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Service Code HCPCS L5450
Hospital Charge Code 27000013
Hospital Revenue Code 274
Min. Negotiated Rate $692.55
Max. Negotiated Rate $989.35
Rate for Payer: Aetna Commercial $934.39
Rate for Payer: Aetna New Business (MI Preferred) $714.53
Rate for Payer: Cash Price $879.42
Rate for Payer: Cofinity Commercial $769.50
Rate for Payer: Cofinity Commercial $945.38
Rate for Payer: Healthscope Commercial $989.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $934.39
Rate for Payer: PHP Commercial $934.39
Rate for Payer: Priority Health Cigna Priority Health $769.50
Rate for Payer: Priority Health SBD $692.55
Service Code HCPCS L0190
Hospital Charge Code 27000014
Hospital Revenue Code 274
Min. Negotiated Rate $777.63
Max. Negotiated Rate $1,110.90
Rate for Payer: Aetna Commercial $1,049.18
Rate for Payer: Aetna New Business (MI Preferred) $802.31
Rate for Payer: Cash Price $987.46
Rate for Payer: Cofinity Commercial $1,061.52
Rate for Payer: Cofinity Commercial $864.03
Rate for Payer: Healthscope Commercial $1,110.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,049.18
Rate for Payer: PHP Commercial $1,049.18
Rate for Payer: Priority Health Cigna Priority Health $864.03
Rate for Payer: Priority Health SBD $777.63
Service Code HCPCS L0190
Hospital Charge Code 27000014
Hospital Revenue Code 274
Min. Negotiated Rate $493.73
Max. Negotiated Rate $1,773.06
Rate for Payer: Aetna Commercial $1,049.18
Rate for Payer: Aetna New Business (MI Preferred) $802.31
Rate for Payer: BCBS Complete $493.73
Rate for Payer: BCBS Trust/PPO $1,773.06
Rate for Payer: Cash Price $987.46
Rate for Payer: Cash Price $987.46
Rate for Payer: Cofinity Commercial $1,061.52
Rate for Payer: Cofinity Commercial $864.03
Rate for Payer: Healthscope Commercial $1,110.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,049.18
Rate for Payer: PHP Commercial $1,049.18
Rate for Payer: Priority Health Cigna Priority Health $864.03
Rate for Payer: Priority Health SBD $777.63
Rate for Payer: UHC All Payor (Choice/PPO) $871.98
Rate for Payer: UHC Exchange $726.65
Service Code HCPCS L1499
Hospital Charge Code 27400030
Hospital Revenue Code 274
Min. Negotiated Rate $420.00
Max. Negotiated Rate $1,378.38
Rate for Payer: Aetna Commercial $892.50
Rate for Payer: Aetna New Business (MI Preferred) $682.50
Rate for Payer: BCBS Complete $420.00
Rate for Payer: BCBS Trust/PPO $1,378.38
Rate for Payer: Cash Price $840.00
Rate for Payer: Cash Price $840.00
Rate for Payer: Cofinity Commercial $903.00
Rate for Payer: Cofinity Commercial $735.00
Rate for Payer: Healthscope Commercial $945.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $892.50
Rate for Payer: PHP Commercial $892.50
Rate for Payer: Priority Health Cigna Priority Health $735.00
Rate for Payer: Priority Health SBD $661.50
Service Code HCPCS L1499
Hospital Charge Code 27400030
Hospital Revenue Code 274
Min. Negotiated Rate $661.50
Max. Negotiated Rate $945.00
Rate for Payer: Aetna Commercial $892.50
Rate for Payer: Aetna New Business (MI Preferred) $682.50
Rate for Payer: Cash Price $840.00
Rate for Payer: Cofinity Commercial $735.00
Rate for Payer: Cofinity Commercial $903.00
Rate for Payer: Healthscope Commercial $945.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $892.50
Rate for Payer: PHP Commercial $892.50
Rate for Payer: Priority Health Cigna Priority Health $735.00
Rate for Payer: Priority Health SBD $661.50
