|
HC ACB NEW PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
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 NEW PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.06 |
| 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 |
$108.06
|
| 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 |
$240.90
|
| Rate for Payer: Priority Health Narrow Network |
$192.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
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 NEW PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.00 |
| 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 |
$115.00
|
| 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 |
$766.25
|
| Rate for Payer: Priority Health Narrow Network |
$613.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
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 NEW PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.00 |
| 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: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$859.85
|
| Rate for Payer: Cash Price |
$834.30
|
| 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 ACCESS AORTA
|
Facility
|
IP
|
$3,998.72
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,999.04 |
| Max. Negotiated Rate |
$3,998.72 |
| Rate for Payer: Aetna Commercial |
$3,598.85
|
| Rate for Payer: ASR ASR |
$3,878.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,283.75
|
| Rate for Payer: BCN Commercial |
$3,283.75
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cofinity Commercial |
$3,758.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.98
|
| Rate for Payer: Healthscope Commercial |
$3,878.76
|
| Rate for Payer: Healthscope Whirlpool |
$3,998.72
|
| Rate for Payer: Mclaren Commercial |
$3,598.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.91
|
| Rate for Payer: Nomi Health Commercial |
$3,278.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,518.87
|
|
|
HC ACCESS AORTA
|
Facility
|
OP
|
$3,998.72
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,479.53 |
| Max. Negotiated Rate |
$3,998.72 |
| Rate for Payer: Aetna Commercial |
$3,598.85
|
| Rate for Payer: Aetna Medicare |
$1,479.53
|
| Rate for Payer: ASR ASR |
$3,878.76
|
| Rate for Payer: BCBS Complete |
$1,599.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,296.94
|
| Rate for Payer: BCN Commercial |
$3,296.94
|
| Rate for Payer: Cash Price |
$3,198.98
|
| Rate for Payer: Cofinity Commercial |
$3,758.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,198.98
|
| Rate for Payer: Healthscope Commercial |
$3,878.76
|
| Rate for Payer: Healthscope Whirlpool |
$3,998.72
|
| Rate for Payer: Mclaren Commercial |
$3,598.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,198.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,398.91
|
| Rate for Payer: Nomi Health Commercial |
$3,278.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,999.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,503.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,803.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,518.87
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
OP
|
$510.94
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.05 |
| Max. Negotiated Rate |
$510.94 |
| Rate for Payer: Aetna Commercial |
$459.85
|
| Rate for Payer: Aetna Medicare |
$189.05
|
| Rate for Payer: ASR ASR |
$495.61
|
| Rate for Payer: BCBS Complete |
$204.38
|
| Rate for Payer: BCBS Trust/PPO |
$421.27
|
| Rate for Payer: BCN Commercial |
$421.27
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cofinity Commercial |
$480.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.75
|
| Rate for Payer: Healthscope Commercial |
$495.61
|
| Rate for Payer: Healthscope Whirlpool |
$510.94
|
| Rate for Payer: Mclaren Commercial |
$459.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.30
|
| Rate for Payer: Nomi Health Commercial |
$418.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$447.69
|
| Rate for Payer: Priority Health Narrow Network |
$358.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.63
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
IP
|
$510.94
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$510.94 |
| Rate for Payer: Aetna Commercial |
$459.85
|
| Rate for Payer: ASR ASR |
$495.61
|
| Rate for Payer: BCBS Trust/PPO |
$419.58
|
| Rate for Payer: BCN Commercial |
$419.58
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cofinity Commercial |
$480.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.75
|
| Rate for Payer: Healthscope Commercial |
$495.61
|
| Rate for Payer: Healthscope Whirlpool |
$510.94
|
| Rate for Payer: Mclaren Commercial |
$459.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.30
|
| Rate for Payer: Nomi Health Commercial |
$418.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.63
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
OP
|
$436.13
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.37 |
| Max. Negotiated Rate |
$436.13 |
| Rate for Payer: Aetna Commercial |
$392.52
|
| Rate for Payer: Aetna Medicare |
$161.37
|
| Rate for Payer: ASR ASR |
$423.05
|
| Rate for Payer: BCBS Complete |
$174.45
|
| Rate for Payer: BCBS Trust/PPO |
$359.59
|
| Rate for Payer: BCN Commercial |
$359.59
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cofinity Commercial |
$409.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.90
