|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$275.71
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
27400050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.28 |
| Max. Negotiated Rate |
$275.71 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$137.85
|
| Rate for Payer: ASR ASR |
$267.44
|
| Rate for Payer: ASR Commercial |
$267.44
|
| Rate for Payer: BCBS Complete |
$110.28
|
| Rate for Payer: BCBS Trust/PPO |
$225.78
|
| Rate for Payer: BCN Commercial |
$213.76
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$275.71
|
| Rate for Payer: Healthscope Whirlpool |
$267.44
|
| Rate for Payer: Mclaren Commercial |
$248.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.58
|
| Rate for Payer: Priority Health Narrow Network |
$193.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.62
|
|
|
HC EP+ABL ARRHYTHMIA
|
Facility
|
OP
|
$17,739.50
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,530.67 |
| Max. Negotiated Rate |
$37,085.08 |
| Rate for Payer: Aetna Commercial |
$15,965.55
|
| Rate for Payer: Aetna Medicare |
$23,925.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,907.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,907.33
|
| Rate for Payer: ASR ASR |
$17,207.31
|
| Rate for Payer: ASR Commercial |
$17,207.31
|
| Rate for Payer: BCBS Complete |
$13,465.47
|
| Rate for Payer: BCBS MAPPO |
$23,925.86
|
| Rate for Payer: BCBS Trust/PPO |
$14,526.88
|
| Rate for Payer: BCN Commercial |
$13,753.43
|
| Rate for Payer: BCN Medicare Advantage |
$23,925.86
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$16,675.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,925.86
|
| Rate for Payer: Healthscope Commercial |
$17,739.50
|
| Rate for Payer: Healthscope Whirlpool |
$17,207.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,925.86
|
| Rate for Payer: Mclaren Commercial |
$15,965.55
|
| Rate for Payer: Mclaren Medicaid |
$12,824.26
|
| Rate for Payer: Mclaren Medicare |
$23,925.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,122.15
|
| Rate for Payer: Meridian Medicaid |
$13,465.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,514.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: Nomi Health Commercial |
$14,546.39
|
| Rate for Payer: PACE Medicare |
$22,729.57
|
| Rate for Payer: PACE SWMI |
$23,925.86
|
| Rate for Payer: PHP Commercial |
$26,318.45
|
| Rate for Payer: PHP Medicaid |
$12,824.26
|
| Rate for Payer: PHP Medicare Advantage |
$23,925.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,824.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,543.35
|
| Rate for Payer: Priority Health Medicare |
$23,925.86
|
| Rate for Payer: Priority Health Narrow Network |
$12,435.39
|
| Rate for Payer: Railroad Medicare Medicare |
$23,925.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,610.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,925.86
|
| Rate for Payer: UHC Exchange |
$37,085.08
|
| Rate for Payer: UHC Medicare Advantage |
$23,925.86
|
| Rate for Payer: UHCCP DNSP |
$23,925.86
|
| Rate for Payer: UHCCP Medicaid |
$12,824.26
|
| Rate for Payer: VA VA |
$23,925.86
|
|
|
HC EP+ABL ARRHYTHMIA
|
Facility
|
IP
|
$17,739.50
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
48100091
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,530.67 |
| Max. Negotiated Rate |
$17,739.50 |
| Rate for Payer: Aetna Commercial |
$15,965.55
|
| Rate for Payer: ASR ASR |
$17,207.31
|
| Rate for Payer: ASR Commercial |
$17,207.31
|
| Rate for Payer: BCBS Trust/PPO |
$14,455.92
|
| Rate for Payer: BCN Commercial |
$13,753.43
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$16,675.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Healthscope Commercial |
$17,739.50
|
| Rate for Payer: Healthscope Whirlpool |
$17,207.31
|
| Rate for Payer: Mclaren Commercial |
$15,965.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: Nomi Health Commercial |
$14,546.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,610.76
|
|
|
HC EP+ABL VT
|
Facility
|
OP
|
$17,739.50
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,530.67 |
| Max. Negotiated Rate |
$37,085.08 |
| Rate for Payer: Aetna Commercial |
