|
HC ADMIN TOCILIZUMAB COVID 19 2ND DOSE
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
77100045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.89 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$420.28
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$462.31
|
| Rate for Payer: PHP Medicaid |
$229.89
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$372.24
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: VA VA |
$420.28
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
OP
|
$83.04
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$83.04 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: Aetna Medicare |
$38.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.41
|
| Rate for Payer: ASR ASR |
$80.55
|
| Rate for Payer: BCBS Complete |
$22.25
|
| Rate for Payer: BCBS MAPPO |
$38.73
|
| Rate for Payer: BCBS Trust/PPO |
$64.38
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: BCN Medicare Advantage |
$38.73
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.73
|
| Rate for Payer: Healthscope Commercial |
$83.04
|
| Rate for Payer: Healthscope Whirlpool |
$80.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.73
|
| Rate for Payer: Mclaren Commercial |
$74.74
|
| Rate for Payer: Mclaren Medicaid |
$21.19
|
| Rate for Payer: Mclaren Medicare |
$38.73
|
| Rate for Payer: Meridian Medicaid |
$22.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: PACE Medicare |
$36.79
|
| Rate for Payer: PACE SWMI |
$38.73
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: PHP Medicaid |
$21.19
|
| Rate for Payer: PHP Medicare Advantage |
$38.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.57
|
| Rate for Payer: Priority Health Medicare |
$38.73
|
| Rate for Payer: Priority Health Narrow Network |
$58.96
|
| Rate for Payer: Railroad Medicare Medicare |
$38.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.08
|
| Rate for Payer: UHC Medicare Advantage |
$39.89
|
| Rate for Payer: VA VA |
$38.73
|
|
|
HC ADMN SARSCOV2 VACC 1 DOSE
|
Facility
|
IP
|
$83.04
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
77100064
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$83.04 |
| Rate for Payer: Aetna Commercial |
$74.74
|
| Rate for Payer: ASR ASR |
$80.55
|
| Rate for Payer: BCBS Trust/PPO |
$64.38
|
| Rate for Payer: BCN Commercial |
$64.38
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.43
|
| Rate for Payer: Healthscope Commercial |
$83.04
|
| Rate for Payer: Healthscope Whirlpool |
$80.55
|
| Rate for Payer: Mclaren Commercial |
$74.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.08
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ADMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200020
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
OP
|
$60.50
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$197.54 |
| Rate for Payer: Aetna Commercial |
$54.45
|
| Rate for Payer: Aetna Medicare |
$38.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.28
|
| Rate for Payer: ASR ASR |
$58.68
|
| Rate for Payer: BCBS Complete |
$22.18
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$46.91
|
| Rate for Payer: BCN Commercial |
$46.91
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cofinity Commercial |
$56.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$60.50
|
| Rate for Payer: Healthscope Whirlpool |
$58.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.62
|
| Rate for Payer: Mclaren Commercial |
$54.45
|
| Rate for Payer: Mclaren Medicaid |
$21.13
|
| Rate for Payer: Mclaren Medicare |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$22.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.42
|
| Rate for Payer: PACE Medicare |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicaid |
$21.13
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.54
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health Narrow Network |
$158.03
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.24
|
| Rate for Payer: UHC Medicare Advantage |
$39.78
|
| Rate for Payer: VA VA |
$38.62
|
|
|
HC ADRENOCORTICOTROPIC HORMONE
|
Facility
|
IP
|
$60.50
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
30100071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$60.50 |
| Rate for Payer: Aetna Commercial |
$54.45
|
| Rate for Payer: ASR ASR |
$58.68
|
| Rate for Payer: BCBS Trust/PPO |
$46.91
|
| Rate for Payer: BCN Commercial |
$46.91
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cofinity Commercial |
$56.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.40
|
| Rate for Payer: Healthscope Commercial |
$60.50
|
| Rate for Payer: Healthscope Whirlpool |
$58.68
|
| Rate for Payer: Mclaren Commercial |
$54.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.24
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: ASR ASR |
$14.55
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.63
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$15.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$13.50
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.75
