|
HC ABSCESS DRAINAGE COMPLICATED
|
Facility
|
OP
|
$508.61
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.61 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$457.75
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$493.35
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$419.35
|
| Rate for Payer: BCN Commercial |
$419.35
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cofinity Commercial |
$478.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$493.35
|
| Rate for Payer: Healthscope Whirlpool |
$508.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$457.75
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.32
|
| Rate for Payer: Nomi Health Commercial |
$417.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.46
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.01
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$205.61
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
OP
|
$407.83
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$407.83 |
| Rate for Payer: Aetna Commercial |
$367.05
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$395.60
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$336.26
|
| Rate for Payer: BCN Commercial |
$336.26
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$326.26
|
| Rate for Payer: Cash Price |
$326.26
|
| Rate for Payer: Cofinity Commercial |
$383.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$395.60
|
| Rate for Payer: Healthscope Whirlpool |
$407.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$367.05
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.66
|
| Rate for Payer: Nomi Health Commercial |
$334.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.87
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.01
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$205.61
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
IP
|
$407.83
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.87 |
| Max. Negotiated Rate |
$407.83 |
| Rate for Payer: Aetna Commercial |
$367.05
|
| Rate for Payer: ASR ASR |
$395.60
|
| Rate for Payer: BCBS Trust/PPO |
$334.91
|
| Rate for Payer: BCN Commercial |
$334.91
|
| Rate for Payer: Cash Price |
$326.26
|
| Rate for Payer: Cofinity Commercial |
$383.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.26
|
| Rate for Payer: Healthscope Commercial |
$395.60
|
| Rate for Payer: Healthscope Whirlpool |
$407.83
|
| Rate for Payer: Mclaren Commercial |
$367.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.66
|
| Rate for Payer: Nomi Health Commercial |
$334.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$358.89
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
OP
|
$1,825.18
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$4,060.21 |
| Rate for Payer: Aetna Commercial |
$1,642.66
|
| Rate for Payer: Aetna Medicare |
$1,192.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: ASR ASR |
$1,770.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,504.86
|
| Rate for Payer: BCN Commercial |
$1,504.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Cash Price |
$1,460.14
|
| Rate for Payer: Cash Price |
$1,460.14
|
| Rate for Payer: Cofinity Commercial |
$1,715.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,460.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Healthscope Commercial |
$1,770.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,825.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,192.34
|
| Rate for Payer: Mclaren Commercial |
$1,642.66
|
| Rate for Payer: Mclaren Medicaid |
$1,192.34
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$654.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,551.40
|
| Rate for Payer: Nomi Health Commercial |
$1,496.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,368.88
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Commercial |
$1,311.57
|
| Rate for Payer: PHP Medicaid |
$639.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,060.21
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Narrow Network |
$3,248.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,606.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Exchange |
$1,848.13
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP DNSP |
$1,192.34
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
IP
|
$1,825.18
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.88 |
| Max. Negotiated Rate |
$1,825.18 |
| Rate for Payer: Aetna Commercial |
$1,642.66
|
| Rate for Payer: ASR ASR |
$1,770.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.84
|
| Rate for Payer: BCN Commercial |
$1,498.84
|
| Rate for Payer: Cash Price |
$1,460.14
|
| Rate for Payer: Cofinity Commercial |
$1,715.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,460.14
|
| Rate for Payer: Healthscope Commercial |
$1,770.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,825.18
|
| Rate for Payer: Mclaren Commercial |
$1,642.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,551.40
|
| Rate for Payer: Nomi Health Commercial |
$1,496.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,368.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,606.16
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$199.90
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$199.90 |
| Rate for Payer: Aetna Commercial |
$179.91
|
| Rate for Payer: Aetna Medicare |
$73.96
|
| Rate for Payer: ASR ASR |
$193.90
|
| Rate for Payer: BCBS Complete |
$79.96
|
| Rate for Payer: BCBS Trust/PPO |
$164.82
|
| Rate for Payer: BCN Commercial |
$164.82
|
| Rate for Payer: Cash Price |
$159.92
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.92
|
| Rate for Payer: Healthscope Commercial |
$193.90
|
| Rate for Payer: Healthscope Whirlpool |
$199.90
|
| Rate for Payer: Mclaren Commercial |
$179.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.91
|
