|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$6,140.04
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,298.03 |
| Max. Negotiated Rate |
$6,140.04 |
| Rate for Payer: Aetna Commercial |
$5,526.04
|
| Rate for Payer: ASR ASR |
$5,955.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,760.37
|
| Rate for Payer: BCN Commercial |
$4,760.37
|
| Rate for Payer: Cash Price |
$4,912.03
|
| Rate for Payer: Cofinity Commercial |
$5,771.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.03
|
| Rate for Payer: Healthscope Commercial |
$6,140.04
|
| Rate for Payer: Healthscope Whirlpool |
$5,955.84
|
| Rate for Payer: Mclaren Commercial |
$5,526.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,403.24
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$4,912.03
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,438.42 |
| Max. Negotiated Rate |
$4,912.03 |
| Rate for Payer: Aetna Commercial |
$4,420.83
|
| Rate for Payer: ASR ASR |
$4,764.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,808.30
|
| Rate for Payer: BCN Commercial |
$3,808.30
|
| Rate for Payer: Cash Price |
$3,929.62
|
| Rate for Payer: Cofinity Commercial |
$4,617.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,929.62
|
| Rate for Payer: Healthscope Commercial |
$4,912.03
|
| Rate for Payer: Healthscope Whirlpool |
$4,764.67
|
| Rate for Payer: Mclaren Commercial |
$4,420.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,175.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,438.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,322.59
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$4,912.03
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,438.42 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$4,420.83
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$4,764.67
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,808.30
|
| Rate for Payer: BCN Commercial |
$3,808.30
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$3,929.62
|
| Rate for Payer: Cash Price |
$3,929.62
|
| Rate for Payer: Cofinity Commercial |
$4,617.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,929.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$4,912.03
|
| Rate for Payer: Healthscope Whirlpool |
$4,764.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$4,420.83
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,175.23
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,438.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,469.95
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$3,487.54
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,322.59
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
HC VEST SUPPLY
|
Facility
|
IP
|
$455.60
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Aetna Commercial |
$410.04
|
| Rate for Payer: ASR ASR |
$441.93
|
| Rate for Payer: BCBS Trust/PPO |
$353.23
|
| Rate for Payer: BCN Commercial |
$353.23
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cofinity Commercial |
$428.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.48
|
| Rate for Payer: Healthscope Commercial |
$455.60
|
| Rate for Payer: Healthscope Whirlpool |
$441.93
|
| Rate for Payer: Mclaren Commercial |
$410.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$400.93
|
|
|
HC VEST SUPPLY
|
Facility
|
OP
|
$455.60
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Aetna Commercial |
$410.04
|
| Rate for Payer: ASR ASR |
$441.93
|
| Rate for Payer: BCBS Complete |
$182.24
|
| Rate for Payer: BCBS Trust/PPO |
$353.23
|
| Rate for Payer: BCN Commercial |
$353.23
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cofinity Commercial |
$428.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.48
|
| Rate for Payer: Healthscope Commercial |
$455.60
|
| Rate for Payer: Healthscope Whirlpool |
$441.93
|
| Rate for Payer: Mclaren Commercial |
$410.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.60
|
| Rate for Payer: Priority Health Narrow Network |
$323.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$400.93
|
|
|
HC VIABAHN 2
|
Facility
|
OP
|
$7,954.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,181.96 |
| Max. Negotiated Rate |
$7,954.90 |
| Rate for Payer: Aetna Commercial |
$7,159.41
|
| Rate for Payer: ASR ASR |
$7,716.25
|
| Rate for Payer: BCBS Complete |
$3,181.96
|
| Rate for Payer: BCBS Trust/PPO |
$6,167.43
|
| Rate for Payer: BCN Commercial |
$6,167.43
|
| Rate for Payer: Cash Price |
$6,363.92
|
| Rate for Payer: Cofinity Commercial |
$7,477.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,363.92
|
| Rate for Payer: Healthscope Commercial |
$7,954.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,716.25
|
| Rate for Payer: Mclaren Commercial |
$7,159.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,761.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,568.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,238.96
|
| Rate for Payer: Priority Health Narrow Network |
$5,647.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,000.31
|
|
|
HC VIABAHN 2
|
Facility
|
IP
|
$7,954.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,568.43 |
| Max. Negotiated Rate |
$7,954.90 |
| Rate for Payer: Aetna Commercial |
$7,159.41
|
| Rate for Payer: ASR ASR |
$7,716.25
|
| Rate for Payer: BCBS Trust/PPO |
$6,167.43
|
| Rate for Payer: BCN Commercial |
$6,167.43
|
| Rate for Payer: Cash Price |
