|
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
|
|
|
HC ACCESS AORTA
|
Facility
|
OP
|
$3,920.31
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.12 |
| Max. Negotiated Rate |
$3,920.31 |
| Rate for Payer: Aetna Commercial |
$3,528.28
|
| Rate for Payer: Aetna Medicare |
$1,960.15
|
| Rate for Payer: ASR ASR |
$3,802.70
|
| Rate for Payer: ASR Commercial |
$3,802.70
|
| Rate for Payer: BCBS Complete |
$1,568.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,210.34
|
| Rate for Payer: BCN Commercial |
$3,039.42
|
| Rate for Payer: Cash Price |
$3,136.25
|
| Rate for Payer: Cofinity Commercial |
$3,685.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,136.25
|
| Rate for Payer: Healthscope Commercial |
$3,920.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,802.70
|
| Rate for Payer: Mclaren Commercial |
$3,528.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,332.26
|
| Rate for Payer: Nomi Health Commercial |
$3,214.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,434.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,748.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,449.87
|
|
|
HC ACCESS AORTA
|
Facility
|
IP
|
$3,920.31
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,548.20 |
| Max. Negotiated Rate |
$3,920.31 |
| Rate for Payer: Aetna Commercial |
$3,528.28
|
| Rate for Payer: ASR ASR |
$3,802.70
|
| Rate for Payer: ASR Commercial |
$3,802.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,194.66
|
| Rate for Payer: BCN Commercial |
$3,039.42
|
| Rate for Payer: Cash Price |
$3,136.25
|
| Rate for Payer: Cofinity Commercial |
$3,685.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,136.25
|
| Rate for Payer: Healthscope Commercial |
$3,920.31
|
| Rate for Payer: Healthscope Whirlpool |
$3,802.70
|
| Rate for Payer: Mclaren Commercial |
$3,528.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,332.26
|
| Rate for Payer: Nomi Health Commercial |
$3,214.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,548.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,449.87
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
OP
|
$500.92
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.37 |
| Max. Negotiated Rate |
$500.92 |
| Rate for Payer: Aetna Commercial |
$450.83
|
| Rate for Payer: Aetna Medicare |
$250.46
|
| Rate for Payer: ASR ASR |
$485.89
|
| Rate for Payer: ASR Commercial |
$485.89
|
| Rate for Payer: BCBS Complete |
$200.37
|
| Rate for Payer: BCBS Trust/PPO |
$410.20
|
| Rate for Payer: BCN Commercial |
$388.36
|
| Rate for Payer: Cash Price |
$400.74
|
| Rate for Payer: Cofinity Commercial |
$470.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.74
|
| Rate for Payer: Healthscope Commercial |
$500.92
|
| Rate for Payer: Healthscope Whirlpool |
$485.89
|
| Rate for Payer: Mclaren Commercial |
$450.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.78
|
| Rate for Payer: Nomi Health Commercial |
$410.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$438.91
|
| Rate for Payer: Priority Health Narrow Network |
$351.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.81
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
IP
|
$500.92
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$500.92 |
| Rate for Payer: Aetna Commercial |
$450.83
|
| Rate for Payer: ASR ASR |
$485.89
|
| Rate for Payer: ASR Commercial |
$485.89
|
| Rate for Payer: BCBS Trust/PPO |
$408.20
|
| Rate for Payer: BCN Commercial |
$388.36
|
| Rate for Payer: Cash Price |
$400.74
|
| Rate for Payer: Cofinity Commercial |
$470.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.74
|
| Rate for Payer: Healthscope Commercial |
$500.92
|
| Rate for Payer: Healthscope Whirlpool |
$485.89
|
| Rate for Payer: Mclaren Commercial |
$450.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.78
|
| Rate for Payer: Nomi Health Commercial |
$410.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.81
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
IP
|
$427.58
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.93 |
| Max. Negotiated Rate |
$427.58 |
| Rate for Payer: Aetna Commercial |
$384.82
|
| Rate for Payer: ASR ASR |
$414.75
|
| Rate for Payer: ASR Commercial |
$414.75
|
| Rate for Payer: BCBS Trust/PPO |
$348.43
|
| Rate for Payer: BCN Commercial |
$331.50
|
| Rate for Payer: Cash Price |
$342.06
|
| Rate for Payer: Cofinity Commercial |
$401.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.06
|
| Rate for Payer: Healthscope Commercial |
$427.58
|
| Rate for Payer: Healthscope Whirlpool |
$414.75
|
| Rate for Payer: Mclaren Commercial |
$384.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.44
|
| Rate for Payer: Nomi Health Commercial |
$350.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.27