| Rate for Payer: Nomi Health Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$175.15
|
| Rate for Payer: Priority Health Narrow Network |
$140.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.91
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$199.90
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$199.90 |
| Rate for Payer: Aetna Commercial |
$179.91
|
| Rate for Payer: ASR ASR |
$193.90
|
| Rate for Payer: BCBS Trust/PPO |
$164.16
|
| Rate for Payer: BCN Commercial |
$164.16
|
| Rate for Payer: Cash Price |
$159.92
|
| Rate for Payer: Cofinity Commercial |
$187.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.92
|
| Rate for Payer: Healthscope Commercial |
$193.90
|
| Rate for Payer: Healthscope Whirlpool |
$199.90
|
| Rate for Payer: Mclaren Commercial |
$179.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.91
|
| Rate for Payer: Nomi Health Commercial |
$163.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.91
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$96.18
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$96.18 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: ASR ASR |
$93.29
|
| Rate for Payer: BCBS Trust/PPO |
$78.98
|
| Rate for Payer: BCN Commercial |
$78.98
|
| Rate for Payer: Cash Price |
$76.94
|
| Rate for Payer: Cofinity Commercial |
$90.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.94
|
| Rate for Payer: Healthscope Commercial |
$93.29
|
| Rate for Payer: Healthscope Whirlpool |
$96.18
|
| Rate for Payer: Mclaren Commercial |
$86.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.75
|
| Rate for Payer: Nomi Health Commercial |
$78.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.64
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$96.18
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$93.29
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$79.30
|
| Rate for Payer: BCN Commercial |
$79.30
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$76.94
|
| Rate for Payer: Cash Price |
$76.94
|
| Rate for Payer: Cofinity Commercial |
$90.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$93.29
|
| Rate for Payer: Healthscope Whirlpool |
$96.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$86.56
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.75
|
| Rate for Payer: Nomi Health Commercial |
$78.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.14
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.25
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$37.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
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 |
$21.87 |
| Max. Negotiated Rate |
$355.31 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: Aetna Medicare |
$131.46
|
| Rate for Payer: ASR ASR |
$344.65
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS Trust/PPO |
$292.95
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$292.95
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$333.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$344.65
|
| Rate for Payer: Healthscope Whirlpool |
$355.31
|
| Rate for Payer: Mclaren Commercial |
$319.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.67
|
|
|
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 |
$266.48 |
| Max. Negotiated Rate |
$355.31 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: ASR ASR |
$344.65
|
| Rate for Payer: BCBS Trust/PPO |
$291.78
|
| Rate for Payer: BCN Commercial |
$291.78
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$333.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$344.65
|
| Rate for Payer: Healthscope Whirlpool |
$355.31
|
| Rate for Payer: Mclaren Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.01
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.67
|
|
|
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 |
$370.82 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Trust/PPO |
$406.03
|
| Rate for Payer: BCN Commercial |
$406.03
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$479.60
|
| Rate for Payer: Healthscope Whirlpool |
$494.43
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
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 |
$21.87 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: Aetna Medicare |
$182.94
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$407.66
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$407.66
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$479.60
|
| Rate for Payer: Healthscope Whirlpool |
$494.43
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.42
|
| Rate for Payer: Priority Health Narrow Network |
$167.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
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 |
$87.68 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.97
|
| Rate for Payer: Aetna Medicare |
$254.87
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$567.96
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$567.96
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$647.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$668.18
|
| Rate for Payer: Healthscope Whirlpool |
$688.85
|
| Rate for Payer: Mclaren Commercial |
$619.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.65
|
| Rate for Payer: Priority Health Narrow Network |
$186.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
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 |
$516.64 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.97
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: BCBS Trust/PPO |
$565.68
|
| Rate for Payer: BCN Commercial |
$565.68
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$647.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$668.18
|
| Rate for Payer: Healthscope Whirlpool |
$688.85
|
| Rate for Payer: Mclaren Commercial |
$619.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
