|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$134.34 |
| Max. Negotiated Rate |
$1,257.09 |
| Rate for Payer: Aetna Commercial |
$1,131.38
|
| Rate for Payer: Aetna Medicare |
$250.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$313.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$313.29
|
| Rate for Payer: ASR ASR |
$1,219.38
|
| Rate for Payer: ASR Commercial |
$1,219.38
|
| Rate for Payer: BCBS Complete |
$141.05
|
| Rate for Payer: BCBS MAPPO |
$250.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.43
|
| Rate for Payer: BCN Commercial |
$974.62
|
| Rate for Payer: BCN Medicare Advantage |
$250.63
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.63
|
| Rate for Payer: Healthscope Commercial |
$1,257.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,219.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$250.63
|
| Rate for Payer: Mclaren Commercial |
$1,131.38
|
| Rate for Payer: Mclaren Medicaid |
$134.34
|
| Rate for Payer: Mclaren Medicare |
$250.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.16
|
| Rate for Payer: Meridian Medicaid |
$141.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: Nomi Health Commercial |
$1,030.81
|
| Rate for Payer: PACE Medicare |
$238.10
|
| Rate for Payer: PACE SWMI |
$250.63
|
| Rate for Payer: PHP Commercial |
$275.69
|
| Rate for Payer: PHP Medicaid |
$134.34
|
| Rate for Payer: PHP Medicare Advantage |
$250.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.62
|
| Rate for Payer: Priority Health Medicare |
$250.63
|
| Rate for Payer: Priority Health Narrow Network |
$435.70
|
| Rate for Payer: Railroad Medicare Medicare |
$250.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,106.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.63
|
| Rate for Payer: UHC Exchange |
$388.48
|
| Rate for Payer: UHC Medicare Advantage |
$250.63
|
| Rate for Payer: UHCCP DNSP |
$250.63
|
| Rate for Payer: UHCCP Medicaid |
$134.34
|
| Rate for Payer: VA VA |
$250.63
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
OP
|
$203.97
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$203.97 |
| Rate for Payer: Aetna Commercial |
$183.57
|
| Rate for Payer: Aetna Medicare |
$71.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.04
|
| Rate for Payer: ASR ASR |
$197.85
|
| Rate for Payer: ASR Commercial |
$197.85
|
| Rate for Payer: BCBS Complete |
$40.09
|
| Rate for Payer: BCBS MAPPO |
$71.23
|
| Rate for Payer: BCBS Trust/PPO |
$167.03
|
| Rate for Payer: BCN Commercial |
$158.14
|
| Rate for Payer: BCN Medicare Advantage |
$71.23
|
| Rate for Payer: Cash Price |
$163.18
|
| Rate for Payer: Cash Price |
$163.18
|
| Rate for Payer: Cofinity Commercial |
$191.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.23
|
| Rate for Payer: Healthscope Commercial |
$203.97
|
| Rate for Payer: Healthscope Whirlpool |
$197.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.23
|
| Rate for Payer: Mclaren Commercial |
$183.57
|
| Rate for Payer: Mclaren Medicaid |
$38.18
|
| Rate for Payer: Mclaren Medicare |
$71.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.79
|
| Rate for Payer: Meridian Medicaid |
$40.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.37
|
| Rate for Payer: Nomi Health Commercial |
$167.26
|
| Rate for Payer: PACE Medicare |
$67.67
|
| Rate for Payer: PACE SWMI |
$71.23
|
| Rate for Payer: PHP Commercial |
$78.35
|
| Rate for Payer: PHP Medicaid |
$38.18
|
| Rate for Payer: PHP Medicare Advantage |
$71.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.72
|
| Rate for Payer: Priority Health Medicare |
$71.23
|
| Rate for Payer: Priority Health Narrow Network |
$142.98
|
| Rate for Payer: Railroad Medicare Medicare |
$71.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.23
|
| Rate for Payer: UHC Exchange |
$110.41
|
| Rate for Payer: UHC Medicare Advantage |
$71.23
|
| Rate for Payer: UHCCP DNSP |
$71.23
|
| Rate for Payer: UHCCP Medicaid |
$38.18
|
| Rate for Payer: VA VA |
$71.23
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
IP
|
$203.97
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.58 |
| Max. Negotiated Rate |
$203.97 |
| Rate for Payer: Aetna Commercial |
$183.57
|
| Rate for Payer: ASR ASR |
$197.85
|
| Rate for Payer: ASR Commercial |
$197.85
|
| Rate for Payer: BCBS Trust/PPO |
$166.22
|
| Rate for Payer: BCN Commercial |
$158.14
|
| Rate for Payer: Cash Price |
$163.18
|
| Rate for Payer: Cofinity Commercial |