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
OP
|
$427.58
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.03 |
| Max. Negotiated Rate |
$427.58 |
| Rate for Payer: Aetna Commercial |
$384.82
|
| Rate for Payer: Aetna Medicare |
$213.79
|
| Rate for Payer: ASR ASR |
$414.75
|
| Rate for Payer: ASR Commercial |
$414.75
|
| Rate for Payer: BCBS Complete |
$171.03
|
| Rate for Payer: BCBS Trust/PPO |
$350.15
|
| Rate for Payer: BCN Commercial |
$331.50
|
| Rate for Payer: Cash Price |
$342.06
|
| Rate for Payer: Cofinity Commercial |
$401.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.06
|
| Rate for Payer: Healthscope Commercial |
$427.58
|
| Rate for Payer: Healthscope Whirlpool |
$414.75
|
| Rate for Payer: Mclaren Commercial |
$384.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.44
|
| Rate for Payer: Nomi Health Commercial |
$350.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.65
|
| Rate for Payer: Priority Health Narrow Network |
$299.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.27
|
|
|
HC ACCESS VEIN
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$194.35
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.59
|
| Rate for Payer: Priority Health Narrow Network |
$272.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC ACCESS VEIN
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
IP
|
$1,069.35
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.08 |
| Max. Negotiated Rate |
$1,069.35 |
| Rate for Payer: Aetna Commercial |
$962.41
|
| Rate for Payer: ASR ASR |
$1,037.27
|
| Rate for Payer: ASR Commercial |
$1,037.27
|
| Rate for Payer: BCBS Trust/PPO |
$871.41
|
| Rate for Payer: BCN Commercial |
$829.07
|
| Rate for Payer: Cash Price |
$855.48
|
| Rate for Payer: Cofinity Commercial |
$1,005.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.48
|
| Rate for Payer: Healthscope Commercial |
$1,069.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.27
|
| Rate for Payer: Mclaren Commercial |
$962.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.95
|
| Rate for Payer: Nomi Health Commercial |
$876.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$941.03
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
OP
|
$1,069.35
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$427.74 |
| Max. Negotiated Rate |
$1,069.35 |
| Rate for Payer: Aetna Commercial |
$962.41
|
| Rate for Payer: Aetna Medicare |
$534.67
|
| Rate for Payer: ASR ASR |
$1,037.27
|
| Rate for Payer: ASR Commercial |
$1,037.27
|
| Rate for Payer: BCBS Complete |
$427.74
|
| Rate for Payer: BCBS Trust/PPO |
$875.69
|
| Rate for Payer: BCN Commercial |
$829.07
|
| Rate for Payer: Cash Price |
$855.48
|
| Rate for Payer: Cofinity Commercial |
$1,005.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.48
|
| Rate for Payer: Healthscope Commercial |
$1,069.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.27
|
| Rate for Payer: Mclaren Commercial |
$962.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.95
|
| Rate for Payer: Nomi Health Commercial |
$876.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.96
|
| Rate for Payer: Priority Health Narrow Network |
$749.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$941.03
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
IP
|
$3,128.58
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,033.58 |
| Max. Negotiated Rate |
$3,128.58 |
| Rate for Payer: Aetna Commercial |
$2,815.72
|
| Rate for Payer: ASR ASR |
$3,034.72
|
| Rate for Payer: ASR Commercial |
$3,034.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,549.48
|
| Rate for Payer: BCN Commercial |
$2,425.59
|
| Rate for Payer: Cash Price |
$2,502.86
|
| Rate for Payer: Cofinity Commercial |
$2,940.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,502.86
|
| Rate for Payer: Healthscope Commercial |
$3,128.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,034.72
|
| Rate for Payer: Mclaren Commercial |
$2,815.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,659.29
|
| Rate for Payer: Nomi Health Commercial |
$2,565.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,033.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,753.15
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
OP
|
$3,128.58
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,251.43 |
| Max. Negotiated Rate |
$3,128.58 |
| Rate for Payer: Aetna Commercial |
$2,815.72
|
| Rate for Payer: Aetna Medicare |
$1,564.29
|
| Rate for Payer: ASR ASR |
$3,034.72
|
| Rate for Payer: ASR Commercial |
$3,034.72
|
| Rate for Payer: BCBS Complete |
$1,251.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,561.99
|
| Rate for Payer: BCN Commercial |
$2,425.59
|
| Rate for Payer: Cash Price |
$2,502.86
|
| Rate for Payer: Cofinity Commercial |
