|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,377.00
|
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: ASR ASR |
$1,484.10
|
| Rate for Payer: ASR Commercial |
$1,484.10
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.92
|
| Rate for Payer: BCN Commercial |
$1,186.21
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,438.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.10
|
| Rate for Payer: Mclaren Commercial |
$1,377.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Nomi Health Commercial |
$1,254.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,340.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,072.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.40
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$2,295.00
|
| Rate for Payer: ASR ASR |
$2,473.50
|
| Rate for Payer: ASR Commercial |
$2,473.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,078.00
|
| Rate for Payer: BCN Commercial |
$1,977.02
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$2,397.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.50
|
| Rate for Payer: Mclaren Commercial |
$2,295.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.50
|
| Rate for Payer: Nomi Health Commercial |
$2,091.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,244.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$2,295.00
|
| Rate for Payer: Aetna Medicare |
$1,275.00
|
| Rate for Payer: ASR ASR |
$2,473.50
|
| Rate for Payer: ASR Commercial |
$2,473.50
|
| Rate for Payer: BCBS Complete |
$1,020.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,088.20
|
| Rate for Payer: BCN Commercial |
$1,977.02
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$2,397.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Commercial |
$2,550.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.50
|
| Rate for Payer: Mclaren Commercial |
$2,295.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.50
|
| Rate for Payer: Nomi Health Commercial |
$2,091.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,234.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,787.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,244.00
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
IP
|
$158.36
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.93 |
| Max. Negotiated Rate |
$158.36 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: ASR ASR |
$153.61
|
| Rate for Payer: ASR Commercial |
$153.61
|
| Rate for Payer: BCBS Trust/PPO |
$129.05
|
| Rate for Payer: BCN Commercial |
$122.78
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.69
|
| Rate for Payer: Healthscope Commercial |
$158.36
|
| Rate for Payer: Healthscope Whirlpool |
$153.61
|
| Rate for Payer: Mclaren Commercial |
$142.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.61
|
| Rate for Payer: Nomi Health Commercial |
$129.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.36
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$158.36
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$153.61
|
| Rate for Payer: ASR Commercial |
$153.61
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$129.68
|
| Rate for Payer: BCN Commercial |
$122.78
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$158.36
|
| Rate for Payer: Healthscope Whirlpool |
$153.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$142.52
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.61
|
| Rate for Payer: Nomi Health Commercial |
$129.86
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: Aetna Medicare |
$28.09
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: ASR Commercial |
$54.49
|
| Rate for Payer: BCBS Complete |
$22.47
|
| Rate for Payer: BCBS Trust/PPO |
$46.01
|
| Rate for Payer: BCN Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Healthscope Whirlpool |
$54.49
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$50.56
|
| Rate for Payer: ASR ASR |
$54.49
|
| Rate for Payer: ASR Commercial |
$54.49
|
| Rate for Payer: BCBS Trust/PPO |
$45.78
|
| Rate for Payer: BCN Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$52.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Healthscope Whirlpool |
$54.49
|
| Rate for Payer: Mclaren Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.44
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.86 |
| Max. Negotiated Rate |
$169.02 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: ASR ASR |
$163.95
|
| Rate for Payer: ASR Commercial |
$163.95
|
| Rate for Payer: BCBS Trust/PPO |
$137.73
|
| Rate for Payer: BCN Commercial |
$131.04
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$169.02
|
| Rate for Payer: Healthscope Whirlpool |
$163.95
|
| Rate for Payer: Mclaren Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.61 |
| Max. Negotiated Rate |
$189.95 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: Aetna Medicare |
$84.51
|
| Rate for Payer: ASR ASR |
$163.95
|
| Rate for Payer: ASR Commercial |
$163.95
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS Trust/PPO |
$138.41
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$131.04
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$169.02
|
| Rate for Payer: Healthscope Whirlpool |
$163.95
|
| Rate for Payer: Mclaren Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.74
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: Aetna Medicare |
$102.55
|
| Rate for Payer: ASR ASR |
$198.95
|
| Rate for Payer: ASR Commercial |
$198.95
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS Trust/PPO |
$167.96
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$205.10
|
| Rate for Payer: Healthscope Whirlpool |
$198.95
|
| Rate for Payer: Mclaren Commercial |
$184.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.50
|
| Rate for Payer: Priority Health Narrow Network |
$174.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.49
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.32 |
| Max. Negotiated Rate |
$205.10 |
| Rate for Payer: Aetna Commercial |
$184.59
|
| Rate for Payer: ASR ASR |
$198.95
|
| Rate for Payer: ASR Commercial |
$198.95
|
| Rate for Payer: BCBS Trust/PPO |
$167.14
|
| Rate for Payer: BCN Commercial |
$159.01
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$192.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$205.10
|
| Rate for Payer: Healthscope Whirlpool |
$198.95
|
| Rate for Payer: Mclaren Commercial |
$184.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.49
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$294.53 |
| Rate for Payer: Aetna Commercial |
$265.08
|
| Rate for Payer: Aetna Medicare |
$147.26
|
| Rate for Payer: ASR ASR |
$285.69
|
| Rate for Payer: ASR Commercial |
$285.69
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$241.19
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$228.35
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$294.53
|
| Rate for Payer: Healthscope Whirlpool |
$285.69
|
| Rate for Payer: Mclaren Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.07
|
| Rate for Payer: Priority Health Narrow Network |
