|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
IP
|
$895.03
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.52 |
| Max. Negotiated Rate |
$895.03 |
| Rate for Payer: Aetna Commercial |
$805.53
|
| Rate for Payer: ASR ASR |
$868.18
|
| Rate for Payer: BCBS Trust/PPO |
$693.92
|
| Rate for Payer: BCN Commercial |
$693.92
|
| Rate for Payer: Cash Price |
$716.02
|
| Rate for Payer: Cofinity Commercial |
$841.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.02
|
| Rate for Payer: Healthscope Commercial |
$895.03
|
| Rate for Payer: Healthscope Whirlpool |
$868.18
|
| Rate for Payer: Mclaren Commercial |
$805.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$760.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$787.63
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
OP
|
$895.03
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.01 |
| Max. Negotiated Rate |
$895.03 |
| Rate for Payer: Aetna Commercial |
$805.53
|
| Rate for Payer: ASR ASR |
$868.18
|
| Rate for Payer: BCBS Complete |
$358.01
|
| Rate for Payer: BCBS Trust/PPO |
$693.92
|
| Rate for Payer: BCN Commercial |
$693.92
|
| Rate for Payer: Cash Price |
$716.02
|
| Rate for Payer: Cofinity Commercial |
$841.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.02
|
| Rate for Payer: Healthscope Commercial |
$895.03
|
| Rate for Payer: Healthscope Whirlpool |
$868.18
|
| Rate for Payer: Mclaren Commercial |
$805.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$760.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.48
|
| Rate for Payer: Priority Health Narrow Network |
$635.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$787.63
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
OP
|
$257.83
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.13 |
| Max. Negotiated Rate |
$257.83 |
| Rate for Payer: Aetna Commercial |
$232.05
|
| Rate for Payer: ASR ASR |
$250.10
|
| Rate for Payer: BCBS Complete |
$103.13
|
| Rate for Payer: BCBS Trust/PPO |
$199.90
|
| Rate for Payer: BCN Commercial |
$199.90
|
| Rate for Payer: Cash Price |
$206.26
|
| Rate for Payer: Cofinity Commercial |
$242.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.26
|
| Rate for Payer: Healthscope Commercial |
$257.83
|
| Rate for Payer: Healthscope Whirlpool |
$250.10
|
| Rate for Payer: Mclaren Commercial |
$232.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.63
|
| Rate for Payer: Priority Health Narrow Network |
$183.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.89
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
IP
|
$257.83
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.48 |
| Max. Negotiated Rate |
$257.83 |
| Rate for Payer: Aetna Commercial |
$232.05
|
| Rate for Payer: ASR ASR |
$250.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.90
|
| Rate for Payer: BCN Commercial |
$199.90
|
| Rate for Payer: Cash Price |
$206.26
|
| Rate for Payer: Cofinity Commercial |
$242.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.26
|
| Rate for Payer: Healthscope Commercial |
$257.83
|
| Rate for Payer: Healthscope Whirlpool |
$250.10
|
| Rate for Payer: Mclaren Commercial |
$232.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.89
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
IP
|
$1,975.92
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,383.14 |
| Max. Negotiated Rate |
$1,975.92 |
| Rate for Payer: Aetna Commercial |
$1,778.33
|
| Rate for Payer: ASR ASR |
$1,916.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,531.93
|
| Rate for Payer: BCN Commercial |
$1,531.93
|
| Rate for Payer: Cash Price |
$1,580.74
|
| Rate for Payer: Cofinity Commercial |
$1,857.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.74
|
| Rate for Payer: Healthscope Commercial |
$1,975.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,916.64
|
| Rate for Payer: Mclaren Commercial |
$1,778.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,679.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,738.81
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
OP
|
$1,975.92
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,975.92 |
| Rate for Payer: Aetna Commercial |
$1,778.33
|
| Rate for Payer: ASR ASR |
$1,916.64
|
| Rate for Payer: BCBS Complete |
$790.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,531.93
|
| Rate for Payer: BCN Commercial |
$1,531.93
|
| Rate for Payer: Cash Price |
$1,580.74
|
| Rate for Payer: Cofinity Commercial |
$1,857.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.74
|
| Rate for Payer: Healthscope Commercial |
$1,975.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,916.64
|
| Rate for Payer: Mclaren Commercial |
$1,778.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,679.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,798.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,738.81
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$393.30
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$353.97
|
| Rate for Payer: ASR ASR |
$381.50
|
| Rate for Payer: BCBS Complete |
$157.32
|
| Rate for Payer: BCBS Trust/PPO |
$304.93
|
| Rate for Payer: BCN Commercial |
$304.93
