|
HC ABLATION VEIN OF MARSHALL
|
Facility
|
IP
|
$8,899.96
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100122
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,784.97 |
| Max. Negotiated Rate |
$8,899.96 |
| Rate for Payer: Aetna Commercial |
$8,009.96
|
| Rate for Payer: ASR ASR |
$8,632.96
|
| Rate for Payer: ASR Commercial |
$8,632.96
|
| Rate for Payer: BCBS Trust/PPO |
$7,252.58
|
| Rate for Payer: BCN Commercial |
$6,900.14
|
| Rate for Payer: Cash Price |
$7,119.97
|
| Rate for Payer: Cofinity Commercial |
$8,365.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,119.97
|
| Rate for Payer: Healthscope Commercial |
$8,899.96
|
| Rate for Payer: Healthscope Whirlpool |
$8,632.96
|
| Rate for Payer: Mclaren Commercial |
$8,009.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,564.97
|
| Rate for Payer: Nomi Health Commercial |
$7,297.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,784.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,831.96
|
|
|
HC ABLATION VEIN OF MARSHALL
|
Facility
|
OP
|
$8,899.96
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100122
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$8,899.96 |
| Rate for Payer: Aetna Commercial |
$8,009.96
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$8,632.96
|
| Rate for Payer: ASR Commercial |
$8,632.96
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$7,288.18
|
| Rate for Payer: BCN Commercial |
$6,900.14
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$7,119.97
|
| Rate for Payer: Cash Price |
$7,119.97
|
| Rate for Payer: Cofinity Commercial |
$8,365.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,119.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$8,899.96
|
| Rate for Payer: Healthscope Whirlpool |
$8,632.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$8,009.96
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,564.97
|
| Rate for Payer: Nomi Health Commercial |
$7,297.97
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,784.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.99
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$134.39
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,831.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC ABLAVAR
|
Facility
|
OP
|
$26.52
|
|
|
Service Code
|
HCPCS A9583
|
| Hospital Charge Code |
63600007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: ASR ASR |
$25.72
|
| Rate for Payer: ASR Commercial |
$25.72
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.72
|
| Rate for Payer: BCN Commercial |
$20.56
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$26.52
|
| Rate for Payer: Healthscope Whirlpool |
$25.72
|
| Rate for Payer: Mclaren Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.54
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.86
|
| Rate for Payer: Priority Health Narrow Network |
$14.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.34
|
|
|
HC ABLAVAR
|
Facility
|
IP
|
$26.52
|
|
|
Service Code
|
HCPCS A9583
|
| Hospital Charge Code |
63600007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: ASR ASR |
$25.72
|
| Rate for Payer: ASR Commercial |
$25.72
|
| Rate for Payer: BCBS Trust/PPO |
$21.61
|
| Rate for Payer: BCN Commercial |
$20.56
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$26.52
|
| Rate for Payer: Healthscope Whirlpool |
$25.72
|
| Rate for Payer: Mclaren Commercial |
$23.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.54
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.34
|
|
|
HC ABSCESS DRAINAGE COMPLICATED
|
Facility
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.12 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Trust/PPO |
$406.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
|
|
HC ABSCESS DRAINAGE COMPLICATED
|
Facility
|
OP
|
$498.64
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
76100037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.49 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$408.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.11
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$186.49
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
OP
|
$399.83
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$399.83 |
| Rate for Payer: Aetna Commercial |
$359.85
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$387.84
|
| Rate for Payer: ASR Commercial |
$387.84
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$327.42
|
| Rate for Payer: BCN Commercial |
$309.99
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cofinity Commercial |
$375.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$399.83
|
| Rate for Payer: Healthscope Whirlpool |
$387.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$359.85
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.86
|
| Rate for Payer: Nomi Health Commercial |
$327.86
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.11
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$186.49
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC ABSCESS DRAINAGE SIMPLE
|
Facility
|
IP
|
$399.83
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
36100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.89 |
| Max. Negotiated Rate |
$399.83 |
| Rate for Payer: Aetna Commercial |
$359.85
|
| Rate for Payer: ASR ASR |
$387.84
|
| Rate for Payer: ASR Commercial |
$387.84
|
| Rate for Payer: BCBS Trust/PPO |
$325.82
|
| Rate for Payer: BCN Commercial |
$309.99
|
| Rate for Payer: Cash Price |
$319.86
|
| Rate for Payer: Cofinity Commercial |
$375.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.86
|
| Rate for Payer: Healthscope Commercial |
$399.83
|
| Rate for Payer: Healthscope Whirlpool |
$387.84
|
| Rate for Payer: Mclaren Commercial |
$359.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.86
|
| Rate for Payer: Nomi Health Commercial |
$327.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$351.85
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
OP
|
$1,789.39
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.21 |
| Max. Negotiated Rate |
$3,682.73 |
