|
HC AFB SMEAR
|
Facility
|
OP
|
$57.50
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$51.75
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.74
|
| Rate for Payer: ASR ASR |
$55.78
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$44.58
|
| Rate for Payer: BCN Commercial |
$44.58
|
| Rate for Payer: BCN Medicare Advantage |
$5.39
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cofinity Commercial |
$54.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.39
|
| Rate for Payer: Healthscope Commercial |
$57.50
|
| Rate for Payer: Healthscope Whirlpool |
$55.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.39
|
| Rate for Payer: Mclaren Commercial |
$51.75
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicare |
$5.39
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.88
|
| Rate for Payer: PACE Medicare |
$5.12
|
| Rate for Payer: PACE SWMI |
$5.39
|
| Rate for Payer: PHP Commercial |
$5.93
|
| Rate for Payer: PHP Medicaid |
$2.95
|
| Rate for Payer: PHP Medicare Advantage |
$5.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.06
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Narrow Network |
$64.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.60
|
| Rate for Payer: UHC Medicare Advantage |
$5.55
|
| Rate for Payer: VA VA |
$5.39
|
|
|
HC AFB SMEAR
|
Facility
|
IP
|
$57.50
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
30600105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna Commercial |
$51.75
|
| Rate for Payer: ASR ASR |
$55.78
|
| Rate for Payer: BCBS Trust/PPO |
$44.58
|
| Rate for Payer: BCN Commercial |
$44.58
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cofinity Commercial |
$54.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$57.50
|
| Rate for Payer: Healthscope Whirlpool |
$55.78
|
| Rate for Payer: Mclaren Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.60
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
IP
|
$706.86
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna Commercial |
$636.17
|
| Rate for Payer: ASR ASR |
$685.65
|
| Rate for Payer: BCBS Trust/PPO |
$548.03
|
| Rate for Payer: BCN Commercial |
$548.03
|
| Rate for Payer: Cash Price |
$565.49
|
| Rate for Payer: Cofinity Commercial |
$664.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.49
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Healthscope Whirlpool |
$685.65
|
| Rate for Payer: Mclaren Commercial |
$636.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.04
|
|
|
HC AFFINITY 1.5 X 1.5 PER SQ CM
|
Facility
|
OP
|
$706.86
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.74 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna Commercial |
$636.17
|
| Rate for Payer: ASR ASR |
$685.65
|
| Rate for Payer: BCBS Complete |
$282.74
|
| Rate for Payer: BCBS Trust/PPO |
$548.03
|
| Rate for Payer: BCN Commercial |
$548.03
|
| Rate for Payer: Cash Price |
$565.49
|
| Rate for Payer: Cofinity Commercial |
$664.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.49
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Healthscope Whirlpool |
$685.65
|
| Rate for Payer: Mclaren Commercial |
$636.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.24
|
| Rate for Payer: Priority Health Narrow Network |
$501.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.04
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
IP
|
$426.26
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.38 |
| Max. Negotiated Rate |
$426.26 |
| Rate for Payer: Aetna Commercial |
$383.63
|
| Rate for Payer: ASR ASR |
$413.47
|
| Rate for Payer: BCBS Trust/PPO |
$330.48
|
| Rate for Payer: BCN Commercial |
$330.48
|
| Rate for Payer: Cash Price |
$341.01
|
| Rate for Payer: Cofinity Commercial |
$400.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.01
|
| Rate for Payer: Healthscope Commercial |
$426.26
|
| Rate for Payer: Healthscope Whirlpool |
$413.47
|
| Rate for Payer: Mclaren Commercial |
$383.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.11
|
|
|
HC AFFINITY 2.5 X 2.5 PER SQ CM
|
Facility
|
OP
|
$426.26
|
|
|
Service Code
|
HCPCS Q4159
|
| Hospital Charge Code |
63600125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$426.26 |
| Rate for Payer: Aetna Commercial |
$383.63
|
| Rate for Payer: ASR ASR |
$413.47
|
| Rate for Payer: BCBS Complete |
$170.50
|
| Rate for Payer: BCBS Trust/PPO |
$330.48
|
| Rate for Payer: BCN Commercial |
$330.48
|
| Rate for Payer: Cash Price |
$341.01
|
| Rate for Payer: Cofinity Commercial |
$400.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.01
|
| Rate for Payer: Healthscope Commercial |
$426.26
|
| Rate for Payer: Healthscope Whirlpool |
$413.47
|
| Rate for Payer: Mclaren Commercial |
$383.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.90
|
| Rate for Payer: Priority Health Narrow Network |
$302.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.11
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC AFP SINGLE MARKER SCRN,MS
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100622
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$105.69 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$16.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.96
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: BCBS MAPPO |
$16.77
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: BCN Medicare Advantage |
$16.77
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.77
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.77
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$9.17
|
| Rate for Payer: Mclaren Medicare |
$16.77
|
| Rate for Payer: Meridian Medicaid |
$9.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PACE Medicare |
$15.93
|
| Rate for Payer: PACE SWMI |
$16.77
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: PHP Medicaid |
$9.17
|
| Rate for Payer: PHP Medicare Advantage |
$16.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.69
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health Narrow Network |
$84.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: VA VA |
$16.77
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.51
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Healthscope Whirlpool |
$19.40
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.20
|
| Rate for Payer: Priority Health Narrow Network |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
HC AFTER HOURS ACCESS
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 99050
|
| Hospital Charge Code |
98300006
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: BCBS Trust/PPO |
$15.51
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Healthscope Whirlpool |
$19.40
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
HC ALBUMIN SERUM
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.53 |
| Max. Negotiated Rate |