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$369.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Healthscope Whirlpool |
$381.50
|
| Rate for Payer: Mclaren Commercial |
$353.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.90
|
| Rate for Payer: Priority Health Narrow Network |
$279.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.10
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$393.30
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.31 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$353.97
|
| Rate for Payer: ASR ASR |
$381.50
|
| Rate for Payer: BCBS Trust/PPO |
$304.93
|
| Rate for Payer: BCN Commercial |
$304.93
|
| Rate for Payer: Cash Price |
$314.64
|
| Rate for Payer: Cofinity Commercial |
$369.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.64
|
| Rate for Payer: Healthscope Commercial |
$393.30
|
| Rate for Payer: Healthscope Whirlpool |
$381.50
|
| Rate for Payer: Mclaren Commercial |
$353.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.10
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
OP
|
$3,073.19
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,229.28 |
| Max. Negotiated Rate |
$3,073.19 |
| Rate for Payer: Aetna Commercial |
$2,765.87
|
| Rate for Payer: ASR ASR |
$2,980.99
|
| Rate for Payer: BCBS Complete |
$1,229.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,382.64
|
| Rate for Payer: BCN Commercial |
$2,382.64
|
| Rate for Payer: Cash Price |
$2,458.55
|
| Rate for Payer: Cofinity Commercial |
$2,888.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.55
|
| Rate for Payer: Healthscope Commercial |
$3,073.19
|
| Rate for Payer: Healthscope Whirlpool |
$2,980.99
|
| Rate for Payer: Mclaren Commercial |
$2,765.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,796.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,181.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,704.41
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
IP
|
$3,073.19
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,151.23 |
| Max. Negotiated Rate |
$3,073.19 |
| Rate for Payer: Aetna Commercial |
$2,765.87
|
| Rate for Payer: ASR ASR |
$2,980.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,382.64
|
| Rate for Payer: BCN Commercial |
$2,382.64
|
| Rate for Payer: Cash Price |
$2,458.55
|
| Rate for Payer: Cofinity Commercial |
$2,888.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,458.55
|
| Rate for Payer: Healthscope Commercial |
$3,073.19
|
| Rate for Payer: Healthscope Whirlpool |
$2,980.99
|
| Rate for Payer: Mclaren Commercial |
$2,765.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,612.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,704.41
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,178.99
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$471.60 |
| Max. Negotiated Rate |
$1,178.99 |
| Rate for Payer: Aetna Commercial |
$1,061.09
|
| Rate for Payer: ASR ASR |
$1,143.62
|
| Rate for Payer: BCBS Complete |
$471.60
|
| Rate for Payer: BCBS Trust/PPO |
$914.07
|
| Rate for Payer: BCN Commercial |
$914.07
|
| Rate for Payer: Cash Price |
$943.19
|
| Rate for Payer: Cofinity Commercial |
$1,108.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.19
|
| Rate for Payer: Healthscope Commercial |
$1,178.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.62
|
| Rate for Payer: Mclaren Commercial |
$1,061.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.88
|
| Rate for Payer: Priority Health Narrow Network |
$837.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,037.51
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,178.99
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$825.29 |
| Max. Negotiated Rate |
$1,178.99 |
| Rate for Payer: Aetna Commercial |
$1,061.09
|
| Rate for Payer: ASR ASR |
$1,143.62
|
| Rate for Payer: BCBS Trust/PPO |
$914.07
|
| Rate for Payer: BCN Commercial |
$914.07
|
| Rate for Payer: Cash Price |
$943.19
|
| Rate for Payer: Cofinity Commercial |
$1,108.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$943.19
|
| Rate for Payer: Healthscope Commercial |
$1,178.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,143.62
|
| Rate for Payer: Mclaren Commercial |
$1,061.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,002.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,037.51
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,645.08
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,458.03 |
| Max. Negotiated Rate |
$3,645.08 |
| Rate for Payer: Aetna Commercial |
$3,280.57
|
| Rate for Payer: ASR ASR |
$3,535.73
|
| Rate for Payer: BCBS Complete |
$1,458.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,826.03
|
| Rate for Payer: BCN Commercial |
$2,826.03
|
| Rate for Payer: Cash Price |
$2,916.06
|
| Rate for Payer: Cofinity Commercial |
$3,426.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,916.06
|
| Rate for Payer: Healthscope Commercial |
$3,645.08
|
| Rate for Payer: Healthscope Whirlpool |
$3,535.73
|
| Rate for Payer: Mclaren Commercial |
