|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$57.73
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$57.73 |
| Rate for Payer: Aetna Commercial |
$51.96
|
| Rate for Payer: ASR ASR |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$47.41
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Cofinity Commercial |
$54.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.18
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$57.73
|
| Rate for Payer: Mclaren Commercial |
$51.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.07
|
| Rate for Payer: Nomi Health Commercial |
$47.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.80
|
|
|
HC LOBSTER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$98.30
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$98.30 |
| Rate for Payer: Aetna Commercial |
$88.47
|
| Rate for Payer: ASR ASR |
$95.35
|
| Rate for Payer: BCBS Trust/PPO |
$80.72
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: Cash Price |
$78.64
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.64
|
| Rate for Payer: Healthscope Commercial |
$95.35
|
| Rate for Payer: Healthscope Whirlpool |
$98.30
|
| Rate for Payer: Mclaren Commercial |
$88.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.50
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$98.30
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$98.30 |
| Rate for Payer: Aetna Commercial |
$88.47
|
| Rate for Payer: Aetna Medicare |
$36.37
|
| Rate for Payer: ASR ASR |
$95.35
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: BCBS Trust/PPO |
$81.05
|
| Rate for Payer: BCN Commercial |
$81.05
|
| Rate for Payer: Cash Price |
$78.64
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.64
|
| Rate for Payer: Healthscope Commercial |
$95.35
|
| Rate for Payer: Healthscope Whirlpool |
$98.30
|
| Rate for Payer: Mclaren Commercial |
$88.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.13
|
| Rate for Payer: Priority Health Narrow Network |
$68.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.50
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$356.63
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$267.47 |
| Max. Negotiated Rate |
$356.63 |
| Rate for Payer: Aetna Commercial |
$320.97
|
| Rate for Payer: ASR ASR |
$345.93
|
| Rate for Payer: BCBS Trust/PPO |
$292.86
|
| Rate for Payer: BCN Commercial |
$292.86
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cofinity Commercial |
$335.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.30
|
| Rate for Payer: Healthscope Commercial |
$345.93
|
| Rate for Payer: Healthscope Whirlpool |
$356.63
|
| Rate for Payer: Mclaren Commercial |
$320.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Nomi Health Commercial |
$292.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.83
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$356.63
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$356.63 |
| Rate for Payer: Aetna Commercial |
$320.97
|
| Rate for Payer: Aetna Medicare |
$131.95
|
| Rate for Payer: ASR ASR |
$345.93
|
| Rate for Payer: BCBS Complete |
$142.65
|
| Rate for Payer: BCBS Trust/PPO |
$294.04
|
| Rate for Payer: BCN Commercial |
$294.04
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cofinity Commercial |
$335.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.30
|
| Rate for Payer: Healthscope Commercial |
$345.93
|
| Rate for Payer: Healthscope Whirlpool |
$356.63
|
| Rate for Payer: Mclaren Commercial |
$320.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Nomi Health Commercial |
$292.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$312.48
|
| Rate for Payer: Priority Health Narrow Network |
$250.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.83
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$210.97
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.23 |
| Max. Negotiated Rate |
$210.97 |
| Rate for Payer: Aetna Commercial |
$189.87
|
| Rate for Payer: ASR ASR |
$204.64
|
| Rate for Payer: BCBS Trust/PPO |
$173.25
|
| Rate for Payer: BCN Commercial |
$173.25
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$198.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.78
|
| Rate for Payer: Healthscope Commercial |
$204.64
|
| Rate for Payer: Healthscope Whirlpool |
$210.97
|
| Rate for Payer: Mclaren Commercial |
$189.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.32
|
| Rate for Payer: Nomi Health Commercial |
$173.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.65
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$210.97
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$210.97 |
| Rate for Payer: Aetna Commercial |
$189.87
|
| Rate for Payer: Aetna Medicare |
$78.06
|
| Rate for Payer: ASR ASR |
$204.64
|
| Rate for Payer: BCBS Complete |
$84.39
|
| Rate for Payer: BCBS Trust/PPO |
$173.94
|
| Rate for Payer: BCN Commercial |
$173.94
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cofinity Commercial |
$198.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.78
|
| Rate for Payer: Healthscope Commercial |
$204.64
|
| Rate for Payer: Healthscope Whirlpool |
$210.97
|
| Rate for Payer: Mclaren Commercial |
$189.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.32
|
| Rate for Payer: Nomi Health Commercial |
$173.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$184.85
|
| Rate for Payer: Priority Health Narrow Network |
$147.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.65
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: ASR ASR |
$142.47
|
| Rate for Payer: BCBS Trust/PPO |