$2,940.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,502.86
|
| Rate for Payer: Healthscope Commercial |
$3,128.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,034.72
|
| Rate for Payer: Mclaren Commercial |
$2,815.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,659.29
|
| Rate for Payer: Nomi Health Commercial |
$2,565.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,033.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,753.15
|
|
|
HC ACCESS WINDOW
|
Facility
|
OP
|
$38.93
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$38.93 |
| Rate for Payer: Aetna Commercial |
$35.04
|
| Rate for Payer: Aetna Medicare |
$19.46
|
| Rate for Payer: ASR ASR |
$37.76
|
| Rate for Payer: ASR Commercial |
$37.76
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS Trust/PPO |
$31.88
|
| Rate for Payer: BCN Commercial |
$30.18
|
| Rate for Payer: Cash Price |
$31.14
|
| Rate for Payer: Cofinity Commercial |
$36.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$38.93
|
| Rate for Payer: Healthscope Whirlpool |
$37.76
|
| Rate for Payer: Mclaren Commercial |
$35.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.09
|
| Rate for Payer: Nomi Health Commercial |
$31.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.11
|
| Rate for Payer: Priority Health Narrow Network |
$27.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.26
|
|
|
HC ACCESS WINDOW
|
Facility
|
IP
|
$38.93
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$38.93 |
| Rate for Payer: Aetna Commercial |
$35.04
|
| Rate for Payer: ASR ASR |
$37.76
|
| Rate for Payer: ASR Commercial |
$37.76
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$30.18
|
| Rate for Payer: Cash Price |
$31.14
|
| Rate for Payer: Cofinity Commercial |
$36.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$38.93
|
| Rate for Payer: Healthscope Whirlpool |
$37.76
|
| Rate for Payer: Mclaren Commercial |
$35.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.09
|
| Rate for Payer: Nomi Health Commercial |
$31.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.26
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
OP
|
$4,011.59
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,604.64 |
| Max. Negotiated Rate |
$4,011.59 |
| Rate for Payer: Aetna Commercial |
$3,610.43
|
| Rate for Payer: Aetna Medicare |
$2,005.80
|
| Rate for Payer: ASR ASR |
$3,891.24
|
| Rate for Payer: ASR Commercial |
$3,891.24
|
| Rate for Payer: BCBS Complete |
$1,604.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,285.09
|
| Rate for Payer: BCN Commercial |
$3,110.19
|
| Rate for Payer: Cash Price |
$3,209.27
|
| Rate for Payer: Cofinity Commercial |
$3,770.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,209.27
|
| Rate for Payer: Healthscope Commercial |
$4,011.59
|
| Rate for Payer: Healthscope Whirlpool |
$3,891.24
|
| Rate for Payer: Mclaren Commercial |
$3,610.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,409.85
|
| Rate for Payer: Nomi Health Commercial |
$3,289.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,607.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,514.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,812.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,530.20
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
IP
|
$4,011.59
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,607.53 |
| Max. Negotiated Rate |
$4,011.59 |
| Rate for Payer: Aetna Commercial |
$3,610.43
|
| Rate for Payer: ASR ASR |
$3,891.24
|
| Rate for Payer: ASR Commercial |
$3,891.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,269.04
|
| Rate for Payer: BCN Commercial |
$3,110.19
|
| Rate for Payer: Cash Price |
$3,209.27
|
| Rate for Payer: Cofinity Commercial |
$3,770.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,209.27
|
| Rate for Payer: Healthscope Commercial |
$4,011.59
|
| Rate for Payer: Healthscope Whirlpool |
$3,891.24
|
| Rate for Payer: Mclaren Commercial |
$3,610.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,409.85
|
| Rate for Payer: Nomi Health Commercial |
$3,289.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,607.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,530.20
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
OP
|
$129.11
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna Commercial |
$116.20
|
| 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 |
$125.24
|
| Rate for Payer: ASR Commercial |
$125.24
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$105.73
|
| Rate for Payer: BCN Commercial |
$100.10
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Commercial |
$121.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$129.11
|
| Rate for Payer: Healthscope Whirlpool |
$125.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$116.20