Hospital Charge Code 27000032
Hospital Revenue Code 274
Min. Negotiated Rate $3,633.45
Max. Negotiated Rate $5,190.64
Rate for Payer: Aetna Commercial $4,902.27
Rate for Payer: Aetna New Business (MI Preferred) $3,748.80
Rate for Payer: Cash Price $4,613.90
Rate for Payer: Cofinity Commercial $4,037.17
Rate for Payer: Cofinity Commercial $4,959.95
Rate for Payer: Healthscope Commercial $5,190.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $4,902.27
Rate for Payer: PHP Commercial $4,902.27
Rate for Payer: Priority Health Cigna Priority Health $4,037.17
Rate for Payer: Priority Health SBD $3,633.45
Hospital Charge Code 27000032
Hospital Revenue Code 274
Min. Negotiated Rate $2,306.95
Max. Negotiated Rate $5,190.64
Rate for Payer: Aetna Commercial $4,902.27
Rate for Payer: Aetna New Business (MI Preferred) $3,748.80
Rate for Payer: BCBS Complete $2,306.95
Rate for Payer: Cash Price $4,613.90
Rate for Payer: Cofinity Commercial $4,037.17
Rate for Payer: Cofinity Commercial $4,959.95
Rate for Payer: Healthscope Commercial $5,190.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $4,902.27
Rate for Payer: PHP Commercial $4,902.27
Rate for Payer: Priority Health Cigna Priority Health $4,037.17
Rate for Payer: Priority Health SBD $3,633.45
Service Code HCPCS L0200
Hospital Charge Code 27400029
Hospital Revenue Code 274
Min. Negotiated Rate $915.39
Max. Negotiated Rate $1,307.70
Rate for Payer: Aetna Commercial $1,235.05
Rate for Payer: Aetna New Business (MI Preferred) $944.45
Rate for Payer: Cash Price $1,162.40
Rate for Payer: Cofinity Commercial $1,017.10
Rate for Payer: Cofinity Commercial $1,249.58
Rate for Payer: Healthscope Commercial $1,307.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,235.05
Rate for Payer: PHP Commercial $1,235.05
Rate for Payer: Priority Health Cigna Priority Health $1,017.10
Rate for Payer: Priority Health SBD $915.39
Service Code HCPCS L0200
Hospital Charge Code 27400029
Hospital Revenue Code 274
Min. Negotiated Rate $581.20
Max. Negotiated Rate $2,056.63
Rate for Payer: Aetna Commercial $1,235.05
Rate for Payer: Aetna New Business (MI Preferred) $944.45
Rate for Payer: BCBS Complete $581.20
Rate for Payer: BCBS Trust/PPO $2,056.63
Rate for Payer: Cash Price $1,162.40
Rate for Payer: Cash Price $1,162.40
Rate for Payer: Cofinity Commercial $1,017.10
Rate for Payer: Cofinity Commercial $1,249.58
Rate for Payer: Healthscope Commercial $1,307.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,235.05
Rate for Payer: PHP Commercial $1,235.05
Rate for Payer: Priority Health Cigna Priority Health $1,017.10
Rate for Payer: Priority Health SBD $915.39
Rate for Payer: UHC All Payor (Choice/PPO) $909.04
Rate for Payer: UHC Exchange $757.53
Service Code HCPCS L1499
Hospital Charge Code 27400045
Hospital Revenue Code 274
Min. Negotiated Rate $170.10
Max. Negotiated Rate $243.00
Rate for Payer: Aetna Commercial $229.50
Rate for Payer: Aetna New Business (MI Preferred) $175.50
Rate for Payer: Cash Price $216.00
Rate for Payer: Cofinity Commercial $189.00
Rate for Payer: Cofinity Commercial $232.20
Rate for Payer: Healthscope Commercial $243.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $229.50
Rate for Payer: PHP Commercial $229.50
Rate for Payer: Priority Health Cigna Priority Health $189.00
Rate for Payer: Priority Health SBD $170.10
Service Code HCPCS L1499
Hospital Charge Code 27400045
Hospital Revenue Code 274
Min. Negotiated Rate $108.00