$15,965.55
|
| Rate for Payer: Aetna Medicare |
$23,925.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,907.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,907.33
|
| Rate for Payer: ASR ASR |
$17,207.31
|
| Rate for Payer: ASR Commercial |
$17,207.31
|
| Rate for Payer: BCBS Complete |
$13,465.47
|
| Rate for Payer: BCBS MAPPO |
$23,925.86
|
| Rate for Payer: BCBS Trust/PPO |
$14,526.88
|
| Rate for Payer: BCN Commercial |
$13,753.43
|
| Rate for Payer: BCN Medicare Advantage |
$23,925.86
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$16,675.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,925.86
|
| Rate for Payer: Healthscope Commercial |
$17,739.50
|
| Rate for Payer: Healthscope Whirlpool |
$17,207.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,925.86
|
| Rate for Payer: Mclaren Commercial |
$15,965.55
|
| Rate for Payer: Mclaren Medicaid |
$12,824.26
|
| Rate for Payer: Mclaren Medicare |
$23,925.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,122.15
|
| Rate for Payer: Meridian Medicaid |
$13,465.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,514.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: Nomi Health Commercial |
$14,546.39
|
| Rate for Payer: PACE Medicare |
$22,729.57
|
| Rate for Payer: PACE SWMI |
$23,925.86
|
| Rate for Payer: PHP Commercial |
$26,318.45
|
| Rate for Payer: PHP Medicaid |
$12,824.26
|
| Rate for Payer: PHP Medicare Advantage |
$23,925.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,824.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,543.35
|
| Rate for Payer: Priority Health Medicare |
$23,925.86
|
| Rate for Payer: Priority Health Narrow Network |
$12,435.39
|
| Rate for Payer: Railroad Medicare Medicare |
$23,925.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,610.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,925.86
|
| Rate for Payer: UHC Exchange |
$37,085.08
|
| Rate for Payer: UHC Medicare Advantage |
$23,925.86
|
| Rate for Payer: UHCCP DNSP |
$23,925.86
|
| Rate for Payer: UHCCP Medicaid |
$12,824.26
|
| Rate for Payer: VA VA |
$23,925.86
|
|
|
HC EP+ABL VT
|
Facility
|
IP
|
$17,739.50
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
48100092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,530.67 |
| Max. Negotiated Rate |
$17,739.50 |
| Rate for Payer: Aetna Commercial |
$15,965.55
|
| Rate for Payer: ASR ASR |
$17,207.31
|
| Rate for Payer: ASR Commercial |
$17,207.31
|
| Rate for Payer: BCBS Trust/PPO |
$14,455.92
|
| Rate for Payer: BCN Commercial |
$13,753.43
|
| Rate for Payer: Cash Price |
$14,191.60
|
| Rate for Payer: Cofinity Commercial |
$16,675.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,191.60
|
| Rate for Payer: Healthscope Commercial |
$17,739.50
|
| Rate for Payer: Healthscope Whirlpool |
$17,207.31
|
| Rate for Payer: Mclaren Commercial |
$15,965.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,078.58
|
| Rate for Payer: Nomi Health Commercial |
$14,546.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,530.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,610.76
|
|
|
HC EP AFTER DRUGS
|
Facility
|
IP
|
$7,423.93
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,825.55 |
| Max. Negotiated Rate |
$7,423.93 |
| Rate for Payer: Aetna Commercial |
$6,681.54
|
| Rate for Payer: ASR ASR |
$7,201.21
|
| Rate for Payer: ASR Commercial |
$7,201.21
|
| Rate for Payer: BCBS Trust/PPO |
$6,049.76
|
| Rate for Payer: BCN Commercial |
$5,755.77
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$6,978.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Healthscope Commercial |
$7,423.93
|
| Rate for Payer: Healthscope Whirlpool |
$7,201.21
|
| Rate for Payer: Mclaren Commercial |
$6,681.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: Nomi Health Commercial |
$6,087.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,533.06
|
|
|
HC EP AFTER DRUGS
|
Facility
|
OP
|
$7,423.93
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,969.57 |
| Max. Negotiated Rate |
$7,423.93 |
| Rate for Payer: Aetna Commercial |
$6,681.54
|
| Rate for Payer: Aetna Medicare |
$3,711.97
|
| Rate for Payer: ASR ASR |
$7,201.21
|