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.39
|
| Rate for Payer: PHP Medicaid |
$1.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health Narrow Network |
$10.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.20
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC ADULTERANT SURVEY URINE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700010
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: ASR ASR |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.63
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$15.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.20
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.70
|
| Rate for Payer: Priority Health Narrow Network |
$23.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MIN
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
51000091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MIN
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
51000090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.04
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Complete |
$45.51
|
| Rate for Payer: BCBS MAPPO |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: BCN Medicare Advantage |
$79.23
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$79.23
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Mclaren Medicaid |
$43.34
|
| Rate for Payer: Mclaren Medicare |
$79.23
|
| Rate for Payer: Meridian Medicaid |
$45.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: PACE Medicare |
$75.27
|
| Rate for Payer: PACE SWMI |
$79.23
|
| Rate for Payer: PHP Commercial |
$87.15
|
| Rate for Payer: PHP Medicaid |
$43.34
|
| Rate for Payer: PHP Medicare Advantage |
$79.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.70
|
| Rate for Payer: Priority Health Medicare |
$79.23
|
| Rate for Payer: Priority Health Narrow Network |
$23.17
|
| Rate for Payer: Railroad Medicare Medicare |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
| Rate for Payer: UHC Medicare Advantage |
$81.61
|
| Rate for Payer: VA VA |
$79.23
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$153.26
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$122.50
|
| Rate for Payer: BCN Commercial |
$122.50
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Healthscope Whirlpool |
$153.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$142.20
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.78
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$112.18
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.04
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: ASR ASR |
$153.26
|
| Rate for Payer: BCBS Trust/PPO |
$122.50
|
| Rate for Payer: BCN Commercial |
$122.50
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$148.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.40
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Healthscope Whirlpool |
$153.26
|
| Rate for Payer: Mclaren Commercial |
$142.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.04
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.71
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$199.51
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47100401
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
HC AEROBIKA
|
Facility
|
OP
|
$147.32
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$147.32 |
| Rate for Payer: Aetna Commercial |
$132.59
|
| Rate for Payer: ASR ASR |
$142.90
|
| Rate for Payer: BCBS Complete |
$58.93
|
| Rate for Payer: BCBS Trust/PPO |
$114.22
|
| Rate for Payer: BCN Commercial |
$114.22
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$138.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Healthscope Commercial |
$147.32
|
| Rate for Payer: Healthscope Whirlpool |
$142.90
|
| Rate for Payer: Mclaren Commercial |
$132.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.64
|
|
|
HC AEROBIKA
|
Facility
|
IP
|
$147.32
|
|
| Hospital Charge Code |
27000612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$147.32 |
| Rate for Payer: Aetna Commercial |
$132.59
|
| Rate for Payer: ASR ASR |
$142.90
|
| Rate for Payer: BCBS Trust/PPO |
$114.22
|
| Rate for Payer: BCN Commercial |
$114.22
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$138.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.86
|
| Rate for Payer: Healthscope Commercial |
$147.32
|
| Rate for Payer: Healthscope Whirlpool |
$142.90
|
| Rate for Payer: Mclaren Commercial |
$132.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.64
|
|
|
HC AERONEB SUPPLY
|
Facility
|
OP
|
$163.93
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.57 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Aetna Commercial |
$147.54
|
| Rate for Payer: ASR ASR |
$159.01
|
| Rate for Payer: BCBS Complete |
$65.57
|
| Rate for Payer: BCBS Trust/PPO |
$127.09
|
| Rate for Payer: BCN Commercial |
$127.09
|
| Rate for Payer: Cash Price |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$154.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.14
|
| Rate for Payer: Healthscope Commercial |
$163.93
|
| Rate for Payer: Healthscope Whirlpool |