$6,363.92
|
| Rate for Payer: Cofinity Commercial |
$7,477.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,363.92
|
| Rate for Payer: Healthscope Commercial |
$7,954.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,716.25
|
| Rate for Payer: Mclaren Commercial |
$7,159.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,761.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,568.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,000.31
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: BCBS Complete |
$6.70
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCBS Trust/PPO |
$53.77
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.67
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$6.38
|
| Rate for Payer: Mclaren Medicare |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$6.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Medicare |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Commercial |
$12.84
|
| Rate for Payer: PHP Medicaid |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.12
|
| Rate for Payer: Priority Health Medicare |
$11.67
|
| Rate for Payer: Priority Health Narrow Network |
$49.25
|
| Rate for Payer: Railroad Medicare Medicare |
$11.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
| Rate for Payer: UHC Medicare Advantage |
$12.02
|
| Rate for Payer: VA VA |
$11.67
|
|
|
HC VISCOSITY
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$53.77
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: ASR ASR |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.45
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: ASR ASR |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.70
|
| Rate for Payer: Mclaren Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.05
|
| Rate for Payer: Priority Health Narrow Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.45
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$38.95
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Aetna Commercial |
$35.06
|
| Rate for Payer: ASR ASR |
$37.78
|
| Rate for Payer: BCBS Trust/PPO |
$30.20
|
| Rate for Payer: BCN Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$36.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.16
|
| Rate for Payer: Healthscope Commercial |
$38.95
|
| Rate for Payer: Healthscope Whirlpool |
$37.78
|
| Rate for Payer: Mclaren Commercial |
$35.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.28
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$38.95
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Aetna Commercial |
$35.06
|
| Rate for Payer: ASR ASR |
$37.78
|
| Rate for Payer: BCBS Complete |
$15.58
|
| Rate for Payer: BCBS Trust/PPO |
$30.20
|
| Rate for Payer: BCN Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$36.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.16
|
| Rate for Payer: Healthscope Commercial |
$38.95
|
| Rate for Payer: Healthscope Whirlpool |
$37.78
|
| Rate for Payer: Mclaren Commercial |
$35.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.44
|
| Rate for Payer: Priority Health Narrow Network |
$27.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.28
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$145.61 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: ASR ASR |
$201.77
|
| Rate for Payer: BCBS Trust/PPO |
$161.27
|
| Rate for Payer: BCN Commercial |
$161.27
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$195.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Healthscope Whirlpool |
$201.77
|
| Rate for Payer: Mclaren Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.05
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$201.77
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$161.27
|
| Rate for Payer: BCN Commercial |
$161.27
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$195.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Healthscope Whirlpool |
$201.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$187.21
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.29
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$147.69
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.05
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$262.79
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$183.95 |
| Max. Negotiated Rate |
$262.79 |
| Rate for Payer: Aetna Commercial |
$236.51
|
| Rate for Payer: ASR ASR |
$254.91
|
| Rate for Payer: BCBS Trust/PPO |
$203.74
|
| Rate for Payer: BCN Commercial |
$203.74
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cofinity Commercial |
$247.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.23
|
| Rate for Payer: Healthscope Commercial |
$262.79
|
| Rate for Payer: Healthscope Whirlpool |
$254.91
|
| Rate for Payer: Mclaren Commercial |
$236.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.26
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$262.79
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$262.79 |
| Rate for Payer: Aetna Commercial |
$236.51
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$254.91
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$203.74
|
| Rate for Payer: BCN Commercial |
$203.74
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cofinity Commercial |
$247.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$262.79
|
| Rate for Payer: Healthscope Whirlpool |
$254.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$236.51