|
| Rate for Payer: Healthscope Commercial |
$423.05
|
| Rate for Payer: Healthscope Whirlpool |
$436.13
|
| Rate for Payer: Mclaren Commercial |
$392.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$348.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.71
|
| Rate for Payer: Nomi Health Commercial |
$357.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$382.14
|
| Rate for Payer: Priority Health Narrow Network |
$305.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.79
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
IP
|
$436.13
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.10 |
| Max. Negotiated Rate |
$436.13 |
| Rate for Payer: Aetna Commercial |
$392.52
|
| Rate for Payer: ASR ASR |
$423.05
|
| Rate for Payer: BCBS Trust/PPO |
$358.15
|
| Rate for Payer: BCN Commercial |
$358.15
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cofinity Commercial |
$409.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.90
|
| Rate for Payer: Healthscope Commercial |
$423.05
|
| Rate for Payer: Healthscope Whirlpool |
$436.13
|
| Rate for Payer: Mclaren Commercial |
$392.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.71
|
| Rate for Payer: Nomi Health Commercial |
$357.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.79
|
|
|
HC ACCESS VEIN
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Trust/PPO |
$325.59
|
| Rate for Payer: BCN Commercial |
$325.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC ACCESS VEIN
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: Aetna Medicare |
$146.70
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$326.90
|
| Rate for Payer: BCN Commercial |
$326.90
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$347.40
|
| Rate for Payer: Priority Health Narrow Network |
$277.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
IP
|
$1,090.74
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.05 |
| Max. Negotiated Rate |
$1,090.74 |
| Rate for Payer: Aetna Commercial |
$981.67
|
| Rate for Payer: ASR ASR |
$1,058.02
|
| Rate for Payer: BCBS Trust/PPO |
$895.72
|
| Rate for Payer: BCN Commercial |
$895.72
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Commercial |
$1,025.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Healthscope Commercial |
$1,058.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,090.74
|
| Rate for Payer: Mclaren Commercial |
$981.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Nomi Health Commercial |
$894.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$959.85
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
OP
|
$1,090.74
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.57 |
| Max. Negotiated Rate |
$1,090.74 |
| Rate for Payer: Aetna Commercial |
$981.67
|
| Rate for Payer: Aetna Medicare |
$403.57
|
| Rate for Payer: ASR ASR |
$1,058.02
|
| Rate for Payer: BCBS Complete |
$436.30
|
| Rate for Payer: BCBS Trust/PPO |
$899.32
|
| Rate for Payer: BCN Commercial |
$899.32
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Commercial |
$1,025.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Healthscope Commercial |
$1,058.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,090.74
|
| Rate for Payer: Mclaren Commercial |
$981.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$872.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Nomi Health Commercial |
$894.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$955.71
|
| Rate for Payer: Priority Health Narrow Network |
$764.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$959.85
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
IP
|
$3,285.01
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,463.76 |
| Max. Negotiated Rate |
$3,285.01 |
| Rate for Payer: Aetna Commercial |
$2,956.51
|
| Rate for Payer: ASR ASR |
$3,186.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,697.65
|
| Rate for Payer: BCN Commercial |
$2,697.65
|
| Rate for Payer: Cash Price |
$2,628.01
|
| Rate for Payer: Cofinity Commercial |
$3,087.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,628.01
|
| Rate for Payer: Healthscope Commercial |
$3,186.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,285.01
|
| Rate for Payer: Mclaren Commercial |
$2,956.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,792.26
|
| Rate for Payer: Nomi Health Commercial |
$2,693.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,463.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,890.81
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
OP
|
$3,285.01
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,215.45 |
| Max. Negotiated Rate |
$3,285.01 |
| Rate for Payer: Aetna Commercial |
$2,956.51
|
| Rate for Payer: Aetna Medicare |
$1,215.45
|
| Rate for Payer: ASR ASR |
$3,186.46
|
| Rate for Payer: BCBS Complete |
$1,314.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,708.49
|
| Rate for Payer: BCN Commercial |
$2,708.49
|
| Rate for Payer: Cash Price |
$2,628.01
|
| Rate for Payer: Cofinity Commercial |
$3,087.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,628.01
|
| Rate for Payer: Healthscope Commercial |
$3,186.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,285.01
|
| Rate for Payer: Mclaren Commercial |
$2,956.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,792.26
|
| Rate for Payer: Nomi Health Commercial |