| Rate for Payer: ASR Commercial |
$7,201.21
|
| Rate for Payer: BCBS Complete |
$2,969.57
|
| Rate for Payer: BCBS Trust/PPO |
$6,079.46
|
| Rate for Payer: BCN Commercial |
$5,755.77
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$6,978.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Healthscope Commercial |
$7,423.93
|
| Rate for Payer: Healthscope Whirlpool |
$7,201.21
|
| Rate for Payer: Mclaren Commercial |
$6,681.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: Nomi Health Commercial |
$6,087.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,504.85
|
| Rate for Payer: Priority Health Narrow Network |
$5,204.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,533.06
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
OP
|
$3,342.81
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,337.12 |
| Max. Negotiated Rate |
$3,342.81 |
| Rate for Payer: Aetna Commercial |
$3,008.53
|
| Rate for Payer: Aetna Medicare |
$1,671.40
|
| Rate for Payer: ASR ASR |
$3,242.53
|
| Rate for Payer: ASR Commercial |
$3,242.53
|
| Rate for Payer: BCBS Complete |
$1,337.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,737.43
|
| Rate for Payer: BCN Commercial |
$2,591.68
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cofinity Commercial |
$3,142.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.25
|
| Rate for Payer: Healthscope Commercial |
$3,342.81
|
| Rate for Payer: Healthscope Whirlpool |
$3,242.53
|
| Rate for Payer: Mclaren Commercial |
$3,008.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.39
|
| Rate for Payer: Nomi Health Commercial |
$2,741.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,928.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,343.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,941.67
|
|
|
HC EP EVAL OF SQ ICD
|
Facility
|
IP
|
$3,342.81
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
48000027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,172.83 |
| Max. Negotiated Rate |
$3,342.81 |
| Rate for Payer: Aetna Commercial |
$3,008.53
|
| Rate for Payer: ASR ASR |
$3,242.53
|
| Rate for Payer: ASR Commercial |
$3,242.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,724.06
|
| Rate for Payer: BCN Commercial |
$2,591.68
|
| Rate for Payer: Cash Price |
$2,674.25
|
| Rate for Payer: Cofinity Commercial |
$3,142.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.25
|
| Rate for Payer: Healthscope Commercial |
$3,342.81
|
| Rate for Payer: Healthscope Whirlpool |
$3,242.53
|
| Rate for Payer: Mclaren Commercial |
$3,008.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,841.39
|
| Rate for Payer: Nomi Health Commercial |
$2,741.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,941.67
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
IP
|
$2,388.64
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,552.62 |
| Max. Negotiated Rate |
$2,388.64 |
| Rate for Payer: Aetna Commercial |
$2,149.78
|
| Rate for Payer: ASR ASR |
$2,316.98
|
| Rate for Payer: ASR Commercial |
$2,316.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,946.50
|
| Rate for Payer: BCN Commercial |
$1,851.91
|
| Rate for Payer: Cash Price |
$1,910.91
|
| Rate for Payer: Cofinity Commercial |
$2,245.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,910.91
|
| Rate for Payer: Healthscope Commercial |
$2,388.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,316.98
|
| Rate for Payer: Mclaren Commercial |
$2,149.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.34
|
| Rate for Payer: Nomi Health Commercial |
$1,958.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,102.00
|
|
|
HC EP EVALUATION OF GEN/LEADS
|
Facility
|
OP
|
$2,388.64
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$955.46 |
| Max. Negotiated Rate |
$2,388.64 |
| Rate for Payer: Aetna Commercial |
$2,149.78
|
| Rate for Payer: Aetna Medicare |
$1,194.32
|
| Rate for Payer: ASR ASR |
$2,316.98
|
| Rate for Payer: ASR Commercial |
$2,316.98
|
| Rate for Payer: BCBS Complete |
$955.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.06
|
| Rate for Payer: BCN Commercial |
$1,851.91
|
| Rate for Payer: Cash Price |
$1,910.91
|
