|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,880.38 |
| Max. Negotiated Rate |
$5,969.82 |
| Rate for Payer: Aetna Commercial |
$5,372.84
|
| Rate for Payer: ASR ASR |
$5,790.73
|
| Rate for Payer: ASR Commercial |
$5,790.73
|
| Rate for Payer: BCBS Trust/PPO |
$4,864.81
|
| Rate for Payer: BCN Commercial |
$4,628.40
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$5,611.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Healthscope Commercial |
$5,969.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,790.73
|
| Rate for Payer: Mclaren Commercial |
$5,372.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: Nomi Health Commercial |
$4,895.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,253.44
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$7,684.82 |
| Rate for Payer: Aetna Commercial |
$5,372.84
|
| Rate for Payer: Aetna Medicare |
$4,957.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: ASR ASR |
$5,790.73
|
| Rate for Payer: ASR Commercial |
$5,790.73
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCBS Trust/PPO |
$4,888.69
|
| Rate for Payer: BCN Commercial |
$4,628.40
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$5,611.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Healthscope Commercial |
$5,969.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,790.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,957.95
|
| Rate for Payer: Mclaren Commercial |
$5,372.84
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: Nomi Health Commercial |
$4,895.25
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Commercial |
$5,453.74
|
| Rate for Payer: PHP Medicaid |
$2,657.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,230.76
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Priority Health Narrow Network |
$4,184.84
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,253.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$7,684.82
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP DNSP |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$138.43 |
| Rate for Payer: Aetna Commercial |
$124.59
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: ASR ASR |
$134.28
|
| Rate for Payer: ASR Commercial |
$134.28
|
| Rate for Payer: BCBS Complete |
$55.37
|
| Rate for Payer: BCBS Trust/PPO |
$113.36
|
| Rate for Payer: BCN Commercial |
$107.32
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$130.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$138.43
|
| Rate for Payer: Healthscope Whirlpool |
$134.28
|
| Rate for Payer: Mclaren Commercial |
$124.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: Nomi Health Commercial |
$113.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.29
|
| Rate for Payer: Priority Health Narrow Network |
$97.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.82
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$138.43 |
| Rate for Payer: Aetna Commercial |
$124.59
|
| Rate for Payer: ASR ASR |
$134.28
|
| Rate for Payer: ASR Commercial |
$134.28
|
| Rate for Payer: BCBS Trust/PPO |
$112.81
|
| Rate for Payer: BCN Commercial |
$107.32
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$130.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$138.43
|
| Rate for Payer: Healthscope Whirlpool |
$134.28
|
| Rate for Payer: Mclaren Commercial |
$124.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: Nomi Health Commercial |
$113.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.82
|
|
|
HC KIT ATS
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC KIT DILATOR VASC
|
Facility
|
IP
|
$535.50
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.07 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$481.95
|
| Rate for Payer: ASR ASR |
$519.43
|
| Rate for Payer: ASR Commercial |
$519.43
|
| Rate for Payer: BCBS Trust/PPO |
$436.38
|
| Rate for Payer: BCN Commercial |
$415.17
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$503.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Healthscope Whirlpool |
$519.43
|
| Rate for Payer: Mclaren Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.24
|
|
|
HC KIT DILATOR VASC
|
Facility
|
OP
|
$535.50
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$481.95
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: ASR ASR |
$519.43
|
| Rate for Payer: ASR Commercial |
$519.43
|
| Rate for Payer: BCBS Complete |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$438.52
|
| Rate for Payer: BCN Commercial |
$415.17
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$503.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Healthscope Whirlpool |
$519.43
|
| Rate for Payer: Mclaren Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: Nomi Health Commercial |
$439.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.21
|
| Rate for Payer: Priority Health Narrow Network |
$375.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.24
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$123.22
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.09 |
| Max. Negotiated Rate |
$123.22 |
| Rate for Payer: Aetna Commercial |
$110.90
|
| Rate for Payer: ASR ASR |
$119.52
|
| Rate for Payer: ASR Commercial |