$2,693.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,463.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,878.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,302.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,890.81
|
|
|
HC ACCESS WINDOW
|
Facility
|
OP
|
$39.71
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Aetna Commercial |
$35.74
|
| Rate for Payer: Aetna Medicare |
$14.69
|
| Rate for Payer: ASR ASR |
$38.52
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS Trust/PPO |
$32.74
|
| Rate for Payer: BCN Commercial |
$32.74
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Healthscope Commercial |
$38.52
|
| Rate for Payer: Healthscope Whirlpool |
$39.71
|
| Rate for Payer: Mclaren Commercial |
$35.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.75
|
| Rate for Payer: Nomi Health Commercial |
$32.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.79
|
| Rate for Payer: Priority Health Narrow Network |
$27.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.94
|
|
|
HC ACCESS WINDOW
|
Facility
|
IP
|
$39.71
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Aetna Commercial |
$35.74
|
| Rate for Payer: ASR ASR |
$38.52
|
| Rate for Payer: BCBS Trust/PPO |
$32.61
|
| Rate for Payer: BCN Commercial |
$32.61
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Healthscope Commercial |
$38.52
|
| Rate for Payer: Healthscope Whirlpool |
$39.71
|
| Rate for Payer: Mclaren Commercial |
$35.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.75
|
| Rate for Payer: Nomi Health Commercial |
$32.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.94
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
IP
|
$4,091.82
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,068.86 |
| Max. Negotiated Rate |
$4,091.82 |
| Rate for Payer: Aetna Commercial |
$3,682.64
|
| Rate for Payer: ASR ASR |
$3,969.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,360.20
|
| Rate for Payer: BCN Commercial |
$3,360.20
|
| Rate for Payer: Cash Price |
$3,273.46
|
| Rate for Payer: Cofinity Commercial |
$3,846.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.46
|
| Rate for Payer: Healthscope Commercial |
$3,969.07
|
| Rate for Payer: Healthscope Whirlpool |
$4,091.82
|
| Rate for Payer: Mclaren Commercial |
$3,682.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.05
|
| Rate for Payer: Nomi Health Commercial |
$3,355.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,068.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,600.80
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
OP
|
$4,091.82
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,513.97 |
| Max. Negotiated Rate |
$4,091.82 |
| Rate for Payer: Aetna Commercial |
$3,682.64
|
| Rate for Payer: Aetna Medicare |
$1,513.97
|
| Rate for Payer: ASR ASR |
$3,969.07
|
| Rate for Payer: BCBS Complete |
$1,636.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,373.71
|
| Rate for Payer: BCN Commercial |
$3,373.71
|
| Rate for Payer: Cash Price |
$3,273.46
|
| Rate for Payer: Cofinity Commercial |
$3,846.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.46
|
| Rate for Payer: Healthscope Commercial |
$3,969.07
|
| Rate for Payer: Healthscope Whirlpool |
$4,091.82
|
| Rate for Payer: Mclaren Commercial |
$3,682.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,273.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.05
|
| Rate for Payer: Nomi Health Commercial |
$3,355.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,068.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,585.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,868.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,600.80
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
OP
|
$131.69
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$131.69 |
| Rate for Payer: Aetna Commercial |
$118.52
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: ASR ASR |
$127.74
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$108.58
|
| Rate for Payer: BCN Commercial |
$108.58
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$123.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$127.74
|
| Rate for Payer: Healthscope Whirlpool |
$131.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$118.52
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.94
|
| Rate for Payer: Nomi Health Commercial |
$107.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.77
|
| 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 |
$33.31
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115.39
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$92.31
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
IP
|
$131.69
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$131.69 |
| Rate for Payer: Aetna Commercial |
$118.52
|
| Rate for Payer: ASR ASR |
$127.74
|
| Rate for Payer: BCBS Trust/PPO |
$108.14
|
| Rate for Payer: BCN Commercial |
$108.14
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Cofinity Commercial |
$123.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.35
|
| Rate for Payer: Healthscope Commercial |
$127.74
|
| Rate for Payer: Healthscope Whirlpool |
$131.69
|
| Rate for Payer: Mclaren Commercial |
$118.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.94
|
| Rate for Payer: Nomi Health Commercial |
$107.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.89
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