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 |
$87.68 |
| Max. Negotiated Rate |
$874.52 |
| Rate for Payer: Aetna Commercial |
$787.07
|
| Rate for Payer: Aetna Medicare |
$323.57
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS Trust/PPO |
$721.04
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$721.04
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$848.28
|
| Rate for Payer: Healthscope Whirlpool |
$874.52
|
| Rate for Payer: Mclaren Commercial |
$787.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.85
|
| Rate for Payer: Priority Health Narrow Network |
$206.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$655.89 |
| Max. Negotiated Rate |
$874.52 |
| Rate for Payer: Aetna Commercial |
$787.07
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: BCBS Trust/PPO |
$718.16
|
| Rate for Payer: BCN Commercial |
$718.16
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$848.28
|
| Rate for Payer: Healthscope Whirlpool |
$874.52
|
| Rate for Payer: Mclaren Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.34
|
| Rate for Payer: Nomi Health Commercial |
$717.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$385.87 |
| Max. Negotiated Rate |
$1,042.88 |
| Rate for Payer: Aetna Commercial |
$938.59
|
| Rate for Payer: Aetna Medicare |
$385.87
|
| Rate for Payer: ASR ASR |
$1,011.59
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$859.85
|
| Rate for Payer: BCN Commercial |
$859.85
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$980.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$1,011.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.88
|
| Rate for Payer: Mclaren Commercial |
$938.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$834.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$913.77
|
| Rate for Payer: Priority Health Narrow Network |
$731.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.73
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$782.16 |
| Max. Negotiated Rate |
$1,042.88 |
| Rate for Payer: Aetna Commercial |
$938.59
|
| Rate for Payer: ASR ASR |
$1,011.59
|
| Rate for Payer: BCBS Trust/PPO |
$856.41
|
| Rate for Payer: BCN Commercial |
$856.41
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$980.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$1,011.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.88
|
| Rate for Payer: Mclaren Commercial |
$938.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$886.45
|
| Rate for Payer: Nomi Health Commercial |
$855.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$782.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.73
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.56 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna Commercial |
$335.47
|
| Rate for Payer: ASR ASR |
$361.56
|
| Rate for Payer: BCBS Trust/PPO |
$306.09
|
| Rate for Payer: BCN Commercial |
$306.09
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$361.56
|
| Rate for Payer: Healthscope Whirlpool |
$372.74
|
| Rate for Payer: Mclaren Commercial |
$335.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Nomi Health Commercial |
$305.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.01
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna Commercial |
$335.47
|
| Rate for Payer: Aetna Medicare |
$137.91
|
| Rate for Payer: ASR ASR |
$361.56
|
| Rate for Payer: BCBS Complete |
$149.10
|
| Rate for Payer: BCBS Trust/PPO |
$307.32
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$307.32
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$361.56
|
| Rate for Payer: Healthscope Whirlpool |
$372.74
|
| Rate for Payer: Mclaren Commercial |
$335.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.83
|
| Rate for Payer: Nomi Health Commercial |
$305.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.01
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: Aetna Commercial |
$148.64
|
| Rate for Payer: ASR ASR |
$160.21
|
| Rate for Payer: BCBS Trust/PPO |
$135.63
|
| Rate for Payer: BCN Commercial |
$135.63
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$160.21
|
| Rate for Payer: Healthscope Whirlpool |
$165.16
|
| Rate for Payer: Mclaren Commercial |
$148.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Nomi Health Commercial |
$135.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.34
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: Aetna Commercial |
$148.64
|
| Rate for Payer: Aetna Medicare |
$61.11
|
| Rate for Payer: ASR ASR |
$160.21
|
| Rate for Payer: BCBS Complete |
$66.06
|
| Rate for Payer: BCBS Trust/PPO |
$136.17
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$136.17
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$160.21
|
| Rate for Payer: Healthscope Whirlpool |
$165.16
|
| Rate for Payer: Mclaren Commercial |
$148.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Nomi Health Commercial |
$135.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.34
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: Aetna Medicare |
$182.94
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$407.66
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$407.66
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$479.60
|
| Rate for Payer: Healthscope Whirlpool |
$494.43
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.42
|
| Rate for Payer: Priority Health Narrow Network |
$167.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$370.82 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Trust/PPO |
$406.03
|
| Rate for Payer: BCN Commercial |
$406.03
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$479.60
|
| Rate for Payer: Healthscope Whirlpool |
$494.43
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.27
|
| Rate for Payer: Nomi Health Commercial |
$405.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