$206.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.19
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$294.53 |
| Rate for Payer: Aetna Commercial |
$265.08
|
| Rate for Payer: ASR ASR |
$285.69
|
| Rate for Payer: ASR Commercial |
$285.69
|
| Rate for Payer: BCBS Trust/PPO |
$240.01
|
| Rate for Payer: BCN Commercial |
$228.35
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$276.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$294.53
|
| Rate for Payer: Healthscope Whirlpool |
$285.69
|
| Rate for Payer: Mclaren Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.19
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.78 |
| Max. Negotiated Rate |
$490.43 |
| Rate for Payer: Aetna Commercial |
$441.39
|
| Rate for Payer: ASR ASR |
$475.72
|
| Rate for Payer: ASR Commercial |
$475.72
|
| Rate for Payer: BCBS Trust/PPO |
$399.65
|
| Rate for Payer: BCN Commercial |
$380.23
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$490.43
|
| Rate for Payer: Healthscope Whirlpool |
$475.72
|
| Rate for Payer: Mclaren Commercial |
$441.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.58
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$490.43 |
| Rate for Payer: Aetna Commercial |
$441.39
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: ASR ASR |
$475.72
|
| Rate for Payer: ASR Commercial |
$475.72
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS Trust/PPO |
$401.61
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$380.23
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$461.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$490.43
|
| Rate for Payer: Healthscope Whirlpool |
$475.72
|
| Rate for Payer: Mclaren Commercial |
$441.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.71
|
| Rate for Payer: Priority Health Narrow Network |
$343.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.58
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: ASR Commercial |
$60.35
|
| Rate for Payer: BCBS Complete |
$24.89
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.52
|
| Rate for Payer: Priority Health Narrow Network |
$43.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: ASR Commercial |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$50.70
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.76
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.69
|
| Rate for Payer: Priority Health Narrow Network |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: ASR Commercial |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.56
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,430.50
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,229.82 |
| Max. Negotiated Rate |
$3,430.50 |
| Rate for Payer: Aetna Commercial |
$3,087.45
|
| Rate for Payer: ASR ASR |
$3,327.58
|
| Rate for Payer: ASR Commercial |
$3,327.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,795.51
|
| Rate for Payer: BCN Commercial |
$2,659.67
|
| Rate for Payer: Cash Price |
$2,744.40
|
| Rate for Payer: Cofinity Commercial |
$3,224.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.40
|
| Rate for Payer: Healthscope Commercial |
$3,430.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,327.58
|
| Rate for Payer: Mclaren Commercial |
$3,087.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.92
|
| Rate for Payer: Nomi Health Commercial |
$2,813.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,229.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,018.84
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$5,085.75
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$3,305.74 |
| Max. Negotiated Rate |
$5,085.75 |
| Rate for Payer: Aetna Commercial |
$4,577.18
|
| Rate for Payer: ASR ASR |
$4,933.18
|
| Rate for Payer: ASR Commercial |
$4,933.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,144.38
|
| Rate for Payer: BCN Commercial |
$3,942.98
|
| Rate for Payer: Cash Price |
$4,068.60
|
| Rate for Payer: Cofinity Commercial |
$4,780.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,068.60
|
| Rate for Payer: Healthscope Commercial |
$5,085.75
|
| Rate for Payer: Healthscope Whirlpool |
$4,933.18
|
| Rate for Payer: Mclaren Commercial |
$4,577.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,322.89
|
| Rate for Payer: Nomi Health Commercial |
$4,170.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,305.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,475.46
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$3,461.64 |
| Max. Negotiated Rate |
$5,325.60 |
| Rate for Payer: Aetna Commercial |
$4,793.04
|
| Rate for Payer: ASR ASR |
$5,165.83
|
| Rate for Payer: ASR Commercial |
$5,165.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,339.83
|
| Rate for Payer: BCN Commercial |
$4,128.94
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$5,006.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Healthscope Commercial |
$5,325.60
|
| Rate for Payer: Healthscope Whirlpool |
$5,165.83
|
| Rate for Payer: Mclaren Commercial |
$4,793.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,686.53
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: Aetna Medicare |
$100.47
|
| Rate for Payer: ASR ASR |
$194.91
|
| Rate for Payer: ASR Commercial |
$194.91
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS Trust/PPO |
$164.55
|
| Rate for Payer: BCN Commercial |
$155.79
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$188.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$200.94
|
| Rate for Payer: Healthscope Whirlpool |
$194.91
|
| Rate for Payer: Mclaren Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.83
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$200.94 |
| Rate for Payer: Aetna Commercial |
$180.85
|
| Rate for Payer: ASR ASR |
$194.91
|
| Rate for Payer: ASR Commercial |
$194.91
|
| Rate for Payer: BCBS Trust/PPO |
$163.75
|
| Rate for Payer: BCN Commercial |
$155.79
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$188.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$200.94
|
| Rate for Payer: Healthscope Whirlpool |
$194.91
|
| Rate for Payer: Mclaren Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.83
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,362.67
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,535.74 |
| Max. Negotiated Rate |
$2,362.67 |
| Rate for Payer: Aetna Commercial |
$2,126.40
|
| Rate for Payer: ASR ASR |
$2,291.79
|
| Rate for Payer: ASR Commercial |
$2,291.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,925.34
|
| Rate for Payer: BCN Commercial |
$1,831.78
|
| Rate for Payer: Cash Price |
$1,890.14
|
| Rate for Payer: Cofinity Commercial |
$2,220.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,890.14
|
| Rate for Payer: Healthscope Commercial |
$2,362.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,291.79
|
| Rate for Payer: Mclaren Commercial |
$2,126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,008.27
|
| Rate for Payer: Nomi Health Commercial |
$1,937.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,079.15
|
|