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: Nomi Health Commercial |
$105.87
|
| 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 |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.13
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$90.51
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$96.32
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP DNSP |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
IP
|
$129.11
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna Commercial |
$116.20
|
| Rate for Payer: ASR ASR |
$125.24
|
| Rate for Payer: ASR Commercial |
$125.24
|
| Rate for Payer: BCBS Trust/PPO |
$105.21
|
| Rate for Payer: BCN Commercial |
$100.10
|
| Rate for Payer: Cash Price |
$103.29
|
| Rate for Payer: Cofinity Commercial |
$121.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.29
|
| Rate for Payer: Healthscope Commercial |
$129.11
|
| Rate for Payer: Healthscope Whirlpool |
$125.24
|
| Rate for Payer: Mclaren Commercial |
$116.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.74
|
| Rate for Payer: Nomi Health Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.62
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: ASR ASR |
$40.37
|
| Rate for Payer: ASR Commercial |
$40.37
|
| Rate for Payer: BCBS Trust/PPO |
$33.92
|
| Rate for Payer: BCN Commercial |
$32.27
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$39.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$41.62
|
| Rate for Payer: Healthscope Whirlpool |
$40.37
|
| Rate for Payer: Mclaren Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.63
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$74.68
|
| Rate for Payer: ASR Commercial |
$74.68
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$63.05
|
| Rate for Payer: BCN Commercial |
$59.69
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$76.99
|
| Rate for Payer: Healthscope Whirlpool |
$74.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$69.29
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.46
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$53.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.40
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$76.99 |
| Rate for Payer: Aetna Commercial |
$69.29
|
| Rate for Payer: ASR ASR |
$74.68
|
| Rate for Payer: ASR Commercial |
$74.68
|
| Rate for Payer: BCBS Trust/PPO |
$62.74
|
| Rate for Payer: BCN Commercial |
$59.69
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$72.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Healthscope Commercial |
$76.99
|
| Rate for Payer: Healthscope Whirlpool |
$74.68
|
| Rate for Payer: Mclaren Commercial |
$69.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$63.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.75
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
OP
|
$108.61
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$108.61 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.36
|
| Rate for Payer: ASR ASR |
$105.35
|
| Rate for Payer: ASR Commercial |
$105.35
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: BCBS Trust/PPO |
$88.94
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$86.89
|
| Rate for Payer: Cash Price |
$86.89
|
| Rate for Payer: Cofinity Commercial |
$102.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$108.61
|
| Rate for Payer: Healthscope Whirlpool |
$105.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.29
|
| Rate for Payer: Mclaren Commercial |
$97.75
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.32
|
| Rate for Payer: Nomi Health Commercial |
$89.06
|
| Rate for Payer: PACE Medicare |
$11.68
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.16
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$76.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.29
|
| Rate for Payer: UHC Exchange |
$19.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.29
|
| Rate for Payer: UHCCP DNSP |
$12.29
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$12.29
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
IP
|
$108.61
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$108.61 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: ASR ASR |
$105.35
|
| Rate for Payer: ASR Commercial |
$105.35
|
| Rate for Payer: BCBS Trust/PPO |
$88.51
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: Cash Price |
$86.89
|
| Rate for Payer: Cofinity Commercial |
$102.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.89
|
| Rate for Payer: Healthscope Commercial |
$108.61
|
| Rate for Payer: Healthscope Whirlpool |
$105.35
|
| Rate for Payer: Mclaren Commercial |
$97.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.32
|
| Rate for Payer: Nomi Health Commercial |
$89.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.58
|
|
