|
HC PATH SURGERY CYTO INITIAL SITE
|
Facility
|
IP
|
$90.51
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$81.46
|
| Rate for Payer: ASR ASR |
$87.79
|
| Rate for Payer: ASR Commercial |
$87.79
|
| Rate for Payer: BCBS Trust/PPO |
$73.76
|
| Rate for Payer: BCN Commercial |
$70.17
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Healthscope Commercial |
$90.51
|
| Rate for Payer: Healthscope Whirlpool |
$87.79
|
| Rate for Payer: Mclaren Commercial |
$81.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.65
|
|
|
HC PATH SURGERY CYTO INITIAL SITE
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$1,240.59 |
| Rate for Payer: Aetna Commercial |
$81.46
|
| Rate for Payer: Aetna Medicare |
$800.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,000.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,000.48
|
| Rate for Payer: ASR ASR |
$87.79
|
| Rate for Payer: ASR Commercial |
$87.79
|
| Rate for Payer: BCBS Complete |
$450.45
|
| Rate for Payer: BCBS MAPPO |
$800.38
|
| Rate for Payer: BCBS Trust/PPO |
$74.12
|
| Rate for Payer: BCN Commercial |
$70.17
|
| Rate for Payer: BCN Medicare Advantage |
$800.38
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.38
|
| Rate for Payer: Healthscope Commercial |
$90.51
|
| Rate for Payer: Healthscope Whirlpool |
$87.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$800.38
|
| Rate for Payer: Mclaren Commercial |
$81.46
|
| Rate for Payer: Mclaren Medicaid |
$429.00
|
| Rate for Payer: Mclaren Medicare |
$800.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.40
|
| Rate for Payer: Meridian Medicaid |
$450.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$920.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: PACE Medicare |
$760.36
|
| Rate for Payer: PACE SWMI |
$800.38
|
| Rate for Payer: PHP Commercial |
$880.42
|
| Rate for Payer: PHP Medicaid |
$429.00
|
| Rate for Payer: PHP Medicare Advantage |
$800.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$800.38
|
| Rate for Payer: Priority Health Narrow Network |
$63.45
|
| Rate for Payer: Railroad Medicare Medicare |
$800.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.38
|
| Rate for Payer: UHC Exchange |
$1,240.59
|
| Rate for Payer: UHC Medicare Advantage |
$800.38
|
| Rate for Payer: UHCCP DNSP |
$800.38
|
| Rate for Payer: UHCCP Medicaid |
$429.00
|
| Rate for Payer: VA VA |
$800.38
|
|
|
HC PCP SCREEN URIN
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.44 |
| Max. Negotiated Rate |
$94.53 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: ASR ASR |
$91.69
|
| Rate for Payer: ASR Commercial |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$77.03
|
| Rate for Payer: BCN Commercial |
$73.29
|
| 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: Healthscope Commercial |
$94.53
|
| Rate for Payer: Healthscope Whirlpool |
$91.69
|
| Rate for Payer: Mclaren Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: Nomi Health Commercial |
$77.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.19
|
|
|
HC PCP SCREEN URIN
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000136
|
|
Hospital Revenue Code
|
300
|
| 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 |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| 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 PCP SCREEN URN.
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.60
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Medicaid |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$6.75
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC PCP SCREEN URN.