| Rate for Payer: Cofinity Commercial |
$2,245.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,910.91
|
| Rate for Payer: Healthscope Commercial |
$2,388.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,316.98
|
| Rate for Payer: Mclaren Commercial |
$2,149.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,030.34
|
| Rate for Payer: Nomi Health Commercial |
$1,958.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,092.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,674.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,102.00
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
IP
|
$2,189.46
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,423.15 |
| Max. Negotiated Rate |
$2,189.46 |
| Rate for Payer: Aetna Commercial |
$1,970.51
|
| Rate for Payer: ASR ASR |
$2,123.78
|
| Rate for Payer: ASR Commercial |
$2,123.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,784.19
|
| Rate for Payer: BCN Commercial |
$1,697.49
|
| Rate for Payer: Cash Price |
$1,751.57
|
| Rate for Payer: Cofinity Commercial |
$2,058.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.57
|
| Rate for Payer: Healthscope Commercial |
$2,189.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,123.78
|
| Rate for Payer: Mclaren Commercial |
$1,970.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.04
|
| Rate for Payer: Nomi Health Commercial |
$1,795.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,926.72
|
|
|
HC EP EVALUATION OF LEADS
|
Facility
|
OP
|
$2,189.46
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
48100041
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$875.78 |
| Max. Negotiated Rate |
$2,189.46 |
| Rate for Payer: Aetna Commercial |
$1,970.51
|
| Rate for Payer: Aetna Medicare |
$1,094.73
|
| Rate for Payer: ASR ASR |
$2,123.78
|
| Rate for Payer: ASR Commercial |
$2,123.78
|
| Rate for Payer: BCBS Complete |
$875.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,792.95
|
| Rate for Payer: BCN Commercial |
$1,697.49
|
| Rate for Payer: Cash Price |
$1,751.57
|
| Rate for Payer: Cofinity Commercial |
$2,058.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.57
|
| Rate for Payer: Healthscope Commercial |
$2,189.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,123.78
|
| Rate for Payer: Mclaren Commercial |
$1,970.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.04
|
| Rate for Payer: Nomi Health Commercial |
$1,795.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,918.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,926.72
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Medicare |
$337.50
|
| Rate for Payer: ASR ASR |
$654.75
|
| Rate for Payer: ASR Commercial |
$654.75
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: BCBS Trust/PPO |
$552.76
|
| Rate for Payer: BCN Commercial |
$523.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$634.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Healthscope Whirlpool |
$654.75
|
| Rate for Payer: Mclaren Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.75
|
| Rate for Payer: Nomi Health Commercial |
$553.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$591.43
|
| Rate for Payer: Priority Health Narrow Network |
$473.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.00
|
|
|
HC EPIDURAL/LOCAL FLAT
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
37000023
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$438.75 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: ASR ASR |
$654.75
|
| Rate for Payer: ASR Commercial |
$654.75
|
| Rate for Payer: BCBS Trust/PPO |
$550.06
|
| Rate for Payer: BCN Commercial |
$523.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$634.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.00
|
| Rate for Payer: Healthscope Commercial |
$675.00
|
| Rate for Payer: Healthscope Whirlpool |
$654.75
|
| Rate for Payer: Mclaren Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.75
|
| Rate for Payer: Nomi Health Commercial |
$553.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.00
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
IP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$419.96 |
| Max. Negotiated Rate |
