/PPO |
$126.64
|
| Rate for Payer: BCN Commercial |
$119.90
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$154.65
|
| Rate for Payer: Healthscope Whirlpool |
$150.01
|
| Rate for Payer: Mclaren Commercial |
$139.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.50
|
| Rate for Payer: Priority Health Narrow Network |
$108.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.09
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.52 |
| Max. Negotiated Rate |
$154.65 |
| Rate for Payer: Aetna Commercial |
$139.19
|
| Rate for Payer: ASR ASR |
$150.01
|
| Rate for Payer: ASR Commercial |
$150.01
|
| Rate for Payer: BCBS Trust/PPO |
$126.02
|
| Rate for Payer: BCN Commercial |
$119.90
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$145.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$154.65
|
| Rate for Payer: Healthscope Whirlpool |
$150.01
|
| Rate for Payer: Mclaren Commercial |
$139.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.45
|
| Rate for Payer: Nomi Health Commercial |
$126.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.09
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$174.09 |
| Rate for Payer: Aetna Commercial |
$156.68
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: ASR Commercial |
$168.87
|
| Rate for Payer: BCBS Trust/PPO |
$141.87
|
| Rate for Payer: BCN Commercial |
$134.97
|
| 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 |
$174.09
|
| Rate for Payer: Healthscope Whirlpool |
$168.87
|
| 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: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.20
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.64 |
| Max. Negotiated Rate |
$174.09 |
| Rate for Payer: Aetna Commercial |
$156.68
|
| Rate for Payer: Aetna Medicare |
$87.05
|
| Rate for Payer: ASR ASR |
$168.87
|
| Rate for Payer: ASR Commercial |
$168.87
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$142.56
|
| Rate for Payer: BCN Commercial |
$134.97
|
| 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 |
$174.09
|
| Rate for Payer: Healthscope Whirlpool |
$168.87
|
| 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: Priority Health Cigna Priority Health |
$113.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.54
|
| Rate for Payer: Priority Health Narrow Network |
$122.04
|
| 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 |
$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 |
$198.57
|
| 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 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 |
$211.25 |
| 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: BCN Commercial |
$163.78
|
| 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 |
$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 |
$185.10
|
| Rate for Payer: Priority Health Narrow Network |
$148.09
|
| 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 |
$121.35 |
| Max. Negotiated Rate |
$303.37 |
| Rate for Payer: Aetna Commercial |
$273.03
|
| Rate for Payer: Aetna Medicare |
$151.69
|
| 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: 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: Priority Health HMO/PPO/Tiered Network |
$265.81
|
| Rate for Payer: Priority Health Narrow Network |
$212.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.97
|
|
|
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 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 ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.88 |
| 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: 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: Priority Health HMO/PPO/Tiered Network |
$118.03
|
| Rate for Payer: Priority Health Narrow Network |
$94.43
|
| 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
|
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 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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| 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
|
|