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$394.74
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.90 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$355.27
|
| Rate for Payer: Aetna Medicare |
$197.37
|
| Rate for Payer: ASR ASR |
$382.90
|
| Rate for Payer: ASR Commercial |
$382.90
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: BCBS Trust/PPO |
$323.25
|
| Rate for Payer: BCN Commercial |
$306.04
|
| Rate for Payer: Cash Price |
$315.79
|
| Rate for Payer: Cash Price |
$315.79
|
| Rate for Payer: Cofinity Commercial |
$371.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.79
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Healthscope Whirlpool |
$382.90
|
| Rate for Payer: Mclaren Commercial |
$355.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.53
|
| Rate for Payer: Nomi Health Commercial |
$323.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.90
|
| Rate for Payer: Priority Health Narrow Network |
$250.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.37
|
|
|
HC PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$394.74
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
63600208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.58 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$355.27
|
| Rate for Payer: ASR ASR |
$382.90
|
| Rate for Payer: ASR Commercial |
$382.90
|
| Rate for Payer: BCBS Trust/PPO |
$321.67
|
| Rate for Payer: BCN Commercial |
$306.04
|
| Rate for Payer: Cash Price |
$315.79
|
| Rate for Payer: Cofinity Commercial |
$371.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.79
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Healthscope Whirlpool |
$382.90
|
| Rate for Payer: Mclaren Commercial |
$355.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.53
|
| Rate for Payer: Nomi Health Commercial |
$323.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.37
|
|
|
HC PEAK FLOW METER
|
Facility
|
OP
|
$29.15
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$29.15 |
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna Medicare |
$14.58
|
| Rate for Payer: ASR ASR |
$28.28
|
| Rate for Payer: ASR Commercial |
$28.28
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS Trust/PPO |
$23.87
|
| Rate for Payer: BCN Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$27.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$29.15
|
| Rate for Payer: Healthscope Whirlpool |
$28.28
|
| Rate for Payer: Mclaren Commercial |
$26.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.78
|
| Rate for Payer: Nomi Health Commercial |
$23.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.54
|
| Rate for Payer: Priority Health Narrow Network |
$20.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.65
|
|
|
HC PEAK FLOW METER
|
Facility
|
IP
|
$29.15
|
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$29.15 |
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: ASR ASR |
$28.28
|
| Rate for Payer: ASR Commercial |
$28.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.75
|
| Rate for Payer: BCN Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$27.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.32
|
| Rate for Payer: Healthscope Commercial |
$29.15
|
| Rate for Payer: Healthscope Whirlpool |
$28.28
|
| Rate for Payer: Mclaren Commercial |
$26.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.78
|
| Rate for Payer: Nomi Health Commercial |
$23.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.65
|
|
|
HC PEANUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PEANUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200054
|
|
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 PECAN NUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PECAN NUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200117
|
|
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 PED MINOR TREATMENT RM
|
Facility
|
OP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$116.12
|
| Rate for Payer: Aetna Medicare |
$64.51
|
| Rate for Payer: ASR ASR |
$125.15
|
| Rate for Payer: ASR Commercial |
$125.15
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: BCBS Trust/PPO |
$105.65
|
| Rate for Payer: BCN Commercial |
$100.03
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$125.15
|
| Rate for Payer: Mclaren Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.05
|
| Rate for Payer: Priority Health Narrow Network |
$90.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.54
|
|
|
HC PED MINOR TREATMENT RM
|
Facility
|
IP
|
$129.02
|
|
| Hospital Charge Code |
51000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Aetna Commercial |
$116.12
|
| Rate for Payer: ASR ASR |
$125.15
|
| Rate for Payer: ASR Commercial |
$125.15
|
| Rate for Payer: BCBS Trust/PPO |
$105.14
|
| Rate for Payer: BCN Commercial |
$100.03
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$129.02
|
| Rate for Payer: Healthscope Whirlpool |
$125.15
|
| Rate for Payer: Mclaren Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.54
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
OP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna Commercial |
$149.01
|
| Rate for Payer: Aetna Medicare |
$82.78
|
| Rate for Payer: ASR ASR |
$160.60
|
| Rate for Payer: ASR Commercial |
$160.60
|
| Rate for Payer: BCBS Complete |
$66.23
|
| Rate for Payer: BCBS Trust/PPO |
$135.59
|
| Rate for Payer: BCN Commercial |
$128.37
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$165.57
|
| Rate for Payer: Healthscope Whirlpool |
$160.60
|
| Rate for Payer: Mclaren Commercial |
$149.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: Nomi Health Commercial |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.70