$646.09 |
| Rate for Payer: Aetna Commercial |
$581.48
|
| Rate for Payer: ASR ASR |
$626.71
|
| Rate for Payer: ASR Commercial |
$626.71
|
| Rate for Payer: BCBS Trust/PPO |
$526.50
|
| Rate for Payer: BCN Commercial |
$500.91
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$607.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$646.09
|
| Rate for Payer: Healthscope Whirlpool |
$626.71
|
| Rate for Payer: Mclaren Commercial |
$581.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: Nomi Health Commercial |
$529.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.56
|
|
|
HC EPIDURAL PREP (OB)
|
Facility
|
OP
|
$646.09
|
|
| Hospital Charge Code |
37000003
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$646.09 |
| Rate for Payer: Aetna Commercial |
$581.48
|
| Rate for Payer: Aetna Medicare |
$323.05
|
| Rate for Payer: ASR ASR |
$626.71
|
| Rate for Payer: ASR Commercial |
$626.71
|
| Rate for Payer: BCBS Complete |
$258.44
|
| Rate for Payer: BCBS Trust/PPO |
$529.08
|
| Rate for Payer: BCN Commercial |
$500.91
|
| Rate for Payer: Cash Price |
$516.87
|
| Rate for Payer: Cofinity Commercial |
$607.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.87
|
| Rate for Payer: Healthscope Commercial |
$646.09
|
| Rate for Payer: Healthscope Whirlpool |
$626.71
|
| Rate for Payer: Mclaren Commercial |
$581.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.18
|
| Rate for Payer: Nomi Health Commercial |
$529.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.10
|
| Rate for Payer: Priority Health Narrow Network |
$452.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.56
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
OP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$488.47 |
| Rate for Payer: Aetna Commercial |
$439.62
|
| Rate for Payer: Aetna Medicare |
$244.24
|
| Rate for Payer: ASR ASR |
$473.82
|
| Rate for Payer: ASR Commercial |
$473.82
|
| Rate for Payer: BCBS Complete |
$195.39
|
| Rate for Payer: BCBS Trust/PPO |
$400.01
|
| Rate for Payer: BCN Commercial |
$378.71
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$459.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$488.47
|
| Rate for Payer: Healthscope Whirlpool |
$473.82
|
| Rate for Payer: Mclaren Commercial |
$439.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$400.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.00
|
| Rate for Payer: Priority Health Narrow Network |
$342.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.85
|
|
|
HC EPIFIX (14 MM DISC) PER SQ CM
|
Facility
|
IP
|
$488.47
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.51 |
| Max. Negotiated Rate |
$488.47 |
| Rate for Payer: Aetna Commercial |
$439.62
|
| Rate for Payer: ASR ASR |
$473.82
|
| Rate for Payer: ASR Commercial |
$473.82
|
| Rate for Payer: BCBS Trust/PPO |
$398.05
|
| Rate for Payer: BCN Commercial |
$378.71
|
| Rate for Payer: Cash Price |
$390.78
|
| Rate for Payer: Cofinity Commercial |
$459.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.78
|
| Rate for Payer: Healthscope Commercial |
$488.47
|
| Rate for Payer: Healthscope Whirlpool |
$473.82
|
| Rate for Payer: Mclaren Commercial |
$439.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.20
|
| Rate for Payer: Nomi Health Commercial |
$400.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.85
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
IP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$461.21 |
| Max. Negotiated Rate |
$709.55 |
| Rate for Payer: Aetna Commercial |
$638.60
|
| Rate for Payer: ASR ASR |
$688.26
|
| Rate for Payer: ASR Commercial |
$688.26
|
| Rate for Payer: BCBS Trust/PPO |
$578.21
|
| Rate for Payer: BCN Commercial |
$550.11
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$666.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$709.55
|
| Rate for Payer: Healthscope Whirlpool |
$688.26
|
| Rate for Payer: Mclaren Commercial |
$638.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: Nomi Health Commercial |
$581.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.40
|
|
|
HC EPIFIX (18 MM DISC) PER SQ CM
|
Facility
|
OP
|
$709.55
