|
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
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
36000132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.40 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: Aetna Commercial |
$1,103.40
|
| Rate for Payer: Aetna Medicare |
$613.00
|
| Rate for Payer: ASR ASR |
$1,189.22
|
| Rate for Payer: ASR Commercial |
$1,189.22
|
| Rate for Payer: BCBS Complete |
$490.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.97
|
| 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: Priority Health HMO/PPO/Tiered Network |
$1,074.22
|
| Rate for Payer: Priority Health Narrow Network |
$859.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,078.88
|
|
|
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
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: ASR ASR |
$107.67
|
| Rate for Payer: ASR Commercial |
$107.67
|
| Rate for Payer: BCBS Trust/PPO |
$90.45
|
| Rate for Payer: BCN Commercial |
$86.06
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$111.00
|
| Rate for Payer: Healthscope Whirlpool |
$107.67
|
| Rate for Payer: Mclaren Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: Nomi Health Commercial |
$91.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.68
|
|
|
HC OR LEVEL 4 PER MINUTE
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
36000133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: ASR ASR |
$107.67
|
| Rate for Payer: ASR Commercial |
$107.67
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$90.90
|
| Rate for Payer: BCN Commercial |
$86.06
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$104.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.80
|
| Rate for Payer: Healthscope Commercial |
$111.00
|
| Rate for Payer: Healthscope Whirlpool |
$107.67
|
| Rate for Payer: Mclaren Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.35
|
| Rate for Payer: Nomi Health Commercial |
$91.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.26
|
| Rate for Payer: Priority Health Narrow Network |
$77.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.68
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.10 |
| Max. Negotiated Rate |
$1,454.00 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: ASR ASR |
$1,410.38
|
| Rate for Payer: ASR Commercial |
$1,410.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.86
|
| Rate for Payer: BCN Commercial |
$1,127.29
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,366.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,454.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,410.38
|
| Rate for Payer: Mclaren Commercial |
$1,308.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.90
|
| Rate for Payer: Nomi Health Commercial |
$1,192.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,279.52
|
|
|
HC OR LEVEL 5 BASE CHARGE
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
36000134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.60 |
| Max. Negotiated Rate |
$1,454.00 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Medicare |
$727.00
|
| Rate for Payer: ASR ASR |
$1,410.38
|
| Rate for Payer: ASR Commercial |
$1,410.38
|
| Rate for Payer: BCBS Complete |
$581.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.68
|
| Rate for Payer: BCN Commercial |
$1,127.29
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,366.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,163.20
|
| Rate for Payer: Healthscope Commercial |
$1,454.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,410.38
|
| Rate for Payer: Mclaren Commercial |
$1,308.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.90
|
| Rate for Payer: Nomi Health Commercial |
$1,192.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,273.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,279.52
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: ASR ASR |
$117.37
|
| Rate for Payer: ASR Commercial |
$117.37
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Trust/PPO |
$99.09
|
| Rate for Payer: BCN Commercial |
$93.81
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$113.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.80
|
| Rate for Payer: Healthscope Commercial |
$121.00
|
| Rate for Payer: Healthscope Whirlpool |
$117.37
|
| Rate for Payer: Mclaren Commercial |
$108.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.85
|
| Rate for Payer: Nomi Health Commercial |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.02
|
| Rate for Payer: Priority Health Narrow Network |
$84.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.48
|
|
|
HC OR LEVEL 5 PER MINUTE
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
36000135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: ASR ASR |
$117.37
|
| Rate for Payer: ASR Commercial |
$117.37
|
| Rate for Payer: BCBS Trust/PPO |
$98.60
|
| Rate for Payer: BCN Commercial |
$93.81
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$113.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.80
|
| Rate for Payer: Healthscope Commercial |
$121.00
|
| Rate for Payer: Healthscope Whirlpool |
$117.37
|
| Rate for Payer: Mclaren Commercial |
$108.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.85
|
| Rate for Payer: Nomi Health Commercial |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.48
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
IP
|
$30.17
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: ASR ASR |
$29.26
|
| Rate for Payer: ASR Commercial |
$29.26
|
| Rate for Payer: BCBS Trust/PPO |
$24.59
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$29.26
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$30.17
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$15.09
|
| Rate for Payer: ASR ASR |
$29.26
|
| Rate for Payer: ASR Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS Trust/PPO |
$24.71
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$29.26
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.64
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.43
|
| Rate for Payer: Priority Health Narrow Network |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$123.27
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$123.27 |
| Rate for Payer: Aetna Commercial |
$110.94
|
| 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 |
$119.57
|
| Rate for Payer: ASR Commercial |
$119.57
|
| Rate for Payer: BCBS Complete |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$100.95
|
| Rate for Payer: BCN Commercial |
$95.57
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cofinity Commercial |
$115.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$123.27
|
| Rate for Payer: Healthscope Whirlpool |
$119.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$110.94
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| 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 |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.78
|
| Rate for Payer: Nomi Health Commercial |
$101.08
|
| 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 |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.01
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$86.41
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$79.53
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP DNSP |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$27.50
|
| Rate for Payer: VA VA |
$51.31
|
|
