|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.82 |
| Max. Negotiated Rate |
$2,852.05 |
| Rate for Payer: Aetna Commercial |
$2,566.84
|
| Rate for Payer: Aetna Medicare |
$1,426.03
|
| Rate for Payer: ASR ASR |
$2,766.49
|
| Rate for Payer: ASR Commercial |
$2,766.49
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,335.54
|
| Rate for Payer: BCN Commercial |
$2,211.19
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,680.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,852.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,766.49
|
| Rate for Payer: Mclaren Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,498.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,999.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.80
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,853.83 |
| Max. Negotiated Rate |
$2,852.05 |
| Rate for Payer: Aetna Commercial |
$2,566.84
|
| Rate for Payer: ASR ASR |
$2,766.49
|
| Rate for Payer: ASR Commercial |
$2,766.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.14
|
| Rate for Payer: BCN Commercial |
$2,211.19
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$2,680.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,852.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,766.49
|
| Rate for Payer: Mclaren Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: Nomi Health Commercial |
$2,338.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,509.80
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,478.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$1,478.99 |
| Rate for Payer: Aetna Commercial |
$1,331.09
|
| Rate for Payer: Aetna Medicare |
$739.50
|
| Rate for Payer: ASR ASR |
$1,434.62
|
| Rate for Payer: ASR Commercial |
$1,434.62
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.14
|
| Rate for Payer: BCN Commercial |
$1,146.66
|
| Rate for Payer: Cash Price |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,390.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.19
|
| Rate for Payer: Healthscope Commercial |
$1,478.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,434.62
|
| Rate for Payer: Mclaren Commercial |
$1,331.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.14
|
| Rate for Payer: Nomi Health Commercial |
$1,212.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,295.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.51
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,478.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$961.34 |
| Max. Negotiated Rate |
$1,478.99 |
| Rate for Payer: Aetna Commercial |
$1,331.09
|
| Rate for Payer: ASR ASR |
$1,434.62
|
| Rate for Payer: ASR Commercial |
$1,434.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.23
|
| Rate for Payer: BCN Commercial |
$1,146.66
|
| Rate for Payer: Cash Price |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,390.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.19
|
| Rate for Payer: Healthscope Commercial |
$1,478.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,434.62
|
| Rate for Payer: Mclaren Commercial |
$1,331.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.14
|
| Rate for Payer: Nomi Health Commercial |
$1,212.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,301.51
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$56.60
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$56.60 |
| Rate for Payer: Aetna Commercial |
$50.94
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: ASR ASR |
$54.90
|
| Rate for Payer: ASR Commercial |
$54.90
|
| Rate for Payer: BCBS Complete |
$8.19
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$46.35
|
| Rate for Payer: BCN Commercial |
$43.88
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$56.60
|
| Rate for Payer: Healthscope Whirlpool |
$54.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$50.94
|
| Rate for Payer: Mclaren Medicaid |
$7.80
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: Meridian Medicaid |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$46.41
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$16.00
|
| Rate for Payer: PHP Medicaid |
$7.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.59
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$39.68
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Exchange |
$22.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.55
|
| Rate for Payer: UHCCP DNSP |
$14.55
|
| Rate for Payer: UHCCP Medicaid |
$7.80
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$56.60
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$56.60 |
| Rate for Payer: Aetna Commercial |
$50.94
|
| Rate for Payer: ASR ASR |
$54.90
|
| Rate for Payer: ASR Commercial |
$54.90
|
| Rate for Payer: BCBS Trust/PPO |
$46.12
|
| Rate for Payer: BCN Commercial |
$43.88
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Healthscope Commercial |
$56.60
|
| Rate for Payer: Healthscope Whirlpool |
$54.90
|
| Rate for Payer: Mclaren Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.81
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC LOBSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$96.37
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$62.64 |
| Max. Negotiated Rate |
$96.37 |
| Rate for Payer: Aetna Commercial |
$86.73
|
| Rate for Payer: ASR ASR |
$93.48
|
| Rate for Payer: ASR Commercial |
$93.48
|
| Rate for Payer: BCBS Trust/PPO |
$78.53
|
| Rate for Payer: BCN Commercial |
$74.72
|
| Rate for Payer: Cash Price |
$77.10
|
| Rate for Payer: Cofinity Commercial |
$90.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$96.37
|
| Rate for Payer: Healthscope Whirlpool |
$93.48
|
| Rate for Payer: Mclaren Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.91
|