$159.01
|
| Rate for Payer: Mclaren Commercial |
$147.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.18
|
| Rate for Payer: Priority Health Narrow Network |
$116.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.26
|
|
|
HC AERONEB SUPPLY
|
Facility
|
IP
|
$163.93
|
|
| Hospital Charge Code |
27000465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Aetna Commercial |
$147.54
|
| Rate for Payer: ASR ASR |
$159.01
|
| Rate for Payer: BCBS Trust/PPO |
$127.09
|
| Rate for Payer: BCN Commercial |
$127.09
|
| Rate for Payer: Cash Price |
$131.14
|
| Rate for Payer: Cofinity Commercial |
$154.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.14
|
| Rate for Payer: Healthscope Commercial |
$163.93
|
| Rate for Payer: Healthscope Whirlpool |
$159.01
|
| Rate for Payer: Mclaren Commercial |
$147.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.26
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
OP
|
$146.74
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$236.99 |
| Rate for Payer: Aetna Commercial |
$132.07
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.99
|
| Rate for Payer: ASR ASR |
$142.34
|
| Rate for Payer: BCBS Complete |
$108.90
|
| Rate for Payer: BCBS MAPPO |
$189.59
|
| Rate for Payer: BCBS Trust/PPO |
$113.77
|
| Rate for Payer: BCN Commercial |
$113.77
|
| Rate for Payer: BCN Medicare Advantage |
$189.59
|
| Rate for Payer: Cash Price |
$117.39
|
| Rate for Payer: Cash Price |
$117.39
|
| Rate for Payer: Cofinity Commercial |
$137.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.59
|
| Rate for Payer: Healthscope Commercial |
$146.74
|
| Rate for Payer: Healthscope Whirlpool |
$142.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$189.59
|
| Rate for Payer: Mclaren Commercial |
$132.07
|
| Rate for Payer: Mclaren Medicaid |
$103.71
|
| Rate for Payer: Mclaren Medicare |
$189.59
|
| Rate for Payer: Meridian Medicaid |
$108.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.73
|
| Rate for Payer: PACE Medicare |
$180.11
|
| Rate for Payer: PACE SWMI |
$189.59
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicaid |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$189.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.75
|
| Rate for Payer: Priority Health Medicare |
$189.59
|
| Rate for Payer: Priority Health Narrow Network |
$86.20
|
| Rate for Payer: Railroad Medicare Medicare |
$189.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.13
|
| Rate for Payer: UHC Medicare Advantage |
$195.28
|
| Rate for Payer: VA VA |
$189.59
|
|
|
HC AEROSOLIZED MEDICATION
|
Facility
|
IP
|
$146.74
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
41000012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$102.72 |
| Max. Negotiated Rate |
$146.74 |
| Rate for Payer: Aetna Commercial |
$132.07
|
| Rate for Payer: ASR ASR |
$142.34
|
| Rate for Payer: BCBS Trust/PPO |
$113.77
|
| Rate for Payer: BCN Commercial |
$113.77
|
| Rate for Payer: Cash Price |
$117.39
|
| Rate for Payer: Cofinity Commercial |
$137.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$146.74
|
| Rate for Payer: Healthscope Whirlpool |
$142.34
|
| Rate for Payer: Mclaren Commercial |
$132.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.13
|
|
|
HC AFB CULTURE
|
Facility
|
OP
|
$89.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna Commercial |
$80.46
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: ASR ASR |
$86.72
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$69.31
|
| Rate for Payer: BCN Commercial |
$69.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$71.52
|
| Rate for Payer: Cash Price |
$71.52
|
| Rate for Payer: Cofinity Commercial |
$84.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Healthscope Whirlpool |
$86.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.80
|
| Rate for Payer: Mclaren Commercial |
$80.46
|
| Rate for Payer: Mclaren Medicaid |
$5.91
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.99
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$11.88
|
| Rate for Payer: PHP Medicaid |
$5.91
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.67
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health Narrow Network |
$83.74
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.67
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: VA VA |
$10.80
|
|
|
HC AFB CULTURE
|
Facility
|
IP
|
$89.40
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
30600089
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.58 |
| Max. Negotiated Rate |
$89.40 |
| Rate for Payer: Aetna Commercial |
$80.46
|
| Rate for Payer: ASR ASR |
$86.72
|
| Rate for Payer: BCBS Trust/PPO |
$69.31
|
| Rate for Payer: BCN Commercial |
$69.31
|
| Rate for Payer: Cash Price |
$71.52
|
| Rate for Payer: Cofinity Commercial |
$84.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.52
|
| Rate for Payer: Healthscope Commercial |
$89.40
|
| Rate for Payer: Healthscope Whirlpool |
$86.72
|
| Rate for Payer: Mclaren Commercial |
$80.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.67
|
|