Max. Negotiated Rate $1,378.38
Rate for Payer: Aetna Commercial $229.50
Rate for Payer: Aetna New Business (MI Preferred) $175.50
Rate for Payer: BCBS Complete $108.00
Rate for Payer: BCBS Trust/PPO $1,378.38
Rate for Payer: Cash Price $216.00
Rate for Payer: Cash Price $216.00
Rate for Payer: Cofinity Commercial $232.20
Rate for Payer: Cofinity Commercial $189.00
Rate for Payer: Healthscope Commercial $243.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $229.50
Rate for Payer: PHP Commercial $229.50
Rate for Payer: Priority Health Cigna Priority Health $189.00
Rate for Payer: Priority Health SBD $170.10
Service Code HCPCS L3908
Hospital Charge Code 27400013
Hospital Revenue Code 274
Min. Negotiated Rate $27.60
Max. Negotiated Rate $222.34
Rate for Payer: Aetna Commercial $58.65
Rate for Payer: Aetna New Business (MI Preferred) $44.85
Rate for Payer: BCBS Complete $27.60
Rate for Payer: BCBS Trust/PPO $222.34
Rate for Payer: Cash Price $55.20
Rate for Payer: Cash Price $55.20
Rate for Payer: Cofinity Commercial $59.34
Rate for Payer: Cofinity Commercial $48.30
Rate for Payer: Healthscope Commercial $62.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $58.65
Rate for Payer: PHP Commercial $58.65
Rate for Payer: Priority Health Cigna Priority Health $48.30
Rate for Payer: Priority Health SBD $43.47
Rate for Payer: UHC All Payor (Choice/PPO) $103.20
Rate for Payer: UHC Exchange $86.00
Service Code HCPCS L3908
Hospital Charge Code 27400013
Hospital Revenue Code 274
Min. Negotiated Rate $43.47
Max. Negotiated Rate $62.10
Rate for Payer: Aetna Commercial $58.65
Rate for Payer: Aetna New Business (MI Preferred) $44.85
Rate for Payer: Cash Price $55.20
Rate for Payer: Cofinity Commercial $48.30
Rate for Payer: Cofinity Commercial $59.34
Rate for Payer: Healthscope Commercial $62.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $58.65
Rate for Payer: PHP Commercial $58.65
Rate for Payer: Priority Health Cigna Priority Health $48.30
Rate for Payer: Priority Health SBD $43.47
Service Code HCPCS L3760
Hospital Charge Code 27000004
Hospital Revenue Code 274
Min. Negotiated Rate $665.17
Max. Negotiated Rate $950.25
Rate for Payer: Aetna Commercial $897.46
Rate for Payer: Aetna New Business (MI Preferred) $686.29
Rate for Payer: Cash Price $844.66
Rate for Payer: Cofinity Commercial $739.08
Rate for Payer: Cofinity Commercial $908.01
Rate for Payer: Healthscope Commercial $950.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $897.46
Rate for Payer: PHP Commercial $897.46
Rate for Payer: Priority Health Cigna Priority Health $739.08
Rate for Payer: Priority Health SBD $665.17
Service Code HCPCS L3760
Hospital Charge Code 27000004
Hospital Revenue Code 274
Min. Negotiated Rate $422.33
Max. Negotiated Rate $1,516.69
Rate for Payer: Aetna Commercial $897.46
Rate for Payer: Aetna New Business (MI Preferred) $686.29
Rate for Payer: BCBS Complete $422.33
Rate for Payer: BCBS Trust/PPO $1,516.69
Rate for Payer: Cash Price $844.66
Rate for Payer: Cash Price $844.66
Rate for Payer: Cofinity Commercial $739.08
Rate for Payer: Cofinity Commercial $908.01
Rate for Payer: Healthscope Commercial $950.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $897.46
Rate for Payer: PHP Commercial $897.46
Rate for Payer: Priority Health Cigna Priority Health $739.08
Rate for Payer: Priority Health SBD $665.17
Rate for Payer: UHC All Payor (Choice/PPO) $765.42
Rate for Payer: UHC Exchange $637.85
Service Code HCPCS L3763