$3,280.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,098.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,551.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,317.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,588.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,207.67
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,645.08
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,551.56 |
| Max. Negotiated Rate |
$3,645.08 |
| Rate for Payer: Aetna Commercial |
$3,280.57
|
| Rate for Payer: ASR ASR |
$3,535.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,826.03
|
| Rate for Payer: BCN Commercial |
$2,826.03
|
| Rate for Payer: Cash Price |
$2,916.06
|
| Rate for Payer: Cofinity Commercial |
$3,426.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,916.06
|
| Rate for Payer: Healthscope Commercial |
$3,645.08
|
| Rate for Payer: Healthscope Whirlpool |
$3,535.73
|
| Rate for Payer: Mclaren Commercial |
$3,280.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,098.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,551.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,207.67
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,417.04
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.93 |
| Max. Negotiated Rate |
$1,417.04 |
| Rate for Payer: Aetna Commercial |
$1,275.34
|
| Rate for Payer: ASR ASR |
$1,374.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.63
|
| Rate for Payer: BCN Commercial |
$1,098.63
|
| Rate for Payer: Cash Price |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,332.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.63
|
| Rate for Payer: Healthscope Commercial |
$1,417.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,374.53
|
| Rate for Payer: Mclaren Commercial |
$1,275.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,247.00
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,417.04
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$566.82 |
| Max. Negotiated Rate |
$1,417.04 |
| Rate for Payer: Aetna Commercial |
$1,275.34
|
| Rate for Payer: ASR ASR |
$1,374.53
|
| Rate for Payer: BCBS Complete |
$566.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.63
|
| Rate for Payer: BCN Commercial |
$1,098.63
|
| Rate for Payer: Cash Price |
$1,133.63
|
| Rate for Payer: Cofinity Commercial |
$1,332.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.63
|
| Rate for Payer: Healthscope Commercial |
$1,417.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,374.53
|
| Rate for Payer: Mclaren Commercial |
$1,275.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,289.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,006.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,247.00
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
OP
|
$4,339.52
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,735.81 |
| Max. Negotiated Rate |
$4,339.52 |
| Rate for Payer: Aetna Commercial |
$3,905.57
|
| Rate for Payer: ASR ASR |
$4,209.33
|
| Rate for Payer: BCBS Complete |
$1,735.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,364.43
|
| Rate for Payer: BCN Commercial |
$3,364.43
|
| Rate for Payer: Cash Price |
$3,471.62
|
| Rate for Payer: Cofinity Commercial |
$4,079.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.62
|
| Rate for Payer: Healthscope Commercial |
$4,339.52
|
| Rate for Payer: Healthscope Whirlpool |
$4,209.33
|
| Rate for Payer: Mclaren Commercial |
$3,905.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,688.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,037.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,948.96
|
| Rate for Payer: Priority Health Narrow Network |
$3,081.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,818.78
|
|
|
HC LEVEL 4 INIT 30 MIN
|
Facility
|
IP
|
$4,339.52
|
|
| Hospital Charge Code |
36000068
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,037.66 |
| Max. Negotiated Rate |
$4,339.52 |
| Rate for Payer: Aetna Commercial |
$3,905.57
|
| Rate for Payer: ASR ASR |
$4,209.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,364.43
|
| Rate for Payer: BCN Commercial |
$3,364.43
|
| Rate for Payer: Cash Price |
$3,471.62
|
| Rate for Payer: Cofinity Commercial |
$4,079.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.62
|
| Rate for Payer: Healthscope Commercial |
$4,339.52
|
| Rate for Payer: Healthscope Whirlpool |
$4,209.33
|
| Rate for Payer: Mclaren Commercial |
$3,905.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,688.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,037.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,818.78
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,579.11
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,105.38 |
| Max. Negotiated Rate |
$1,579.11 |
| Rate for Payer: Aetna Commercial |
$1,421.20
|
| Rate for Payer: ASR ASR |
$1,531.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,224.28
|
| Rate for Payer: BCN Commercial |
$1,224.28
|
| Rate for Payer: Cash Price |
$1,263.29
|
| Rate for Payer: Cofinity Commercial |
$1,484.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.29
|
| Rate for Payer: Healthscope Commercial |
$1,579.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,531.74
|
