|
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 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 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 APLIGRAF PER SQ CM
|
Facility
|
OP
|
$94.29
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: Aetna Commercial |
$84.86
|
| Rate for Payer: Aetna Medicare |
$47.15
|
| 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: 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 |
$82.62
|
| Rate for Payer: Priority Health Narrow Network |
$66.10
|
| 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 |
$142.12 |
| 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: 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: Priority Health HMO/PPO/Tiered Network |
$311.32
|
| Rate for Payer: Priority Health Narrow Network |
$249.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.67
|
|
|
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 |
$197.77 |
| 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: 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: Priority Health HMO/PPO/Tiered Network |
$433.22
|
| Rate for Payer: Priority Health Narrow Network |
$346.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
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 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 |
$619.97
|
| 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 |
$619.97
|
| 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 |
$275.54 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.97
|
| Rate for Payer: Aetna Medicare |
$344.43
|
| 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: 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 |
$619.97
|
| 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 |
$603.57
|
| Rate for Payer: Priority Health Narrow Network |
$482.88
|
| 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 |
$349.81 |
| 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: 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: 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 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
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna Commercial |
$335.47
|
| Rate for Payer: Aetna Medicare |
$186.37
|
| Rate for Payer: ASR ASR |
$361.56
|
| Rate for Payer: ASR Commercial |
$361.56
|
| Rate for Payer: BCBS Complete |
$149.10
|
| Rate for Payer: BCBS Trust/PPO |
$305.24
|
| 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: Priority Health HMO/PPO/Tiered Network |
$326.59
|
| Rate for Payer: Priority Health Narrow Network |
$261.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.01
|
|
|
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
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.06 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: Aetna Commercial |
$148.64
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: ASR ASR |
$160.21
|
| Rate for Payer: ASR Commercial |
$160.21
|
| Rate for Payer: BCBS Complete |
$66.06
|
| Rate for Payer: BCBS Trust/PPO |
$135.25
|
| Rate for Payer: BCN Commercial |
$128.05
|
| 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 |
$165.16
|
| Rate for Payer: Healthscope Whirlpool |
$160.21
|
| 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: Priority Health Cigna Priority Health |
$107.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.71
|
| Rate for Payer: Priority Health Narrow Network |
$115.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.34
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: Aetna Commercial |
$148.64
|
| Rate for Payer: ASR ASR |
$160.21
|
| Rate for Payer: ASR Commercial |
$160.21
|
| Rate for Payer: BCBS Trust/PPO |
$134.59
|
| Rate for Payer: BCN Commercial |
$128.05
|
| 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 |
$165.16
|
| Rate for Payer: Healthscope Whirlpool |
$160.21
|
| 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: Priority Health Cigna Priority Health |
$107.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.34
|
|
|
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 |
$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 NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.77 |
| 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: 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: Priority Health HMO/PPO/Tiered Network |
$433.22
|
| Rate for Payer: Priority Health Narrow Network |
$346.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
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 |
$275.54 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.97
|
| Rate for Payer: Aetna Medicare |
$344.43
|
| 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: 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 |
$619.97
|
| 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 |
$603.57
|
| Rate for Payer: Priority Health Narrow Network |
$482.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
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 |
$447.75 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.97
|
| 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 |
$619.97
|
| 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 NEW PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
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 NEW PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$349.81 |
| 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: 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: 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 |
$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
|
|