$119.52
|
| Rate for Payer: BCBS Trust/PPO |
$100.41
|
| Rate for Payer: BCN Commercial |
$95.53
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$115.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.58
|
| Rate for Payer: Healthscope Commercial |
$123.22
|
| Rate for Payer: Healthscope Whirlpool |
$119.52
|
| Rate for Payer: Mclaren Commercial |
$110.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.74
|
| Rate for Payer: Nomi Health Commercial |
$101.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.43
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$123.22
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$123.22 |
| Rate for Payer: Aetna Commercial |
$110.90
|
| Rate for Payer: Aetna Medicare |
$7.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.66
|
| Rate for Payer: ASR ASR |
$119.52
|
| Rate for Payer: ASR Commercial |
$119.52
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$100.90
|
| Rate for Payer: BCN Commercial |
$95.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.73
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$115.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.73
|
| Rate for Payer: Healthscope Commercial |
$123.22
|
| Rate for Payer: Healthscope Whirlpool |
$119.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.73
|
| Rate for Payer: Mclaren Commercial |
$110.90
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Mclaren Medicare |
$7.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.12
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.74
|
| Rate for Payer: Nomi Health Commercial |
$101.04
|
| Rate for Payer: PACE Medicare |
$7.34
|
| Rate for Payer: PACE SWMI |
$7.73
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicaid |
$4.14
|
| Rate for Payer: PHP Medicare Advantage |
$7.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.97
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow Network |
$86.38
|
| Rate for Payer: Railroad Medicare Medicare |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.73
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$7.73
|
| Rate for Payer: UHCCP DNSP |
$7.73
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: VA VA |
$7.73
|
|
|
HC KOH PREPARATION
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.97
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$16.77
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC KOH PREPARATION
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: ASR Commercial |
$23.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$23.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.21
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
IP
|
$2,936.43
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,908.68 |
| Max. Negotiated Rate |
$2,936.43 |
| Rate for Payer: Aetna Commercial |
$2,642.79
|
| Rate for Payer: ASR ASR |
$2,848.34
|
| Rate for Payer: ASR Commercial |
$2,848.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,392.90
|
| Rate for Payer: BCN Commercial |
$2,276.61
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cofinity Commercial |
$2,760.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,349.14
|
| Rate for Payer: Healthscope Commercial |
$2,936.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,848.34
|
| Rate for Payer: Mclaren Commercial |
$2,642.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.97
|
| Rate for Payer: Nomi Health Commercial |
$2,407.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,584.06
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
OP
|
$2,936.43
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,174.57 |
| Max. Negotiated Rate |
$2,936.43 |
| Rate for Payer: Aetna Commercial |
$2,642.79
|
| Rate for Payer: Aetna Medicare |
$1,468.21
|
| Rate for Payer: ASR ASR |
$2,848.34
|
| Rate for Payer: ASR Commercial |
$2,848.34
|
| Rate for Payer: BCBS Complete |
$1,174.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,404.64
|
| Rate for Payer: BCN Commercial |
$2,276.61
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cofinity Commercial |
$2,760.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,349.14
|
| Rate for Payer: Healthscope Commercial |
$2,936.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,848.34
|
| Rate for Payer: Mclaren Commercial |
$2,642.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.97
|
| Rate for Payer: Nomi Health Commercial |
$2,407.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,572.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,058.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,584.06
|
|
|
HC LAAC IMPLANT
|
Facility
|
IP
|
$18,571.14
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,071.24 |
| Max. Negotiated Rate |
$18,571.14 |
| Rate for Payer: Aetna Commercial |
$16,714.03
|
| Rate for Payer: ASR ASR |
$18,014.01
|
| Rate for Payer: ASR Commercial |
$18,014.01
|
| Rate for Payer: BCBS Trust/PPO |
$15,133.62
|
| Rate for Payer: BCN Commercial |
$14,398.20
|
| Rate for Payer: Cash Price |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$17,456.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,856.91
|
| Rate for Payer: Healthscope Commercial |