| Rate for Payer: Mclaren Commercial |
$1,421.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,389.62
|
|
|
HC LEVEL 4 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,579.11
|
|
| Hospital Charge Code |
36000069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$631.64 |
| Max. Negotiated Rate |
$1,579.11 |
| Rate for Payer: Aetna Commercial |
$1,421.20
|
| Rate for Payer: ASR ASR |
$1,531.74
|
| Rate for Payer: BCBS Complete |
$631.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,224.28
|
| Rate for Payer: BCN Commercial |
$1,224.28
|
| Rate for Payer: Cash Price |
$1,263.29
|
| Rate for Payer: Cofinity Commercial |
$1,484.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.29
|
| Rate for Payer: Healthscope Commercial |
$1,579.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,531.74
|
| Rate for Payer: Mclaren Commercial |
$1,421.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,121.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,389.62
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
IP
|
$4,842.31
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,389.62 |
| Max. Negotiated Rate |
$4,842.31 |
| Rate for Payer: Aetna Commercial |
$4,358.08
|
| Rate for Payer: ASR ASR |
$4,697.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,754.24
|
| Rate for Payer: BCN Commercial |
$3,754.24
|
| Rate for Payer: Cash Price |
$3,873.85
|
| Rate for Payer: Cofinity Commercial |
$4,551.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,873.85
|
| Rate for Payer: Healthscope Commercial |
$4,842.31
|
| Rate for Payer: Healthscope Whirlpool |
$4,697.04
|
| Rate for Payer: Mclaren Commercial |
$4,358.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,115.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,261.23
|
|
|
HC LEVEL 5 INIT 30 MIN
|
Facility
|
OP
|
$4,842.31
|
|
| Hospital Charge Code |
36000070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,936.92 |
| Max. Negotiated Rate |
$4,842.31 |
| Rate for Payer: Aetna Commercial |
$4,358.08
|
| Rate for Payer: ASR ASR |
$4,697.04
|
| Rate for Payer: BCBS Complete |
$1,936.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,754.24
|
| Rate for Payer: BCN Commercial |
$3,754.24
|
| Rate for Payer: Cash Price |
$3,873.85
|
| Rate for Payer: Cofinity Commercial |
$4,551.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,873.85
|
| Rate for Payer: Healthscope Commercial |
$4,842.31
|
| Rate for Payer: Healthscope Whirlpool |
$4,697.04
|
| Rate for Payer: Mclaren Commercial |
$4,358.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,115.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,389.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,406.50
|
| Rate for Payer: Priority Health Narrow Network |
$3,438.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,261.23
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,979.54
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,385.68 |
| Max. Negotiated Rate |
$1,979.54 |
| Rate for Payer: Aetna Commercial |
$1,781.59
|
| Rate for Payer: ASR ASR |
$1,920.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,534.74
|
| Rate for Payer: BCN Commercial |
$1,534.74
|
| Rate for Payer: Cash Price |
$1,583.63
|
| Rate for Payer: Cofinity Commercial |
$1,860.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,583.63
|
| Rate for Payer: Healthscope Commercial |
$1,979.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,920.15
|
| Rate for Payer: Mclaren Commercial |
$1,781.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,682.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,742.00
|
|
|
HC LEVEL 5 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,979.54
|
|
| Hospital Charge Code |
36000071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$791.82 |
| Max. Negotiated Rate |
$1,979.54 |
| Rate for Payer: Aetna Commercial |
$1,781.59
|
| Rate for Payer: ASR ASR |
$1,920.15
|
| Rate for Payer: BCBS Complete |
$791.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,534.74
|
| Rate for Payer: BCN Commercial |
$1,534.74
|
| Rate for Payer: Cash Price |
$1,583.63
|
| Rate for Payer: Cofinity Commercial |
$1,860.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,583.63
|
| Rate for Payer: Healthscope Commercial |
$1,979.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,920.15
|
| Rate for Payer: Mclaren Commercial |
$1,781.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,682.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,801.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,742.00
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$75.28
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$75.28 |
| Rate for Payer: Aetna Commercial |
$67.75
|
| Rate for Payer: ASR ASR |
$73.02
|
| Rate for Payer: BCBS Trust/PPO |
$58.36
|
| Rate for Payer: BCN Commercial |
$58.36
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$70.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.22
|
| Rate for Payer: Healthscope Commercial |
$75.28
|
| Rate for Payer: Healthscope Whirlpool |
$73.02
|
| Rate for Payer: Mclaren Commercial |
$67.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.25
|
|