| Rate for Payer: Aetna Commercial |
$1,610.45
|
| Rate for Payer: Aetna Medicare |
$1,155.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: ASR ASR |
$1,735.71
|
| Rate for Payer: ASR Commercial |
$1,735.71
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,465.33
|
| Rate for Payer: BCN Commercial |
$1,387.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Cash Price |
$1,431.51
|
| Rate for Payer: Cash Price |
$1,431.51
|
| Rate for Payer: Cofinity Commercial |
$1,682.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Healthscope Commercial |
$1,789.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,735.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,155.24
|
| Rate for Payer: Mclaren Commercial |
$1,610.45
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.98
|
| Rate for Payer: Nomi Health Commercial |
$1,467.30
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Commercial |
$1,270.76
|
| Rate for Payer: PHP Medicaid |
$619.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,163.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,682.73
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,946.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,574.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$1,790.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP DNSP |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
IP
|
$1,789.39
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,163.10 |
| Max. Negotiated Rate |
$1,789.39 |
| Rate for Payer: Aetna Commercial |
$1,610.45
|
| Rate for Payer: ASR ASR |
$1,735.71
|
| Rate for Payer: ASR Commercial |
$1,735.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,458.17
|
| Rate for Payer: BCN Commercial |
$1,387.31
|
| Rate for Payer: Cash Price |
$1,431.51
|
| Rate for Payer: Cofinity Commercial |
$1,682.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.51
|
| Rate for Payer: Healthscope Commercial |
$1,789.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,735.71
|
| Rate for Payer: Mclaren Commercial |
$1,610.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.98
|
| Rate for Payer: Nomi Health Commercial |
$1,467.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,163.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,574.66
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$195.98
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$127.39 |
| Max. Negotiated Rate |
$195.98 |
| Rate for Payer: Aetna Commercial |
$176.38
|
| Rate for Payer: ASR ASR |
$190.10
|
| Rate for Payer: ASR Commercial |
$190.10
|
| Rate for Payer: BCBS Trust/PPO |
$159.70
|
| Rate for Payer: BCN Commercial |
$151.94
|
| Rate for Payer: Cash Price |
$156.78
|
| Rate for Payer: Cofinity Commercial |
$184.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.78
|
| Rate for Payer: Healthscope Commercial |
$195.98
|
| Rate for Payer: Healthscope Whirlpool |
$190.10
|
| Rate for Payer: Mclaren Commercial |
$176.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.58
|
| Rate for Payer: Nomi Health Commercial |
$160.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.46
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$195.98
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.39 |
| Max. Negotiated Rate |
$195.98 |
| Rate for Payer: Aetna Commercial |
$176.38
|
| Rate for Payer: Aetna Medicare |
$97.99
|
| Rate for Payer: ASR ASR |
$190.10
|
| Rate for Payer: ASR Commercial |
$190.10
|
| Rate for Payer: BCBS Complete |
$78.39
|
| Rate for Payer: BCBS Trust/PPO |
$160.49
|
| Rate for Payer: BCN Commercial |
$151.94
|
| Rate for Payer: Cash Price |
$156.78
|
| Rate for Payer: Cofinity Commercial |
$184.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.78
|
| Rate for Payer: Healthscope Commercial |
$195.98
|
| Rate for Payer: Healthscope Whirlpool |
$190.10
|
| Rate for Payer: Mclaren Commercial |
$176.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.58
|
| Rate for Payer: Nomi Health Commercial |
$160.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.72
|
| Rate for Payer: Priority Health Narrow Network |
$137.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.46
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: Aetna Commercial |
$84.86
|
| Rate for Payer: Aetna Medicare |
$47.14
|
| Rate for Payer: ASR ASR |
$91.46
|
| Rate for Payer: ASR Commercial |
$91.46
|
| Rate for Payer: BCBS Complete |
$37.72
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$73.10
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$88.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.43
|
| Rate for Payer: Healthscope Commercial |
$94.29
|
| Rate for Payer: Healthscope Whirlpool |
$91.46
|
| Rate for Payer: Mclaren Commercial |
$84.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.15
|
| Rate for Payer: Nomi Health Commercial |
$77.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.51
|
| Rate for Payer: Priority Health Narrow Network |
$25.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.98
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.29 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: Aetna Commercial |
$84.86
|
| Rate for Payer: ASR ASR |
$91.46
|
| Rate for Payer: ASR Commercial |
$91.46
|
| Rate for Payer: BCBS Trust/PPO |
$76.84
|
| Rate for Payer: BCN Commercial |
$73.10
|
| Rate for Payer: Cash Price |
$75.43
|
| Rate for Payer: Cofinity Commercial |
$88.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.43
|
| Rate for Payer: Healthscope Commercial |
$94.29
|
| Rate for Payer: Healthscope Whirlpool |
$91.46
|
| Rate for Payer: Mclaren Commercial |
$84.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.15
|
| Rate for Payer: Nomi Health Commercial |
$77.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.98
|
|
|
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 |
$230.95 |
| Max. Negotiated Rate |
$355.31 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: ASR ASR |
$344.65
|
| Rate for Payer: ASR Commercial |
$344.65
|
| Rate for Payer: BCBS Trust/PPO |
$289.54
|
| Rate for Payer: BCN Commercial |
$275.47