$37.90 |
| Rate for Payer: Aetna Commercial |
$34.11
|
| Rate for Payer: ASR ASR |
$36.76
|
| Rate for Payer: BCBS Trust/PPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$35.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.32
|
| Rate for Payer: Healthscope Commercial |
$37.90
|
| Rate for Payer: Healthscope Whirlpool |
$36.76
|
| Rate for Payer: Mclaren Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.35
|
|
|
HC ALBUMIN SERUM
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100072
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$37.90 |
| Rate for Payer: Aetna Commercial |
$34.11
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$36.76
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.38
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$35.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$37.90
|
| Rate for Payer: Healthscope Whirlpool |
$36.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: PHP Medicaid |
$2.71
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$12.73
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.35
|
| Rate for Payer: UHC Medicare Advantage |
$5.10
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
IP
|
$40.49
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$40.49 |
| Rate for Payer: Aetna Commercial |
$36.44
|
| Rate for Payer: ASR ASR |
$39.28
|
| Rate for Payer: BCBS Trust/PPO |
$31.39
|
| Rate for Payer: BCN Commercial |
$31.39
|
| Rate for Payer: Cash Price |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$38.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.39
|
| Rate for Payer: Healthscope Commercial |
$40.49
|
| Rate for Payer: Healthscope Whirlpool |
$39.28
|
| Rate for Payer: Mclaren Commercial |
$36.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.63
|
|
|
HC ALBUMIN URINE OR OTHER SOURCE
|
Facility
|
OP
|
$40.49
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$40.49 |
| Rate for Payer: Aetna Commercial |
$36.44
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$39.28
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$31.39
|
| Rate for Payer: BCN Commercial |
$31.39
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$32.39
|
| Rate for Payer: Cash Price |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$38.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$40.49
|
| Rate for Payer: Healthscope Whirlpool |
$39.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$36.44
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.26
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.85
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$28.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.63
|
| Rate for Payer: UHC Medicare Advantage |
$8.01
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
IP
|
$6.12
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: ASR ASR |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.90
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Healthscope Whirlpool |
$5.94
|
| Rate for Payer: Mclaren Commercial |
$5.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.39
|
|
|
HC ALBUTEROL, INHALATION SOLUTION, UNIT DOSE 1MG
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: ASR ASR |
$5.94
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.90
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Healthscope Whirlpool |
$5.94
|
| Rate for Payer: Mclaren Commercial |
$5.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.39
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
HC ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
63600111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.96
|
| Rate for Payer: Mclaren Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
IP
|
$123.41
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.39 |
| Max. Negotiated Rate |
$123.41 |
| Rate for Payer: Aetna Commercial |
$111.07
|
| Rate for Payer: ASR ASR |
$119.71
|
| Rate for Payer: BCBS Trust/PPO |
$95.68
|
| Rate for Payer: BCN Commercial |
$95.68
|
| Rate for Payer: Cash Price |
$98.73
|
| Rate for Payer: Cofinity Commercial |
$116.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.73
|
| Rate for Payer: Healthscope Commercial |
$123.41
|
| Rate for Payer: Healthscope Whirlpool |
$119.71
|
| Rate for Payer: Mclaren Commercial |
$111.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.60
|
|
|
HC ALCOHOL ETHANOL LVL.
|
Facility
|
OP
|
$123.41
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100651
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$123.41 |
| Rate for Payer: Aetna Commercial |
$111.07
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$119.71
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$95.68
|
| Rate for Payer: BCN Commercial |
$95.68
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$98.73
|
| Rate for Payer: Cash Price |
$98.73
|
| Rate for Payer: Cofinity Commercial |
$116.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$123.41
|
| Rate for Payer: Healthscope Whirlpool |
$119.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$111.07
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.90
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.30
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$87.62
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.60
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ALCOHOL ETHANOL LVL REFLEX
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC ALCOHOL ETHANOL LVL REFLEX
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.15
|
| Rate for Payer: Priority Health Narrow Network |
$46.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC ALDER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200071
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC ALDER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200071
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ALDOLASE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
30100079
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: ASR ASR |
$41.71
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$33.34
|
| Rate for Payer: BCN Commercial |
$33.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$43.00
|
| Rate for Payer: Healthscope Whirlpool |
$41.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.71
|
| Rate for Payer: Mclaren Commercial |
$38.70
|
| Rate for Payer: Mclaren Medicaid |
$5.31
|
| Rate for Payer: Mclaren Medicare |
$9.71
|
| Rate for Payer: Meridian Medicaid |
$5.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: PHP Medicaid |
$5.31
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.84
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health Narrow Network |
$26.27
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.84
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
| Rate for Payer: VA VA |
$9.71
|
|