$120.62
|
| Rate for Payer: BCN Commercial |
$120.62
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$138.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$142.47
|
| Rate for Payer: Healthscope Whirlpool |
$146.88
|
| Rate for Payer: Mclaren Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: Nomi Health Commercial |
$120.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.25
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Aetna Medicare |
$54.35
|
| Rate for Payer: ASR ASR |
$142.47
|
| Rate for Payer: BCBS Complete |
$58.75
|
| Rate for Payer: BCBS Trust/PPO |
$121.10
|
| Rate for Payer: BCN Commercial |
$121.10
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$138.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$142.47
|
| Rate for Payer: Healthscope Whirlpool |
$146.88
|
| Rate for Payer: Mclaren Commercial |
$132.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: Nomi Health Commercial |
$120.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$128.70
|
| Rate for Payer: Priority Health Narrow Network |
$102.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.25
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
OP
|
$147.26
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$54.49 |
| Max. Negotiated Rate |
$147.26 |
| Rate for Payer: Aetna Commercial |
$132.53
|
| Rate for Payer: Aetna Medicare |
$54.49
|
| Rate for Payer: ASR ASR |
$142.84
|
| Rate for Payer: BCBS Complete |
$58.90
|
| Rate for Payer: BCBS Trust/PPO |
$121.42
|
| Rate for Payer: BCN Commercial |
$121.42
|
| Rate for Payer: Cash Price |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$138.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.81
|
| Rate for Payer: Healthscope Commercial |
$142.84
|
| Rate for Payer: Healthscope Whirlpool |
$147.26
|
| Rate for Payer: Mclaren Commercial |
$132.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.17
|
| Rate for Payer: Nomi Health Commercial |
$120.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.03
|
| Rate for Payer: Priority Health Narrow Network |
$103.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.59
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
IP
|
$147.26
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$147.26 |
| Rate for Payer: Aetna Commercial |
$132.53
|
| Rate for Payer: ASR ASR |
$142.84
|
| Rate for Payer: BCBS Trust/PPO |
$120.93
|
| Rate for Payer: BCN Commercial |
$120.93
|
| Rate for Payer: Cash Price |
$117.81
|
| Rate for Payer: Cofinity Commercial |
$138.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.81
|
| Rate for Payer: Healthscope Commercial |
$142.84
|
| Rate for Payer: Healthscope Whirlpool |
$147.26
|
| Rate for Payer: Mclaren Commercial |
$132.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.17
|
| Rate for Payer: Nomi Health Commercial |
$120.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.59
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$736.01
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$272.32 |
| Max. Negotiated Rate |
$736.01 |
| Rate for Payer: Aetna Commercial |
$662.41
|
| Rate for Payer: Aetna Medicare |
$272.32
|
| Rate for Payer: ASR ASR |
$713.93
|
| Rate for Payer: BCBS Complete |
$294.40
|
| Rate for Payer: BCBS Trust/PPO |
$606.84
|
| Rate for Payer: BCN Commercial |
$606.84
|
| Rate for Payer: Cash Price |
$588.81
|
| Rate for Payer: Cofinity Commercial |
$691.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.81
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Healthscope Whirlpool |
$736.01
|
| Rate for Payer: Mclaren Commercial |
$662.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.61
|
| Rate for Payer: Nomi Health Commercial |
$603.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$644.89
|
| Rate for Payer: Priority Health Narrow Network |
$515.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$647.69
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$736.01
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$552.01 |
| Max. Negotiated Rate |
$736.01 |
| Rate for Payer: Aetna Commercial |
$662.41
|
| Rate for Payer: ASR ASR |
$713.93
|
| Rate for Payer: BCBS Trust/PPO |
$604.41
|
| Rate for Payer: BCN Commercial |
$604.41
|
| Rate for Payer: Cash Price |
$588.81
|
| Rate for Payer: Cofinity Commercial |
$691.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.81
|
| Rate for Payer: Healthscope Commercial |
$713.93
|
| Rate for Payer: Healthscope Whirlpool |
$736.01
|
| Rate for Payer: Mclaren Commercial |
$662.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.61
|
| Rate for Payer: Nomi Health Commercial |
$603.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$647.69
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: ASR ASR |
$3.72
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Healthscope Whirlpool |
$3.83
|
| Rate for Payer: Mclaren Commercial |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$2.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.37
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: ASR ASR |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Healthscope Whirlpool |
$3.83
|
| Rate for Payer: Mclaren Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.37
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$220.36
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.27 |
| Max. Negotiated Rate |
$220.36 |
| Rate for Payer: Aetna Commercial |
$198.32
|
| Rate for Payer: ASR ASR |
$213.75
|
| Rate for Payer: BCBS Trust/PPO |
$180.96
|
| Rate for Payer: BCN Commercial |
$180.96
|