|
| 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 |
$355.31
|
| Rate for Payer: Healthscope Whirlpool |
$344.65
|
| 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: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.67
|
|
|
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 |
$177.66
|
| Rate for Payer: ASR ASR |
$344.65
|
| Rate for Payer: ASR Commercial |
$344.65
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS Trust/PPO |
$290.96
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$275.47
|
| 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 |
$355.31
|
| Rate for Payer: Healthscope Whirlpool |
$344.65
|
| 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: Priority Health Cigna Priority Health |
$230.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| 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 |
$321.38 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: ASR Commercial |
$479.60
|
| Rate for Payer: BCBS Trust/PPO |
$402.91
|
| Rate for Payer: BCN Commercial |
$383.33
|
| 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 |
$494.43
|
| Rate for Payer: Healthscope Whirlpool |
$479.60
|
| 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: Priority Health Cigna Priority Health |
$321.38
|
| 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 |
$247.22
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: ASR Commercial |
$479.60
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$404.89
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$383.33
|
| 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 |
$494.43
|
| Rate for Payer: Healthscope Whirlpool |
$479.60
|
| 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: Priority Health Cigna Priority Health |
$321.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
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 |
$447.75 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.96
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: ASR Commercial |
$668.18
|
| Rate for Payer: BCBS Trust/PPO |
$561.34
|
| Rate for Payer: BCN Commercial |
$534.07
|
| 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 |
$688.85
|
| Rate for Payer: Healthscope Whirlpool |
$668.18
|
| Rate for Payer: Mclaren Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
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 |
$619.96
|
| Rate for Payer: Aetna Medicare |
$344.42
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: ASR Commercial |
$668.18
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$564.10
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$534.07
|
| 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 |
$688.85
|
| Rate for Payer: Healthscope Whirlpool |
$668.18
|
| Rate for Payer: Mclaren Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.52
|
| Rate for Payer: Nomi Health Commercial |
$564.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.92
|
| Rate for Payer: Priority Health Narrow Network |
$169.54
|
| 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 |
$437.26
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: ASR Commercial |
$848.28
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS Trust/PPO |
$716.14
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$678.02
|
| 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 |
$874.52
|
| Rate for Payer: Healthscope Whirlpool |
$848.28
|
| 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: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.88
|
| Rate for Payer: Priority Health Narrow Network |
$187.10
|
| 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 |
$568.44 |
| Max. Negotiated Rate |
$874.52 |
| Rate for Payer: Aetna Commercial |
$787.07
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: ASR Commercial |
$848.28
|
| Rate for Payer: BCBS Trust/PPO |
$712.65
|
| Rate for Payer: BCN Commercial |
$678.02
|
| 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 |
$874.52
|
| Rate for Payer: Healthscope Whirlpool |
$848.28
|
| 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: Priority Health Cigna Priority Health |
$568.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
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 |
$677.87 |
| Max. Negotiated Rate |
$1,042.88 |
| Rate for Payer: Aetna Commercial |
$938.59
|
| Rate for Payer: ASR ASR |
$1,011.59
|
| Rate for Payer: ASR Commercial |
$1,011.59
|
| Rate for Payer: BCBS Trust/PPO |
$849.84
|
| Rate for Payer: BCN Commercial |
$808.54
|
| 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 |
$1,042.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.59
|
| 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: Priority Health Cigna Priority Health |
$677.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.73
|
|
|
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 |
$417.15 |
| Max. Negotiated Rate |
$1,042.88 |
| Rate for Payer: Aetna Commercial |
$938.59
|
| Rate for Payer: Aetna Medicare |
$521.44
|
| Rate for Payer: ASR ASR |
$1,011.59
|
| Rate for Payer: ASR Commercial |
$1,011.59
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$854.01
|
| Rate for Payer: BCN Commercial |
$808.54
|
| 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 |
$1,042.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.59
|
| 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: Priority Health Cigna Priority Health |
$677.87
|
| Rate for Payer: 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 GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.28 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna Commercial |
$335.47
|
| Rate for Payer: ASR ASR |
$361.56
|
| Rate for Payer: ASR Commercial |
$361.56
|
| Rate for Payer: BCBS Trust/PPO |
$303.75
|
| Rate for Payer: BCN Commercial |
$288.99
|
| 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 |
$372.74
|
| Rate for Payer: Healthscope Whirlpool |
$361.56
|
| 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: Priority Health Cigna Priority Health |
$242.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.01
|
|