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$283.82 |
| Max. Negotiated Rate |
$709.55 |
| Rate for Payer: Aetna Commercial |
$638.60
|
| Rate for Payer: Aetna Medicare |
$354.77
|
| Rate for Payer: ASR ASR |
$688.26
|
| Rate for Payer: ASR Commercial |
$688.26
|
| Rate for Payer: BCBS Complete |
$283.82
|
| Rate for Payer: BCBS Trust/PPO |
$581.05
|
| Rate for Payer: BCN Commercial |
$550.11
|
| Rate for Payer: Cash Price |
$567.64
|
| Rate for Payer: Cofinity Commercial |
$666.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.64
|
| Rate for Payer: Healthscope Commercial |
$709.55
|
| Rate for Payer: Healthscope Whirlpool |
$688.26
|
| Rate for Payer: Mclaren Commercial |
$638.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.12
|
| Rate for Payer: Nomi Health Commercial |
$581.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$621.71
|
| Rate for Payer: Priority Health Narrow Network |
$497.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.40
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
IP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.72 |
| Max. Negotiated Rate |
$691.87 |
| Rate for Payer: Aetna Commercial |
$622.68
|
| Rate for Payer: ASR ASR |
$671.11
|
| Rate for Payer: ASR Commercial |
$671.11
|
| Rate for Payer: BCBS Trust/PPO |
$563.80
|
| Rate for Payer: BCN Commercial |
$536.41
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$650.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$691.87
|
| Rate for Payer: Healthscope Whirlpool |
$671.11
|
| Rate for Payer: Mclaren Commercial |
$622.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: Nomi Health Commercial |
$567.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.85
|
|
|
HC EPIFIX 2X2 PER SQ CM
|
Facility
|
OP
|
$691.87
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.75 |
| Max. Negotiated Rate |
$691.87 |
| Rate for Payer: Aetna Commercial |
$622.68
|
| Rate for Payer: Aetna Medicare |
$345.94
|
| Rate for Payer: ASR ASR |
$671.11
|
| Rate for Payer: ASR Commercial |
$671.11
|
| Rate for Payer: BCBS Complete |
$276.75
|
| Rate for Payer: BCBS Trust/PPO |
$566.57
|
| Rate for Payer: BCN Commercial |
$536.41
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cofinity Commercial |
$650.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.50
|
| Rate for Payer: Healthscope Commercial |
$691.87
|
| Rate for Payer: Healthscope Whirlpool |
$671.11
|
| Rate for Payer: Mclaren Commercial |
$622.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.09
|
| Rate for Payer: Nomi Health Commercial |
$567.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.22
|
| Rate for Payer: Priority Health Narrow Network |
$485.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.85
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.35 |
| Max. Negotiated Rate |
$495.92 |
| Rate for Payer: Aetna Commercial |
$446.33
|
| Rate for Payer: ASR ASR |
$481.04
|
| Rate for Payer: ASR Commercial |
$481.04
|
| Rate for Payer: BCBS Trust/PPO |
$404.13
|
| Rate for Payer: BCN Commercial |
$384.49
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$466.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$495.92
|
| Rate for Payer: Healthscope Whirlpool |
$481.04
|
| Rate for Payer: Mclaren Commercial |
$446.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.41
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$495.92 |
| Rate for Payer: Aetna Commercial |
$446.33
|
| Rate for Payer: Aetna Medicare |
$247.96
|
| Rate for Payer: ASR ASR |
$481.04
|
| Rate for Payer: ASR Commercial |
$481.04
|
| Rate for Payer: BCBS Complete |
$198.37
|
| Rate for Payer: BCBS Trust/PPO |
$406.11
|
| Rate for Payer: BCN Commercial |
$384.49
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$466.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$495.92
|
| Rate for Payer: Healthscope Whirlpool |
$481.04
|
| Rate for Payer: Mclaren Commercial |
$446.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: Nomi Health Commercial |
$406.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.53
|
| Rate for Payer: Priority Health Narrow Network |
$347.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.41
|
|