$18,571.14
|
| Rate for Payer: Healthscope Whirlpool |
$18,014.01
|
| Rate for Payer: Mclaren Commercial |
$16,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,785.47
|
| Rate for Payer: Nomi Health Commercial |
$15,228.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,071.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,342.60
|
|
|
HC LAAC IMPLANT
|
Facility
|
OP
|
$18,571.14
|
|
| Hospital Charge Code |
27800117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,428.46 |
| Max. Negotiated Rate |
$18,571.14 |
| Rate for Payer: Aetna Commercial |
$16,714.03
|
| Rate for Payer: Aetna Medicare |
$9,285.57
|
| Rate for Payer: ASR ASR |
$18,014.01
|
| Rate for Payer: ASR Commercial |
$18,014.01
|
| Rate for Payer: BCBS Complete |
$7,428.46
|
| Rate for Payer: BCBS Trust/PPO |
$15,207.91
|
| Rate for Payer: BCN Commercial |
$14,398.20
|
| Rate for Payer: Cash Price |
$14,856.91
|
| Rate for Payer: Cofinity Commercial |
$17,456.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,856.91
|
| Rate for Payer: Healthscope Commercial |
$18,571.14
|
| Rate for Payer: Healthscope Whirlpool |
$18,014.01
|
| Rate for Payer: Mclaren Commercial |
$16,714.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,785.47
|
| Rate for Payer: Nomi Health Commercial |
$15,228.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,071.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,272.03
|
| Rate for Payer: Priority Health Narrow Network |
$13,018.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,342.60
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,531.01
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$612.40 |
| Max. Negotiated Rate |
$1,531.01 |
| Rate for Payer: Aetna Commercial |
$1,377.91
|
| Rate for Payer: Aetna Medicare |
$765.50
|
| Rate for Payer: ASR ASR |
$1,485.08
|
| Rate for Payer: ASR Commercial |
$1,485.08
|
| Rate for Payer: BCBS Complete |
$612.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.74
|
| Rate for Payer: BCN Commercial |
$1,186.99
|
| Rate for Payer: Cash Price |
$1,224.81
|
| Rate for Payer: Cofinity Commercial |
$1,439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.81
|
| Rate for Payer: Healthscope Commercial |
$1,531.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.08
|
| Rate for Payer: Mclaren Commercial |
$1,377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.36
|
| Rate for Payer: Nomi Health Commercial |
$1,255.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,341.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,073.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.29
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,531.01
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$995.16 |
| Max. Negotiated Rate |
$1,531.01 |
| Rate for Payer: Aetna Commercial |
$1,377.91
|
| Rate for Payer: ASR ASR |
$1,485.08
|
| Rate for Payer: ASR Commercial |
$1,485.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.62
|
| Rate for Payer: BCN Commercial |
$1,186.99
|
| Rate for Payer: Cash Price |
$1,224.81
|
| Rate for Payer: Cofinity Commercial |
$1,439.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.81
|
| Rate for Payer: Healthscope Commercial |
$1,531.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,485.08
|
| Rate for Payer: Mclaren Commercial |
$1,377.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.36
|
| Rate for Payer: Nomi Health Commercial |
$1,255.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.29
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,041.41
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$816.56 |
| Max. Negotiated Rate |
$2,041.41 |
| Rate for Payer: Aetna Commercial |
$1,837.27
|
| Rate for Payer: Aetna Medicare |
$1,020.71
|
| Rate for Payer: ASR ASR |
$1,980.17
|
| Rate for Payer: ASR Commercial |
$1,980.17
|
| Rate for Payer: BCBS Complete |
$816.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,671.71
|
| Rate for Payer: BCN Commercial |
$1,582.71
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,918.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$2,041.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,980.17
|
| Rate for Payer: Mclaren Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,788.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.44
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,041.41
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,326.92 |
| Max. Negotiated Rate |
$2,041.41 |
| Rate for Payer: Aetna Commercial |
$1,837.27
|
| Rate for Payer: ASR ASR |
$1,980.17
|
| Rate for Payer: ASR Commercial |
$1,980.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.55
|
| Rate for Payer: BCN Commercial |
$1,582.71
|
| Rate for Payer: Cash Price |
$1,633.13
|
| Rate for Payer: Cofinity Commercial |
$1,918.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,633.13
|
| Rate for Payer: Healthscope Commercial |
$2,041.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,980.17
|
| Rate for Payer: Mclaren Commercial |
$1,837.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.20
|
| Rate for Payer: Nomi Health Commercial |
$1,673.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,796.44