| Rate for Payer: Nomi Health Commercial |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.81
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$96.37
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$96.37 |
| Rate for Payer: Aetna Commercial |
$86.73
|
| Rate for Payer: Aetna Medicare |
$48.19
|
| Rate for Payer: ASR ASR |
$93.48
|
| Rate for Payer: ASR Commercial |
$93.48
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS Trust/PPO |
$78.92
|
| Rate for Payer: BCN Commercial |
$74.72
|
| Rate for Payer: Cash Price |
$77.10
|
| Rate for Payer: Cofinity Commercial |
$90.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$96.37
|
| Rate for Payer: Healthscope Whirlpool |
$93.48
|
| Rate for Payer: Mclaren Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.91
|
| Rate for Payer: Nomi Health Commercial |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.44
|
| Rate for Payer: Priority Health Narrow Network |
$67.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.81
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$349.64
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$139.86 |
| Max. Negotiated Rate |
$349.64 |
| Rate for Payer: Aetna Commercial |
$314.68
|
| Rate for Payer: Aetna Medicare |
$174.82
|
| Rate for Payer: ASR ASR |
$339.15
|
| Rate for Payer: ASR Commercial |
$339.15
|
| Rate for Payer: BCBS Complete |
$139.86
|
| Rate for Payer: BCBS Trust/PPO |
$286.32
|
| Rate for Payer: BCN Commercial |
$271.08
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$328.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.71
|
| Rate for Payer: Healthscope Commercial |
$349.64
|
| Rate for Payer: Healthscope Whirlpool |
$339.15
|
| Rate for Payer: Mclaren Commercial |
$314.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.19
|
| Rate for Payer: Nomi Health Commercial |
$286.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.35
|
| Rate for Payer: Priority Health Narrow Network |
$245.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.68
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$349.64
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$349.64 |
| Rate for Payer: Aetna Commercial |
$314.68
|
| Rate for Payer: ASR ASR |
$339.15
|
| Rate for Payer: ASR Commercial |
$339.15
|
| Rate for Payer: BCBS Trust/PPO |
$284.92
|
| Rate for Payer: BCN Commercial |
$271.08
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$328.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.71
|
| Rate for Payer: Healthscope Commercial |
$349.64
|
| Rate for Payer: Healthscope Whirlpool |
$339.15
|
| Rate for Payer: Mclaren Commercial |
$314.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.19
|
| Rate for Payer: Nomi Health Commercial |
$286.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.68
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$206.83
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.44 |
| Max. Negotiated Rate |
$206.83 |
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: ASR ASR |
$200.63
|
| Rate for Payer: ASR Commercial |
$200.63
|
| Rate for Payer: BCBS Trust/PPO |
$168.55
|
| Rate for Payer: BCN Commercial |
$160.36
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cofinity Commercial |
$194.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.46
|
| Rate for Payer: Healthscope Commercial |
$206.83
|
| Rate for Payer: Healthscope Whirlpool |
$200.63
|
| Rate for Payer: Mclaren Commercial |
$186.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.81
|
| Rate for Payer: Nomi Health Commercial |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.01
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$206.83
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.73 |
| Max. Negotiated Rate |
$206.83 |
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: Aetna Medicare |
$103.42
|
| Rate for Payer: ASR ASR |
$200.63
|
| Rate for Payer: ASR Commercial |
$200.63
|
| Rate for Payer: BCBS Complete |
$82.73
|
| Rate for Payer: BCBS Trust/PPO |
$169.37
|
| Rate for Payer: BCN Commercial |
$160.36
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cofinity Commercial |
$194.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.46
|
| Rate for Payer: Healthscope Commercial |
$206.83
|
| Rate for Payer: Healthscope Whirlpool |
$200.63
|
| Rate for Payer: Mclaren Commercial |
$186.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.81
|
| Rate for Payer: Nomi Health Commercial |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.22
|
| Rate for Payer: Priority Health Narrow Network |
$144.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.01
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: ASR ASR |
$142.47
|
| Rate for Payer: ASR Commercial |
$142.47
|
| Rate for Payer: BCBS Trust/PPO |
$119.69
|
| Rate for Payer: BCN Commercial |
$113.88
|
| 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 |
$146.88
|
| Rate for Payer: Healthscope Whirlpool |
$142.47
|
| 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: Priority Health Cigna Priority Health |
$95.47
|
| 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 |
$58.75 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Aetna Medicare |
$73.44
|
| Rate for Payer: ASR ASR |
$142.47
|
| Rate for Payer: ASR Commercial |
$142.47
|
| Rate for Payer: BCBS Complete |
$58.75
|
| Rate for Payer: BCBS Trust/PPO |
$120.28
|
| Rate for Payer: BCN Commercial |
$113.88
|
| 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 |
$146.88
|
| Rate for Payer: Healthscope Whirlpool |
$142.47
|
| 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: Priority Health Cigna Priority Health |
$95.47
|
| Rate for Payer: 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
|
IP
|
$144.37
