|
HC ABLATION CATH NON-CARD ENDOVASC IMPLANT
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: BCBS Complete |
$510.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$892.50
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,083.75
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health SBD |
$803.25
|
|
|
HC ABLATION CATH NON-CARD ENDOVASC IMPLANT
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$803.25 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Aetna Commercial |
$1,083.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.75
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.50
|
| Rate for Payer: Cofinity Commercial |
$892.50
|
| Rate for Payer: Healthscope Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,083.75
|
| Rate for Payer: PHP Commercial |
$1,083.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.50
|
| Rate for Payer: Priority Health SBD |
$803.25
|
|
|
HC ABLATION RF LUNG
|
Facility
|
IP
|
$5,899.37
|
|
|
Service Code
|
CPT 32998
|
| Hospital Charge Code |
36100055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,716.60 |
| Max. Negotiated Rate |
$5,309.43 |
| Rate for Payer: Aetna Commercial |
$5,014.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,834.59
|
| Rate for Payer: Cash Price |
$4,719.50
|
| Rate for Payer: Cofinity Commercial |
$4,129.56
|
| Rate for Payer: Cofinity Commercial |
$5,073.46
|
| Rate for Payer: Healthscope Commercial |
$5,309.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,014.46
|
| Rate for Payer: PHP Commercial |
$5,014.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,129.56
|
| Rate for Payer: Priority Health SBD |
$3,716.60
|
|
|
HC ABLATION RF LUNG
|
Facility
|
OP
|
$5,899.37
|
|
|
Service Code
|
CPT 32998
|
| Hospital Charge Code |
36100055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.80 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Commercial |
$5,014.46
|
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,834.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,286.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Cash Price |
$4,719.50
|
| Rate for Payer: Cash Price |
$4,719.50
|
| Rate for Payer: Cofinity Commercial |
$4,129.56
|
| Rate for Payer: Cofinity Commercial |
$5,073.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Healthscope Commercial |
$5,309.43
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,014.46
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Commercial |
$5,014.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,129.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Priority Health SBD |
$3,716.60
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$460.68
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$418.80
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
HC ABLATION VEIN OF MARSHALL
|
Facility
|
OP
|
$8,725.45
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100122
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$7,852.90 |
| Rate for Payer: Aetna Commercial |
$7,416.63
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,671.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$422.58
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$6,980.36
|
| Rate for Payer: Cash Price |
$6,980.36
|
| Rate for Payer: Cofinity Commercial |
$6,107.82
|
| Rate for Payer: Cofinity Commercial |
$7,503.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$7,852.90
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,416.63
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$7,416.63
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,107.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$5,497.03
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC ABLATION VEIN OF MARSHALL
|
Facility
|
IP
|
$8,725.45
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100122
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,497.03 |
| Max. Negotiated Rate |
$7,852.90 |
| Rate for Payer: Aetna Commercial |
$7,416.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,671.54
|
| Rate for Payer: Cash Price |
$6,980.36
|
| Rate for Payer: Cofinity Commercial |
$6,107.82
|
| Rate for Payer: Cofinity Commercial |
$7,503.89
|
| Rate for Payer: Healthscope Commercial |
$7,852.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,416.63
|
| Rate for Payer: PHP Commercial |
$7,416.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,107.82
|
| Rate for Payer: Priority Health SBD |
$5,497.03
|
|
|
HC ABLAVAR
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS A9583
|
| Hospital Charge Code |
63600007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.90
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.74
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$22.36
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.10
|
| Rate for Payer: PHP Commercial |
$22.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health SBD |
$16.38
|
|
|
HC ABLAVAR
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS A9583
|
| Hospital Charge Code |
63600007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.90
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$22.36
|
| Rate for Payer: Healthscope Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.10
|
| Rate for Payer: PHP Commercial |
$22.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health SBD |
$16.38
|
|
|
HC ABSCESS DRAINAGE COMPLICATED
|
Facility
|
OP
|
$488.86
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$1,076.20 |
| Rate for Payer: Aetna Commercial |
$415.53
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Cofinity Commercial |
$420.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$439.97
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$415.53
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$860.96
|
| Rate for Payer: Priority Health SBD |
$307.98
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$182.06
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
HC ABSCESS DRAINAGE COMPLICATED
|
Facility
|
IP
|
$488.86
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.98 |
| Max. Negotiated Rate |
$439.97 |
| Rate for Payer: Aetna Commercial |
$415.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.76
|
| Rate for Payer: Cash Price |
$391.09
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Cofinity Commercial |
$420.42
|
| Rate for Payer: Healthscope Commercial |
$439.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.53
|
| Rate for Payer: PHP Commercial |
$415.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.20
|
| Rate for Payer: Priority Health SBD |
$307.98
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
OP
|
$391.99
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$333.19
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$146.34
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$313.59
|
| Rate for Payer: Cash Price |
$313.59
|
| Rate for Payer: Cofinity Commercial |
$337.11
|
| Rate for Payer: Cofinity Commercial |
$274.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$352.79
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.19
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$333.19
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$246.95
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$105.44
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
