|
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 |
$205.10 |
| 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: 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 |
$133.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.71
|
| Rate for Payer: Priority Health Narrow Network |
$143.78
|
| 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 |
$117.81 |
| 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: 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: 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 |
$196.17 |
| 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: 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: 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
|
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 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 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 |
$3,327.59
|
| Rate for Payer: ASR Commercial |
$3,327.59
|
| 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 |
$3,327.59
|
| Rate for Payer: Mclaren Commercial |
$3,087.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.93
|
| 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 |
$4,170.31
|
| 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
|
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 OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$80.38 |
| 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: 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 |
$176.06
|
| Rate for Payer: Priority Health Narrow Network |
$140.86
|
| 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
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$84.13 |
| Rate for Payer: Aetna Commercial |
$75.72
|
| Rate for Payer: ASR ASR |
$81.61
|
| Rate for Payer: ASR Commercial |
$81.61
|
| Rate for Payer: BCBS Trust/PPO |
$68.56
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$79.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$84.13
|
| Rate for Payer: Healthscope Whirlpool |
$81.61
|
| Rate for Payer: Mclaren Commercial |
$75.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: Nomi Health Commercial |
$68.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.03
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$84.13 |
| Rate for Payer: Aetna Commercial |
$75.72
|
| Rate for Payer: Aetna Medicare |
$42.06
|
| Rate for Payer: ASR ASR |
$81.61
|
| Rate for Payer: ASR Commercial |
$81.61
|
| Rate for Payer: BCBS Complete |
$33.65
|
| Rate for Payer: BCBS Trust/PPO |
$68.89
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$79.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$84.13
|
| Rate for Payer: Healthscope Whirlpool |
$81.61
|
| Rate for Payer: Mclaren Commercial |
$75.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: Nomi Health Commercial |
$68.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.71
|
| Rate for Payer: Priority Health Narrow Network |
$58.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.03
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$50.12 |
| Rate for Payer: Aetna Commercial |
$45.11
|
| Rate for Payer: ASR ASR |
$48.62
|
| Rate for Payer: ASR Commercial |
$48.62
|
| Rate for Payer: BCBS Trust/PPO |
$40.84
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$47.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Healthscope Commercial |
$50.12
|
| Rate for Payer: Healthscope Whirlpool |
$48.62
|
| Rate for Payer: Mclaren Commercial |
$45.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$41.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.11
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$59.33 |
| Rate for Payer: Aetna Commercial |
$45.11
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: ASR ASR |
$48.62
|
| Rate for Payer: ASR Commercial |
$48.62
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$41.04
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$47.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$50.12
|
| Rate for Payer: Healthscope Whirlpool |
$48.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.28
|
| Rate for Payer: Mclaren Commercial |
$45.11
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$41.10
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.11
|
| Rate for Payer: PHP Medicaid |
$20.52
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.92
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health Narrow Network |
$35.13
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP DNSP |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$20.52
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,182.40 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Aetna Commercial |
$4,406.40
|
| Rate for Payer: ASR ASR |
$4,749.12
|
| Rate for Payer: ASR Commercial |
$4,749.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.75
|
| Rate for Payer: BCN Commercial |
$3,795.87
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,602.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Healthscope Commercial |
$4,896.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,749.12
|
| Rate for Payer: Mclaren Commercial |
$4,406.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$4,014.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,308.48
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$4,896.00 |
| Rate for Payer: Aetna Commercial |
$4,406.40
|
| Rate for Payer: Aetna Medicare |
$1,784.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: ASR ASR |
$4,749.12
|
| Rate for Payer: ASR Commercial |
$4,749.12
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCBS Trust/PPO |
$4,009.33
|
| Rate for Payer: BCN Commercial |
$3,795.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,602.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$4,896.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,749.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,784.01
|
| Rate for Payer: Mclaren Commercial |
$4,406.40
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$4,014.72
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,962.41
|
| Rate for Payer: PHP Medicaid |
$956.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,289.88
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,432.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,308.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$2,765.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP DNSP |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$901.67
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$586.09 |
| Max. Negotiated Rate |
$901.67 |
| Rate for Payer: Aetna Commercial |
$811.50
|
| Rate for Payer: ASR ASR |
$874.62
|
| Rate for Payer: ASR Commercial |
$874.62
|
| Rate for Payer: BCBS Trust/PPO |
$734.77
|
| Rate for Payer: BCN Commercial |
$699.06
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cofinity Commercial |
$847.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.34
|
| Rate for Payer: Healthscope Commercial |
$901.67
|
| Rate for Payer: Healthscope Whirlpool |
$874.62
|
| Rate for Payer: Mclaren Commercial |
$811.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.42
|
| Rate for Payer: Nomi Health Commercial |
$739.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.47
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$901.67
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$901.67 |
| Rate for Payer: Aetna Commercial |
$811.50
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$874.62
|
| Rate for Payer: ASR Commercial |
$874.62
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$738.38
|
| Rate for Payer: BCN Commercial |
$699.06
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cofinity Commercial |
$847.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$901.67
|
| Rate for Payer: Healthscope Whirlpool |
$874.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$811.50
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.42
|
| Rate for Payer: Nomi Health Commercial |
$739.37
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$790.04
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$632.07
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,149.41
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$747.12 |
| Max. Negotiated Rate |
$1,149.41 |
| Rate for Payer: Aetna Commercial |
$1,034.47
|
| Rate for Payer: ASR ASR |
$1,114.93
|
| Rate for Payer: ASR Commercial |
$1,114.93
|
| Rate for Payer: BCBS Trust/PPO |
$936.65
|
| Rate for Payer: BCN Commercial |
$891.14
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$1,080.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.53
|
| Rate for Payer: Healthscope Commercial |
$1,149.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.93
|
| Rate for Payer: Mclaren Commercial |
$1,034.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.00
|
| Rate for Payer: Nomi Health Commercial |
$942.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,011.48
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,149.41
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,149.41 |
| Rate for Payer: Aetna Commercial |
$1,034.47
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,114.93
|
| Rate for Payer: ASR Commercial |
$1,114.93
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$941.25
|
| Rate for Payer: BCN Commercial |
$891.14
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$1,080.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,149.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,034.47
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.00
|
| Rate for Payer: Nomi Health Commercial |
$942.52
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.11
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$805.74
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,011.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