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.37
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.01
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$94.41
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.26
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$87.23 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Medicare |
$11.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.51
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: BCBS Complete |
$6.67
|
| Rate for Payer: BCBS MAPPO |
$11.61
|
| Rate for Payer: BCBS Trust/PPO |
$35.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.61
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.61
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.61
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$6.35
|
| Rate for Payer: Mclaren Medicare |
$11.61
|
| Rate for Payer: Meridian Medicaid |
$6.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$11.03
|
| Rate for Payer: PACE SWMI |
$11.61
|
| Rate for Payer: PHP Commercial |
$12.77
|
| Rate for Payer: PHP Medicaid |
$6.35
|
| Rate for Payer: PHP Medicare Advantage |
$11.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.23
|
| Rate for Payer: Priority Health Medicare |
$11.61
|
| Rate for Payer: Priority Health Narrow Network |
$69.78
|
| Rate for Payer: Railroad Medicare Medicare |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
| Rate for Payer: UHC Medicare Advantage |
$11.96
|
| Rate for Payer: VA VA |
$11.61
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: BCBS Trust/PPO |
$35.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$15.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.08
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$8.25
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Meridian Medicaid |
$8.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Medicaid |
$8.25
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.13
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$35.30
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$15.53
|
| Rate for Payer: VA VA |
$15.08
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
OP
|
$184.75
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$184.75 |
| Rate for Payer: Aetna Commercial |
$166.28
|
| Rate for Payer: Aetna Medicare |
$17.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.32
|
| Rate for Payer: ASR ASR |
$179.21
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$143.24
|
| Rate for Payer: BCN Commercial |
$143.24
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$173.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$184.75
|
| Rate for Payer: Healthscope Whirlpool |
$179.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.06
|
| Rate for Payer: Mclaren Commercial |
$166.28
|
| Rate for Payer: Mclaren Medicaid |
$9.33
|
| Rate for Payer: Mclaren Medicare |
$17.06
|
| Rate for Payer: Meridian Medicaid |
$9.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.04
|
| Rate for Payer: PACE Medicare |
$16.21
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Medicaid |
$9.33
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.12
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health Narrow Network |
$131.17
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.58
|
| Rate for Payer: UHC Medicare Advantage |
$17.57
|
| Rate for Payer: VA VA |
$17.06
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
IP
|
$184.75
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.32 |
| Max. Negotiated Rate |
$184.75 |
| Rate for Payer: Aetna Commercial |
$166.28
|
| Rate for Payer: ASR ASR |
$179.21
|
| Rate for Payer: BCBS Trust/PPO |
$143.24
|
| Rate for Payer: BCN Commercial |
$143.24
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$173.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.80
|
| Rate for Payer: Healthscope Commercial |
$184.75
|
| Rate for Payer: Healthscope Whirlpool |
$179.21
|
| Rate for Payer: Mclaren Commercial |
$166.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.58
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$184.71 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: Aetna Medicare |
$28.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.12
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: BCBS Complete |
$16.14
|
| Rate for Payer: BCBS MAPPO |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: BCN Medicare Advantage |
$28.10
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.10
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$28.10
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$15.37
|
| Rate for Payer: Mclaren Medicare |
$28.10
|
| Rate for Payer: Meridian Medicaid |
$16.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PACE Medicare |
$26.70
|
| Rate for Payer: PACE SWMI |
$28.10
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Medicaid |
$15.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.71
|
| Rate for Payer: Priority Health Medicare |
$28.10
|
| Rate for Payer: Priority Health Narrow Network |
$147.77
|
| Rate for Payer: Railroad Medicare Medicare |
$28.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
| Rate for Payer: UHC Medicare Advantage |
$28.94
|
| Rate for Payer: VA VA |
$28.10
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: BCBS Trust/PPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
|
