|
HC ROOM & BOARD PSYCH
|
Facility
|
IP
|
$1,846.93
|
|
| Hospital Charge Code |
12400001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,385.20 |
| Max. Negotiated Rate |
$1,846.93 |
| Rate for Payer: Aetna Commercial |
$1,662.24
|
| Rate for Payer: ASR ASR |
$1,791.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,516.70
|
| Rate for Payer: BCN Commercial |
$1,516.70
|
| Rate for Payer: Cash Price |
$1,477.54
|
| Rate for Payer: Cofinity Commercial |
$1,736.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.54
|
| Rate for Payer: Healthscope Commercial |
$1,791.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,846.93
|
| Rate for Payer: Mclaren Commercial |
$1,662.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,569.89
|
| Rate for Payer: Nomi Health Commercial |
$1,514.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.20
|
|
|
HC ROOM MED SURG
|
Facility
|
IP
|
$3,423.98
|
|
| Hospital Charge Code |
12100001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,567.99 |
| Max. Negotiated Rate |
$3,423.98 |
| Rate for Payer: Aetna Commercial |
$3,081.58
|
| Rate for Payer: ASR ASR |
$3,321.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,811.77
|
| Rate for Payer: BCN Commercial |
$2,811.77
|
| Rate for Payer: Cash Price |
$2,739.18
|
| Rate for Payer: Cofinity Commercial |
$3,218.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,739.18
|
| Rate for Payer: Healthscope Commercial |
$3,321.26
|
| Rate for Payer: Healthscope Whirlpool |
$3,423.98
|
| Rate for Payer: Mclaren Commercial |
$3,081.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,910.38
|
| Rate for Payer: Nomi Health Commercial |
$2,807.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,567.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,013.10
|
|
|
HC ROOM SCU
|
Facility
|
IP
|
$2,399.10
|
|
| Hospital Charge Code |
20000002
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,799.33 |
| Max. Negotiated Rate |
$2,399.10 |
| Rate for Payer: Aetna Commercial |
$2,159.19
|
| Rate for Payer: ASR ASR |
$2,327.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,970.14
|
| Rate for Payer: BCN Commercial |
$1,970.14
|
| Rate for Payer: Cash Price |
$1,919.28
|
| Rate for Payer: Cofinity Commercial |
$2,255.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,919.28
|
| Rate for Payer: Healthscope Commercial |
$2,327.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,399.10
|
| Rate for Payer: Mclaren Commercial |
$2,159.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,039.23
|
| Rate for Payer: Nomi Health Commercial |
$1,967.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,799.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,111.21
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$169.49 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$17.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.93
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$17.93
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$9.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Medicaid |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$135.59
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$27.79
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP DNSP |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RO OR SSA SJOGRENS AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: ASR ASR |
$34.79
|
| Rate for Payer: BCBS Trust/PPO |
$29.46
|
| Rate for Payer: BCN Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Healthscope Whirlpool |
$35.87
|
| Rate for Payer: Mclaren Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.57
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.42
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.04
|
| Rate for Payer: Healthscope Whirlpool |
$4.16
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$3.43
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$4.04
|
| Rate for Payer: Healthscope Whirlpool |
$4.16
|
| Rate for Payer: Mclaren Commercial |
$3.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$152.82 |
| Max. Negotiated Rate |
$203.76 |
| Rate for Payer: Aetna Commercial |
$183.38
|
| Rate for Payer: ASR ASR |
$197.65
|
| Rate for Payer: BCBS Trust/PPO |
$167.33
|
| Rate for Payer: BCN Commercial |
$167.33
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Commercial |
$191.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$197.65
|
| Rate for Payer: Healthscope Whirlpool |
$203.76
|
| Rate for Payer: Mclaren Commercial |
$183.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Nomi Health Commercial |
$167.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.31
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$203.76
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$203.76 |
| Rate for Payer: Aetna Commercial |
$183.38
|
| Rate for Payer: Aetna Medicare |
$75.39
|
| Rate for Payer: ASR ASR |
$197.65
|
| Rate for Payer: BCBS Complete |
$81.50
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Commercial |
$168.00
|
| Rate for Payer: Cash Price |
$163.01
|
| Rate for Payer: Cofinity Commercial |
$191.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.01
|
| Rate for Payer: Healthscope Commercial |
$197.65
|
| Rate for Payer: Healthscope Whirlpool |
$203.76
|
| Rate for Payer: Mclaren Commercial |
$183.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.20
|
| Rate for Payer: Nomi Health Commercial |
$167.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$178.53
|
| Rate for Payer: Priority Health Narrow Network |
$142.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.31
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,579.31 |
| Max. Negotiated Rate |
$4,268.40 |
| Rate for Payer: Aetna Commercial |
$3,841.56
|
| Rate for Payer: Aetna Medicare |
$1,579.31
|
| Rate for Payer: ASR ASR |
$4,140.35
|
| Rate for Payer: BCBS Complete |
$1,707.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,519.30
|
| Rate for Payer: BCN Commercial |
$3,519.30
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Commercial |
$4,012.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$4,140.35
|
| Rate for Payer: Healthscope Whirlpool |
$4,268.40
|
| Rate for Payer: Mclaren Commercial |
$3,841.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,414.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Nomi Health Commercial |