| Rate for Payer: Cash Price |
$176.29
|
| Rate for Payer: Cofinity Commercial |
$207.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.29
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Healthscope Whirlpool |
$220.36
|
| Rate for Payer: Mclaren Commercial |
$198.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.31
|
| Rate for Payer: Nomi Health Commercial |
$180.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.92
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$220.36
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.53 |
| Max. Negotiated Rate |
$220.36 |
| Rate for Payer: Aetna Commercial |
$198.32
|
| Rate for Payer: Aetna Medicare |
$81.53
|
| Rate for Payer: ASR ASR |
$213.75
|
| Rate for Payer: BCBS Complete |
$88.14
|
| Rate for Payer: BCBS Trust/PPO |
$181.69
|
| Rate for Payer: BCN Commercial |
$181.69
|
| Rate for Payer: Cash Price |
$176.29
|
| Rate for Payer: Cofinity Commercial |
$207.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.29
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Healthscope Whirlpool |
$220.36
|
| Rate for Payer: Mclaren Commercial |
$198.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.31
|
| Rate for Payer: Nomi Health Commercial |
$180.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$193.08
|
| Rate for Payer: Priority Health Narrow Network |
$154.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.92
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
OP
|
$562.50
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
37000030
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$208.12 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$506.25
|
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Medicare |
$138.75
|
| Rate for Payer: Aetna Medicare |
$208.12
|
| Rate for Payer: ASR ASR |
$545.62
|
| Rate for Payer: ASR ASR |
$363.75
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS Complete |
$225.00
|
| Rate for Payer: BCBS Trust/PPO |
$463.78
|
| Rate for Payer: BCBS Trust/PPO |
$309.19
|
| Rate for Payer: BCN Commercial |
$309.19
|
| Rate for Payer: BCN Commercial |
$463.78
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$352.50
|
| Rate for Payer: Cofinity Commercial |
$528.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$545.62
|
| Rate for Payer: Healthscope Commercial |
$363.75
|
| Rate for Payer: Healthscope Whirlpool |
$562.50
|
| Rate for Payer: Healthscope Whirlpool |
$375.00
|
| Rate for Payer: Mclaren Commercial |
$506.25
|
| Rate for Payer: Mclaren Commercial |
$337.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.12
|
| Rate for Payer: Nomi Health Commercial |
$307.50
|
| Rate for Payer: Nomi Health Commercial |
$461.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$529.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$529.60
|
| Rate for Payer: Priority Health Narrow Network |
$423.68
|
| Rate for Payer: Priority Health Narrow Network |
$423.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.00
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT CONT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
37000030
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$281.25 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Commercial |
$506.25
|
| Rate for Payer: ASR ASR |
$545.62
|
| Rate for Payer: ASR ASR |
$363.75
|
| Rate for Payer: BCBS Trust/PPO |
$461.93
|
| Rate for Payer: BCBS Trust/PPO |
$307.95
|
| Rate for Payer: BCN Commercial |
$461.93
|
| Rate for Payer: BCN Commercial |
$307.95
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$352.50
|
| Rate for Payer: Cofinity Commercial |
$528.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$363.75
|
| Rate for Payer: Healthscope Commercial |
$545.62
|
| Rate for Payer: Healthscope Whirlpool |
$562.50
|
| Rate for Payer: Healthscope Whirlpool |
$375.00
|
| Rate for Payer: Mclaren Commercial |
$506.25
|
| Rate for Payer: Mclaren Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Nomi Health Commercial |
$461.25
|
| Rate for Payer: Nomi Health Commercial |
$307.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.00
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
37000029
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$111.00
|
| Rate for Payer: Aetna Medicare |
$166.50
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.02
|
| Rate for Payer: BCBS Trust/PPO |
$247.35
|
| Rate for Payer: BCN Commercial |
$247.35
|
| Rate for Payer: BCN Commercial |
$371.02
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Healthscope Commercial |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.17
|
| Rate for Payer: Priority Health Narrow Network |
$173.74
|
| Rate for Payer: Priority Health Narrow Network |
$173.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC LOWER EXT FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
37000029
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$369.54
|
| Rate for Payer: BCBS Trust/PPO |
$246.36
|
| Rate for Payer: BCN Commercial |
$369.54
|
| Rate for Payer: BCN Commercial |
$246.36
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$291.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Healthscope Whirlpool |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: Aetna Medicare |
$34.65
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$77.21
|
| Rate for Payer: BCN Commercial |
$77.21
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.90
|
| Rate for Payer: BCN Commercial |
$76.90
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$93.64
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