|
|
|
HC PED OBSERVATION PER HOUR
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200014
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$165.57 |
| Rate for Payer: Aetna Commercial |
$149.01
|
| Rate for Payer: ASR ASR |
$160.60
|
| Rate for Payer: ASR Commercial |
$160.60
|
| Rate for Payer: BCBS Trust/PPO |
$134.92
|
| Rate for Payer: BCN Commercial |
$128.37
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$165.57
|
| Rate for Payer: Healthscope Whirlpool |
$160.60
|
| Rate for Payer: Mclaren Commercial |
$149.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.73
|
| Rate for Payer: Nomi Health Commercial |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.70
|
|
|
HC PED OR PICU MED SURG R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
11300001
|
|
Hospital Revenue Code
|
113
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$5,325.60 |
| Rate for Payer: Aetna Commercial |
$4,793.04
|
| Rate for Payer: ASR ASR |
$5,165.83
|
| Rate for Payer: ASR Commercial |
$5,165.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.83
|
| Rate for Payer: BCN Commercial |
$4,128.94
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$5,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$5,325.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,165.83
|
| Rate for Payer: Mclaren Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,686.53
|
|
|
HC PED OR PICU ROOM & BOARD
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
12300001
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$5,325.60 |
| Rate for Payer: Aetna Commercial |
$4,793.04
|
| Rate for Payer: ASR ASR |
$5,165.83
|
| Rate for Payer: ASR Commercial |
$5,165.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.83
|
| Rate for Payer: BCN Commercial |
$4,128.94
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$5,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$5,325.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,165.83
|
| Rate for Payer: Mclaren Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,686.53
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Medicare |
$11.22
|
| Rate for Payer: ASR ASR |
$21.78
|
| Rate for Payer: ASR Commercial |
$21.78
|
| Rate for Payer: BCBS Complete |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCN Commercial |
$17.41
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Healthscope Whirlpool |
$21.78
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.67
|
| Rate for Payer: Priority Health Narrow Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.76
|
|
|
HC PED POUCH W/WAFER
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
27000133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: ASR ASR |
$21.78
|
| Rate for Payer: ASR Commercial |
$21.78
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$17.41
|
| Rate for Payer: Cash Price |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$21.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Healthscope Whirlpool |
$21.78
|
| Rate for Payer: Mclaren Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.76
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
IP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$165.29 |
| Rate for Payer: Aetna Commercial |
$148.76
|
| Rate for Payer: ASR ASR |
$160.33
|
| Rate for Payer: ASR Commercial |
$160.33
|
| Rate for Payer: BCBS Trust/PPO |
$134.69
|
| Rate for Payer: BCN Commercial |
$128.15
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$155.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Healthscope Commercial |
$165.29
|
| Rate for Payer: Healthscope Whirlpool |
$160.33
|
| Rate for Payer: Mclaren Commercial |
$148.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: Nomi Health Commercial |
$135.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.46
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 1
|
Facility
|
OP
|
$165.29
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$165.29 |
| Rate for Payer: Aetna Commercial |
$148.76
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$160.33
|
| Rate for Payer: ASR Commercial |
$160.33
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$135.36
|
| Rate for Payer: BCN Commercial |
$128.15
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cash Price |
$132.23
|
| Rate for Payer: Cofinity Commercial |
$155.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$165.29
|
| Rate for Payer: Healthscope Whirlpool |
$160.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$148.76
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.50
|
| Rate for Payer: Nomi Health Commercial |
$135.54
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.83
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$115.87
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.63
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC PEDS AUTOIMM ENCEPH CNS, CMPT 2
|
Facility
|
IP
|
$90.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200498
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.57 |
| Max. Negotiated Rate |
$90.11 |
| Rate for Payer: Aetna Commercial |
$81.10
|
| Rate for Payer: ASR ASR |
$87.41
|
| Rate for Payer: ASR Commercial |
$87.41
|
| Rate for Payer: BCBS Trust/PPO |
$73.43
|
| Rate for Payer: BCN Commercial |
$69.86
|
| Rate for Payer: Cash Price |
$72.09
|
| Rate for Payer: Cofinity Commercial |
$84.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$90.11
|
| Rate for Payer: Healthscope Whirlpool |
$87.41
|
| Rate for Payer: Mclaren Commercial |
$81.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.59
|
| Rate for Payer: Nomi Health Commercial |
$73.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.30
|
|