$3,500.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,739.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,992.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,756.19
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,268.40
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,201.30 |
| Max. Negotiated Rate |
$4,268.40 |
| Rate for Payer: Aetna Commercial |
$3,841.56
|
| Rate for Payer: ASR ASR |
$4,140.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,505.21
|
| Rate for Payer: BCN Commercial |
$3,505.21
|
| Rate for Payer: Cash Price |
$3,414.72
|
| Rate for Payer: Cofinity Commercial |
$4,012.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.72
|
| Rate for Payer: Healthscope Commercial |
$4,140.35
|
| Rate for Payer: Healthscope Whirlpool |
$4,268.40
|
| Rate for Payer: Mclaren Commercial |
$3,841.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,628.14
|
| Rate for Payer: Nomi Health Commercial |
$3,500.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,756.19
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.96 |
| Max. Negotiated Rate |
$111.95 |
| Rate for Payer: Aetna Commercial |
$100.75
|
| Rate for Payer: ASR ASR |
$108.59
|
| Rate for Payer: BCBS Trust/PPO |
$91.93
|
| Rate for Payer: BCN Commercial |
$91.93
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$108.59
|
| Rate for Payer: Healthscope Whirlpool |
$111.95
|
| Rate for Payer: Mclaren Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.52
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$111.95 |
| Rate for Payer: Aetna Commercial |
$100.75
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: ASR ASR |
$108.59
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$92.30
|
| Rate for Payer: BCN Commercial |
$92.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$108.59
|
| Rate for Payer: Healthscope Whirlpool |
$111.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$100.75
|
| Rate for Payer: Mclaren Medicaid |
$11.98
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: Nomi Health Commercial |
$91.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.96
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.31
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$47.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP DNSP |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$182.10 |
| Rate for Payer: Aetna Commercial |
$163.89
|
| Rate for Payer: ASR ASR |
$176.64
|
| Rate for Payer: BCBS Trust/PPO |
$149.54
|
| Rate for Payer: BCN Commercial |
$149.54
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Commercial |
$171.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$176.64
|
| Rate for Payer: Healthscope Whirlpool |
$182.10
|
| Rate for Payer: Mclaren Commercial |
$163.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Nomi Health Commercial |
$149.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.25
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$182.10
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$182.10 |
| Rate for Payer: Aetna Commercial |
$163.89
|
| Rate for Payer: Aetna Medicare |
$67.38
|
| Rate for Payer: ASR ASR |
$176.64
|
| Rate for Payer: BCBS Complete |
$72.84
|
| Rate for Payer: BCBS Trust/PPO |
$150.14
|
| Rate for Payer: BCN Commercial |
$150.14
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cash Price |
$145.68
|
| Rate for Payer: Cofinity Commercial |
$171.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.68
|
| Rate for Payer: Healthscope Commercial |
$176.64
|
| Rate for Payer: Healthscope Whirlpool |
$182.10
|
| Rate for Payer: Mclaren Commercial |
$163.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.78
|
| Rate for Payer: Nomi Health Commercial |
$149.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$167.46
|
| Rate for Payer: Priority Health Narrow Network |
$133.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.25
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$71.06
|
| Rate for Payer: ASR ASR |
$76.59
|
| Rate for Payer: BCBS Trust/PPO |
$64.84
|
| Rate for Payer: BCN Commercial |
$64.84
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$76.59
|
| Rate for Payer: Healthscope Whirlpool |
$78.96
|
| Rate for Payer: Mclaren Commercial |
$71.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.48
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$116.98 |
| Rate for Payer: Aetna Commercial |
$71.06
|
| Rate for Payer: Aetna Medicare |
$29.22
|
| Rate for Payer: ASR ASR |
$76.59
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: BCBS Trust/PPO |
$65.10
|
| Rate for Payer: BCN Commercial |
$65.10
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$76.59
|
| Rate for Payer: Healthscope Whirlpool |
$78.96
|
| Rate for Payer: Mclaren Commercial |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$116.98
|
| Rate for Payer: Priority Health Narrow Network |
$93.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.48
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$398.75 |
| Max. Negotiated Rate |
$531.66 |
| Rate for Payer: Aetna Commercial |
$478.49
|
| Rate for Payer: ASR ASR |
$515.71
|
| Rate for Payer: BCBS Trust/PPO |
$436.60
|
| Rate for Payer: BCN Commercial |
$436.60
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Commercial |
$499.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Healthscope Commercial |
$515.71
|
| Rate for Payer: Healthscope Whirlpool |
$531.66
|
| Rate for Payer: Mclaren Commercial |
$478.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Nomi Health Commercial |
$435.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.86
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$531.66
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$531.66 |
| Rate for Payer: Aetna Commercial |
$478.49
|
| Rate for Payer: Aetna Medicare |
$133.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: ASR ASR |
$515.71
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$438.35
|
| Rate for Payer: BCN Commercial |
$438.35
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cash Price |
$425.33
|
| Rate for Payer: Cofinity Commercial |
$499.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$515.71
|
| Rate for Payer: Healthscope Whirlpool |
$531.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$133.93
|
| Rate for Payer: Mclaren Commercial |
$478.49
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$73.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.91