IP
|
$391.99
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.95 |
| Max. Negotiated Rate |
$352.79 |
| Rate for Payer: Aetna Commercial |
$333.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.79
|
| Rate for Payer: Cash Price |
$313.59
|
| Rate for Payer: Cofinity Commercial |
$274.39
|
| Rate for Payer: Cofinity Commercial |
$337.11
|
| Rate for Payer: Healthscope Commercial |
$352.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.19
|
| Rate for Payer: PHP Commercial |
$333.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.39
|
| Rate for Payer: Priority Health SBD |
$246.95
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
IP
|
$1,754.30
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,105.21 |
| Max. Negotiated Rate |
$1,578.87 |
| Rate for Payer: Aetna Commercial |
$1,491.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,140.30
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cofinity Commercial |
$1,508.70
|
| Rate for Payer: Cofinity Commercial |
$1,228.01
|
| Rate for Payer: Healthscope Commercial |
$1,578.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,491.16
|
| Rate for Payer: PHP Commercial |
$1,491.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.01
|
| Rate for Payer: Priority Health SBD |
$1,105.21
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
OP
|
$1,754.30
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.40 |
| Max. Negotiated Rate |
$1,578.87 |
| Rate for Payer: Aetna Commercial |
$1,491.16
|
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,140.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cofinity Commercial |
$1,508.70
|
| Rate for Payer: Cofinity Commercial |
$1,228.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Healthscope Commercial |
$1,578.87
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,491.16
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Commercial |
$1,491.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.01
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health SBD |
$1,105.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$422.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$192.14
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.05 |
| Max. Negotiated Rate |
$172.93 |
| Rate for Payer: Aetna Commercial |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.89
|
| Rate for Payer: Cash Price |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$172.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.32
|
| Rate for Payer: PHP Commercial |
$163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health SBD |
$121.05
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$192.14
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$172.93 |
| Rate for Payer: Aetna Commercial |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.89
|
| Rate for Payer: BCBS Complete |
$76.86
|
| Rate for Payer: Cash Price |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Commercial |
$165.24
|
| Rate for Payer: Healthscope Commercial |
$172.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.32
|
| Rate for Payer: PHP Commercial |
$163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health SBD |
$121.05
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$92.44
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$78.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.09
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Cofinity Commercial |
$64.71
|
| Rate for Payer: Healthscope Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.57
|
| Rate for Payer: PHP Commercial |
$78.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.71
|
| Rate for Payer: Priority Health SBD |
$58.24
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$92.44
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$1,227.07 |
| Rate for Payer: Aetna Commercial |
$78.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.09
|
| Rate for Payer: BCBS Complete |
$36.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.07
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$64.71
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Healthscope Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.57
|
| Rate for Payer: PHP Commercial |
$78.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.71
|
| Rate for Payer: Priority Health SBD |
$58.24
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
IP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$223.85 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.95
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$248.72
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.01
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.72
|
| Rate for Payer: Priority Health SBD |
$223.85
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
OP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$319.78 |
| Rate for Payer: Aetna Commercial |
$302.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.95
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS Trust/PPO |
$51.75
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$248.72
|
| Rate for Payer: Cofinity Commercial |
$305.57
|
| Rate for Payer: Healthscope Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.01
|
| Rate for Payer: PHP Commercial |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.72
|
| Rate for Payer: Priority Health SBD |
$223.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health SBD |
$311.49
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$444.99 |
| Rate for Payer: Aetna Commercial |
$420.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.38
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$346.10
|
| Rate for Payer: Cofinity Commercial |
$425.21
|
| Rate for Payer: Healthscope Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: PHP Commercial |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health SBD |
$311.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Exchange |
$34.38
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$125.26
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Cofinity Commercial |
$482.20
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health SBD |
$433.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.60
|
| Rate for Payer: UHC Exchange |
$64.18
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$433.98 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$482.20
|
| Rate for Payer: Cofinity Commercial |
$592.41
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: PHP Commercial |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health SBD |
$433.98
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$787.07 |
| Rate for Payer: Aetna Commercial |
$743.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.44
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS Trust/PPO |
$171.35
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$752.09
|
| Rate for Payer: Cofinity Commercial |
$612.16
|
| Rate for Payer: Healthscope Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.34
|
| Rate for Payer: PHP Commercial |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.16
|
| Rate for Payer: Priority Health SBD |
$550.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.09
|
| Rate for Payer: UHC Exchange |
$94.63
|
|