Hospital Charge Code 27400047
Hospital Revenue Code 274
Min. Negotiated Rate $274.00
Max. Negotiated Rate $2,269.47
Rate for Payer: Aetna Commercial $582.25
Rate for Payer: Aetna New Business (MI Preferred) $445.25
Rate for Payer: BCBS Complete $274.00
Rate for Payer: BCBS Trust/PPO $2,269.47
Rate for Payer: Cash Price $548.00
Rate for Payer: Cash Price $548.00
Rate for Payer: Cofinity Commercial $479.50
Rate for Payer: Cofinity Commercial $589.10
Rate for Payer: Healthscope Commercial $616.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $582.25
Rate for Payer: PHP Commercial $582.25
Rate for Payer: Priority Health Cigna Priority Health $479.50
Rate for Payer: Priority Health SBD $431.55
Rate for Payer: UHC All Payor (Choice/PPO) $1,126.78
Rate for Payer: UHC Exchange $938.98
Service Code HCPCS L3763
Hospital Charge Code 27400047
Hospital Revenue Code 274
Min. Negotiated Rate $431.55
Max. Negotiated Rate $616.50
Rate for Payer: Aetna Commercial $582.25
Rate for Payer: Aetna New Business (MI Preferred) $445.25
Rate for Payer: Cash Price $548.00
Rate for Payer: Cofinity Commercial $479.50
Rate for Payer: Cofinity Commercial $589.10
Rate for Payer: Healthscope Commercial $616.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $582.25
Rate for Payer: PHP Commercial $582.25
Rate for Payer: Priority Health Cigna Priority Health $479.50
Rate for Payer: Priority Health SBD $431.55
Service Code HCPCS A9283
Hospital Charge Code 27000005
Hospital Revenue Code 274
Min. Negotiated Rate $25.20
Max. Negotiated Rate $36.00
Rate for Payer: Aetna Commercial $34.00
Rate for Payer: Aetna New Business (MI Preferred) $26.00
Rate for Payer: Cash Price $32.00
Rate for Payer: Cofinity Commercial $28.00
Rate for Payer: Cofinity Commercial $34.40
Rate for Payer: Healthscope Commercial $36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $34.00
Rate for Payer: PHP Commercial $34.00
Rate for Payer: Priority Health Cigna Priority Health $28.00
Rate for Payer: Priority Health SBD $25.20
Service Code HCPCS A9283
Hospital Charge Code 27000005
Hospital Revenue Code 274
Min. Negotiated Rate $16.00
Max. Negotiated Rate $36.00
Rate for Payer: Aetna Commercial $34.00
Rate for Payer: Aetna New Business (MI Preferred) $26.00
Rate for Payer: BCBS Complete $16.00
Rate for Payer: Cash Price $32.00
Rate for Payer: Cofinity Commercial $28.00
Rate for Payer: Cofinity Commercial $34.40
Rate for Payer: Healthscope Commercial $36.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $34.00
Rate for Payer: PHP Commercial $34.00
Rate for Payer: Priority Health Cigna Priority Health $28.00
Rate for Payer: Priority Health SBD $25.20
Service Code HCPCS L3933
Hospital Charge Code 27400043
Hospital Revenue Code 274
Min. Negotiated Rate $78.40
Max. Negotiated Rate $647.07
Rate for Payer: Aetna Commercial $166.60
Rate for Payer: Aetna New Business (MI Preferred) $127.40
Rate for Payer: BCBS Complete $78.40
Rate for Payer: BCBS Trust/PPO $647.07
Rate for Payer: Cash Price $156.80
Rate for Payer: Cash Price $156.80
Rate for Payer: Cofinity Commercial $168.56
Rate for Payer: Cofinity Commercial $137.20
Rate for Payer: Healthscope Commercial $176.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $166.60
Rate for Payer: PHP Commercial $166.60
Rate for Payer: Priority Health Cigna Priority Health $137.20
Rate for Payer: Priority Health SBD $123.48
Rate for Payer: UHC All Payor (Choice/PPO) $326.54
Rate for Payer: UHC Exchange $272.12