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$144.37 |
| Rate for Payer: Aetna Commercial |
$129.93
|
| Rate for Payer: ASR ASR |
$140.04
|
| Rate for Payer: ASR Commercial |
$140.04
|
| Rate for Payer: BCBS Trust/PPO |
$117.65
|
| Rate for Payer: BCN Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$135.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$144.37
|
| Rate for Payer: Healthscope Whirlpool |
$140.04
|
| Rate for Payer: Mclaren Commercial |
$129.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.71
|
| Rate for Payer: Nomi Health Commercial |
$118.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.05
|
|
|
HC LOC INFIL W/CS 15 MIN
|
Facility
|
OP
|
$144.37
|
|
| Hospital Charge Code |
37000007
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$144.37 |
| Rate for Payer: Aetna Commercial |
$129.93
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: ASR ASR |
$140.04
|
| Rate for Payer: ASR Commercial |
$140.04
|
| Rate for Payer: BCBS Complete |
$57.75
|
| Rate for Payer: BCBS Trust/PPO |
$118.22
|
| Rate for Payer: BCN Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cofinity Commercial |
$135.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.50
|
| Rate for Payer: Healthscope Commercial |
$144.37
|
| Rate for Payer: Healthscope Whirlpool |
$140.04
|
| Rate for Payer: Mclaren Commercial |
$129.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.71
|
| Rate for Payer: Nomi Health Commercial |
$118.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.50
|
| Rate for Payer: Priority Health Narrow Network |
$101.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.05
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
IP
|
$721.58
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$469.03 |
| Max. Negotiated Rate |
$721.58 |
| Rate for Payer: Aetna Commercial |
$649.42
|
| Rate for Payer: ASR ASR |
$699.93
|
| Rate for Payer: ASR Commercial |
$699.93
|
| Rate for Payer: BCBS Trust/PPO |
$588.02
|
| Rate for Payer: BCN Commercial |
$559.44
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cofinity Commercial |
$678.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.26
|
| Rate for Payer: Healthscope Commercial |
$721.58
|
| Rate for Payer: Healthscope Whirlpool |
$699.93
|
| Rate for Payer: Mclaren Commercial |
$649.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.34
|
| Rate for Payer: Nomi Health Commercial |
$591.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.99
|
|
|
HC LOC INFIL W/CS 30 MIN
|
Facility
|
OP
|
$721.58
|
|
| Hospital Charge Code |
37000008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$288.63 |
| Max. Negotiated Rate |
$721.58 |
| Rate for Payer: Aetna Commercial |
$649.42
|
| Rate for Payer: Aetna Medicare |
$360.79
|
| Rate for Payer: ASR ASR |
$699.93
|
| Rate for Payer: ASR Commercial |
$699.93
|
| Rate for Payer: BCBS Complete |
$288.63
|
| Rate for Payer: BCBS Trust/PPO |
$590.90
|
| Rate for Payer: BCN Commercial |
$559.44
|
| Rate for Payer: Cash Price |
$577.26
|
| Rate for Payer: Cofinity Commercial |
$678.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.26
|
| Rate for Payer: Healthscope Commercial |
$721.58
|
| Rate for Payer: Healthscope Whirlpool |
$699.93
|
| Rate for Payer: Mclaren Commercial |
$649.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.34
|
| Rate for Payer: Nomi Health Commercial |
$591.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.25
|
| Rate for Payer: Priority Health Narrow Network |
$505.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.99
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: ASR ASR |
$3.64
|
| Rate for Payer: ASR Commercial |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Healthscope Whirlpool |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.30
|
|
|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: ASR ASR |
$3.64
|
| Rate for Payer: ASR Commercial |
$3.64
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Healthscope Whirlpool |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.29
|
| Rate for Payer: Priority Health Narrow Network |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.30
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$216.04 |
| Rate for Payer: Aetna Commercial |
$194.44
|
| Rate for Payer: ASR ASR |
$209.56
|
| Rate for Payer: ASR Commercial |
$209.56
|
| Rate for Payer: BCBS Trust/PPO |
$176.05
|
| Rate for Payer: BCN Commercial |
$167.50
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$203.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$216.04
|
| Rate for Payer: Healthscope Whirlpool |
$209.56
|
| Rate for Payer: Mclaren Commercial |
$194.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.12
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.42 |
| Max. Negotiated Rate |
$216.04 |
| Rate for Payer: Aetna Commercial |
$194.44
|
| Rate for Payer: Aetna Medicare |
$108.02
|
| Rate for Payer: ASR ASR |
$209.56
|
| Rate for Payer: ASR Commercial |
$209.56
|
| Rate for Payer: BCBS Complete |
$86.42
|
| Rate for Payer: BCBS Trust/PPO |
$176.92
|
| Rate for Payer: BCN Commercial |
$167.50
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$203.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$216.04
|
| Rate for Payer: Healthscope Whirlpool |
$209.56
|
| Rate for Payer: Mclaren Commercial |
$194.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.29
|
| Rate for Payer: Priority Health Narrow Network |
$151.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.12
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: ASR Commercial |
$89.05
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.17
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Healthscope Whirlpool |
$89.05
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