|
| Rate for Payer: Nomi Health Commercial |
$435.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.75
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$147.32
|
| Rate for Payer: PHP Medicaid |
$71.79
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$465.84
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health Narrow Network |
$372.69
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$207.59
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP DNSP |
$133.93
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$316.77 |
| Max. Negotiated Rate |
$422.36 |
| Rate for Payer: Aetna Commercial |
$380.12
|
| Rate for Payer: ASR ASR |
$409.69
|
| Rate for Payer: BCBS Trust/PPO |
$346.84
|
| Rate for Payer: BCN Commercial |
$346.84
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Commercial |
$397.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Healthscope Commercial |
$409.69
|
| Rate for Payer: Healthscope Whirlpool |
$422.36
|
| Rate for Payer: Mclaren Commercial |
$380.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Nomi Health Commercial |
$346.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.68
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$422.36
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$422.36 |
| Rate for Payer: Aetna Commercial |
$380.12
|
| Rate for Payer: Aetna Medicare |
$133.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: ASR ASR |
$409.69
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$348.24
|
| Rate for Payer: BCN Commercial |
$348.24
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cash Price |
$337.89
|
| Rate for Payer: Cofinity Commercial |
$397.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$409.69
|
| Rate for Payer: Healthscope Whirlpool |
$422.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$133.93
|
| Rate for Payer: Mclaren Commercial |
$380.12
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$73.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.01
|
| Rate for Payer: Nomi Health Commercial |
$346.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.77
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$147.32
|
| Rate for Payer: PHP Medicaid |
$71.79
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$370.07
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health Narrow Network |
$296.07
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$207.59
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP DNSP |
$133.93
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$853.37 |
| Rate for Payer: Aetna Commercial |
$643.73
|
| Rate for Payer: Aetna Medicare |
$550.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: ASR ASR |
$693.79
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$589.72
|
| Rate for Payer: BCN Commercial |
$589.72
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$672.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$693.79
|
| Rate for Payer: Healthscope Whirlpool |
$715.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$550.56
|
| Rate for Payer: Mclaren Commercial |
$643.73
|
| Rate for Payer: Mclaren Medicaid |
$550.56
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$302.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$605.62
|
| Rate for Payer: PHP Medicaid |
$295.10
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$626.70
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health Narrow Network |
$501.39
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$629.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$853.37
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP DNSP |
$550.56
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$550.56
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$715.25
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$536.44 |
| Max. Negotiated Rate |
$715.25 |
| Rate for Payer: Aetna Commercial |
$643.73
|
| Rate for Payer: ASR ASR |
$693.79
|
| Rate for Payer: BCBS Trust/PPO |
$587.36
|
| Rate for Payer: BCN Commercial |
$587.36
|
| Rate for Payer: Cash Price |
$572.20
|
| Rate for Payer: Cofinity Commercial |
$672.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.20
|
| Rate for Payer: Healthscope Commercial |
$693.79
|
| Rate for Payer: Healthscope Whirlpool |
$715.25
|
| Rate for Payer: Mclaren Commercial |
$643.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.96
|
| Rate for Payer: Nomi Health Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$629.42
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$429.97 |
| Rate for Payer: Aetna Commercial |
$386.97
|
| Rate for Payer: ASR ASR |
$417.07
|
| Rate for Payer: BCBS Trust/PPO |
$353.09
|
| Rate for Payer: BCN Commercial |
$353.09
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$404.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$417.07
|
| Rate for Payer: Healthscope Whirlpool |
$429.97
|
| Rate for Payer: Mclaren Commercial |
$386.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.37
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$429.97
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.99 |
| Max. Negotiated Rate |
$595.68 |
| Rate for Payer: Aetna Commercial |
$386.97
|
| Rate for Payer: Aetna Medicare |
$384.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: ASR ASR |
$417.07
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$354.51
|
| Rate for Payer: BCN Commercial |
$354.51
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$404.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$417.07
|
| Rate for Payer: Healthscope Whirlpool |
$429.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$384.31
|
| Rate for Payer: Mclaren Commercial |
$386.97
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$211.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Nomi Health Commercial |
$352.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$422.74
|
| Rate for Payer: PHP Medicaid |
$205.99
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$376.74
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health Narrow Network |
$301.41
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$378.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$595.68
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP DNSP |
$384.31
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