Service Code HCPCS L3933
Hospital Charge Code 27400043
Hospital Revenue Code 274
Min. Negotiated Rate $123.48
Max. Negotiated Rate $176.40
Rate for Payer: Aetna Commercial $166.60
Rate for Payer: Aetna New Business (MI Preferred) $127.40
Rate for Payer: Cash Price $156.80
Rate for Payer: Cofinity Commercial $137.20
Rate for Payer: Cofinity Commercial $168.56
Rate for Payer: Healthscope Commercial $176.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $166.60
Rate for Payer: PHP Commercial $166.60
Rate for Payer: Priority Health Cigna Priority Health $137.20
Rate for Payer: Priority Health SBD $123.48
Service Code HCPCS L4386
Hospital Charge Code 27400002
Hospital Revenue Code 274
Min. Negotiated Rate $261.05
Max. Negotiated Rate $372.93
Rate for Payer: Aetna Commercial $352.21
Rate for Payer: Aetna New Business (MI Preferred) $269.34
Rate for Payer: Cash Price $331.50
Rate for Payer: Cofinity Commercial $290.06
Rate for Payer: Cofinity Commercial $356.36
Rate for Payer: Healthscope Commercial $372.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $352.21
Rate for Payer: PHP Commercial $352.21
Rate for Payer: Priority Health Cigna Priority Health $290.06
Rate for Payer: Priority Health SBD $261.05
Service Code HCPCS L4386
Hospital Charge Code 27400002
Hospital Revenue Code 274
Min. Negotiated Rate $165.75
Max. Negotiated Rate $528.34
Rate for Payer: Aetna Commercial $352.21
Rate for Payer: Aetna New Business (MI Preferred) $269.34
Rate for Payer: BCBS Complete $165.75
Rate for Payer: BCBS Trust/PPO $528.34
Rate for Payer: Cash Price $331.50
Rate for Payer: Cash Price $331.50
Rate for Payer: Cofinity Commercial $356.36
Rate for Payer: Cofinity Commercial $290.06
Rate for Payer: Healthscope Commercial $372.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $352.21
Rate for Payer: PHP Commercial $352.21
Rate for Payer: Priority Health Cigna Priority Health $290.06
Rate for Payer: Priority Health SBD $261.05
Rate for Payer: UHC All Payor (Choice/PPO) $266.63
Rate for Payer: UHC Exchange $222.19
Service Code HCPCS L4387
Hospital Charge Code 27400022
Hospital Revenue Code 274
Min. Negotiated Rate $198.90
Max. Negotiated Rate $528.34
Rate for Payer: Aetna Commercial $422.65
Rate for Payer: Aetna New Business (MI Preferred) $323.21
Rate for Payer: BCBS Complete $198.90
Rate for Payer: BCBS Trust/PPO $528.34
Rate for Payer: Cash Price $397.79
Rate for Payer: Cash Price $397.79
Rate for Payer: Cofinity Commercial $348.07
Rate for Payer: Cofinity Commercial $427.63
Rate for Payer: Healthscope Commercial $447.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $422.65
Rate for Payer: PHP Commercial $422.65
Rate for Payer: Priority Health Cigna Priority Health $348.07
Rate for Payer: Priority Health SBD $313.26
Rate for Payer: UHC All Payor (Choice/PPO) $266.63
Rate for Payer: UHC Exchange $222.19
Service Code HCPCS L4387
Hospital Charge Code 27400022
Hospital Revenue Code 274
Min. Negotiated Rate $313.26
Max. Negotiated Rate $447.52
Rate for Payer: Aetna Commercial $422.65
Rate for Payer: Aetna New Business (MI Preferred) $323.21
Rate for Payer: Cash Price $397.79
Rate for Payer: Cofinity Commercial $348.07
Rate for Payer: Cofinity Commercial $427.63
Rate for Payer: Healthscope Commercial $447.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $422.65
Rate for Payer: PHP Commercial $422.65
Rate for Payer: Priority Health Cigna Priority Health $348.07
Rate for Payer: Priority Health SBD $313.26