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,551.65
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,020.66 |
| Max. Negotiated Rate |
$2,551.65 |
| Rate for Payer: Aetna Commercial |
$2,296.49
|
| Rate for Payer: Aetna Medicare |
$1,275.83
|
| Rate for Payer: ASR ASR |
$2,475.10
|
| Rate for Payer: ASR Commercial |
$2,475.10
|
| Rate for Payer: BCBS Complete |
$1,020.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,089.55
|
| Rate for Payer: BCN Commercial |
$1,978.29
|
| Rate for Payer: Cash Price |
$2,041.32
|
| Rate for Payer: Cofinity Commercial |
$2,398.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.32
|
| Rate for Payer: Healthscope Commercial |
$2,551.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,475.10
|
| Rate for Payer: Mclaren Commercial |
$2,296.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.90
|
| Rate for Payer: Nomi Health Commercial |
$2,092.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,235.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,788.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.45
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,551.65
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,658.57 |
| Max. Negotiated Rate |
$2,551.65 |
| Rate for Payer: Aetna Commercial |
$2,296.49
|
| Rate for Payer: ASR ASR |
$2,475.10
|
| Rate for Payer: ASR Commercial |
$2,475.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,079.34
|
| Rate for Payer: BCN Commercial |
$1,978.29
|
| Rate for Payer: Cash Price |
$2,041.32
|
| Rate for Payer: Cofinity Commercial |
$2,398.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.32
|
| Rate for Payer: Healthscope Commercial |
$2,551.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,475.10
|
| Rate for Payer: Mclaren Commercial |
$2,296.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.90
|
| Rate for Payer: Nomi Health Commercial |
$2,092.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,245.45
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,062.03
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,990.32 |
| Max. Negotiated Rate |
$3,062.03 |
| Rate for Payer: Aetna Commercial |
$2,755.83
|
| Rate for Payer: ASR ASR |
$2,970.17
|
| Rate for Payer: ASR Commercial |
$2,970.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.25
|
| Rate for Payer: BCN Commercial |
$2,373.99
|
| Rate for Payer: Cash Price |
$2,449.62
|
| Rate for Payer: Cofinity Commercial |
$2,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,449.62
|
| Rate for Payer: Healthscope Commercial |
$3,062.03
|
| Rate for Payer: Healthscope Whirlpool |
$2,970.17
|
| Rate for Payer: Mclaren Commercial |
$2,755.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,602.73
|
| Rate for Payer: Nomi Health Commercial |
$2,510.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,990.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.59
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
OP
|
$3,062.03
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,224.81 |
| Max. Negotiated Rate |
$3,062.03 |
| Rate for Payer: Aetna Commercial |
$2,755.83
|
| Rate for Payer: Aetna Medicare |
$1,531.02
|
| Rate for Payer: ASR ASR |
$2,970.17
|
| Rate for Payer: ASR Commercial |
$2,970.17
|
| Rate for Payer: BCBS Complete |
$1,224.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,507.50
|
| Rate for Payer: BCN Commercial |
$2,373.99
|
| Rate for Payer: Cash Price |
$2,449.62
|
| Rate for Payer: Cofinity Commercial |
$2,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,449.62
|
| Rate for Payer: Healthscope Commercial |
$3,062.03
|
| Rate for Payer: Healthscope Whirlpool |
$2,970.17
|
| Rate for Payer: Mclaren Commercial |
$2,755.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,602.73
|
| Rate for Payer: Nomi Health Commercial |
$2,510.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,990.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,682.95
|
| Rate for Payer: Priority Health Narrow Network |
$2,146.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.59
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
OP
|
$4,589.55
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,835.82 |
| Max. Negotiated Rate |
$4,589.55 |
| Rate for Payer: Aetna Commercial |
$4,130.60
|
| Rate for Payer: Aetna Medicare |
$2,294.78
|
| Rate for Payer: ASR ASR |
$4,451.86
|
| Rate for Payer: ASR Commercial |
$4,451.86
|
| Rate for Payer: BCBS Complete |
$1,835.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,758.38
|
| Rate for Payer: BCN Commercial |
$3,558.28
|
| Rate for Payer: Cash Price |
$3,671.64
|
| Rate for Payer: Cofinity Commercial |
$4,314.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,671.64
|
| Rate for Payer: Healthscope Commercial |
$4,589.55
|
| Rate for Payer: Healthscope Whirlpool |
$4,451.86
|
| Rate for Payer: Mclaren Commercial |
$4,130.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.12
|
| Rate for Payer: Nomi Health Commercial |
$3,763.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,021.36
|
| Rate for Payer: Priority Health Narrow Network |
$3,217.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,038.80
|
|