$191.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.18
|
| Rate for Payer: Healthscope Commercial |
$203.97
|
| Rate for Payer: Healthscope Whirlpool |
$197.85
|
| Rate for Payer: Mclaren Commercial |
$183.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.37
|
| Rate for Payer: Nomi Health Commercial |
$167.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.49
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
OP
|
$157.01
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$157.01 |
| Rate for Payer: Aetna Commercial |
$141.31
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: ASR ASR |
$152.30
|
| Rate for Payer: ASR Commercial |
$152.30
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Trust/PPO |
$128.58
|
| Rate for Payer: BCN Commercial |
$121.73
|
| Rate for Payer: Cash Price |
$125.61
|
| Rate for Payer: Cofinity Commercial |
$147.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.61
|
| Rate for Payer: Healthscope Commercial |
$157.01
|
| Rate for Payer: Healthscope Whirlpool |
$152.30
|
| Rate for Payer: Mclaren Commercial |
$141.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.46
|
| Rate for Payer: Nomi Health Commercial |
$128.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.57
|
| Rate for Payer: Priority Health Narrow Network |
$110.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.17
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
IP
|
$157.01
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$102.06 |
| Max. Negotiated Rate |
$157.01 |
| Rate for Payer: Aetna Commercial |
$141.31
|
| Rate for Payer: ASR ASR |
$152.30
|
| Rate for Payer: ASR Commercial |
$152.30
|
| Rate for Payer: BCBS Trust/PPO |
$127.95
|
| Rate for Payer: BCN Commercial |
$121.73
|
| Rate for Payer: Cash Price |
$125.61
|
| Rate for Payer: Cofinity Commercial |
$147.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.61
|
| Rate for Payer: Healthscope Commercial |
$157.01
|
| Rate for Payer: Healthscope Whirlpool |
$152.30
|
| Rate for Payer: Mclaren Commercial |
$141.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.46
|
| Rate for Payer: Nomi Health Commercial |
$128.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.17
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
IP
|
$370.68
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$240.94 |
| Max. Negotiated Rate |
$370.68 |
| Rate for Payer: Aetna Commercial |
$333.61
|
| Rate for Payer: ASR ASR |
$359.56
|
| Rate for Payer: ASR Commercial |
$359.56
|
| Rate for Payer: BCBS Trust/PPO |
$302.07
|
| Rate for Payer: BCN Commercial |
$287.39
|
| Rate for Payer: Cash Price |
$296.54
|
| Rate for Payer: Cofinity Commercial |
$348.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.54
|
| Rate for Payer: Healthscope Commercial |
$370.68
|
| Rate for Payer: Healthscope Whirlpool |
$359.56
|
| Rate for Payer: Mclaren Commercial |
$333.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.08
|
| Rate for Payer: Nomi Health Commercial |
$303.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.20
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
OP
|
$370.68
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$148.27 |
| Max. Negotiated Rate |
$370.68 |
| Rate for Payer: Aetna Commercial |
$333.61
|
| Rate for Payer: Aetna Medicare |
$185.34
|
| Rate for Payer: ASR ASR |
$359.56
|
| Rate for Payer: ASR Commercial |
$359.56
|
| Rate for Payer: BCBS Complete |
$148.27
|
| Rate for Payer: BCBS Trust/PPO |
$303.55
|
| Rate for Payer: BCN Commercial |
$287.39
|
| Rate for Payer: Cash Price |
$296.54
|
| Rate for Payer: Cofinity Commercial |
$348.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.54
|
| Rate for Payer: Healthscope Commercial |
$370.68
|
| Rate for Payer: Healthscope Whirlpool |
$359.56
|
| Rate for Payer: Mclaren Commercial |
$333.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.08
|
| Rate for Payer: Nomi Health Commercial |
$303.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.79
|
| Rate for Payer: Priority Health Narrow Network |
$259.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.20
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
OP
|
$183.83
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$183.83 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$91.92
|
| Rate for Payer: ASR ASR |
$178.32
|
| Rate for Payer: ASR Commercial |
$178.32
|
| Rate for Payer: BCBS Complete |
$73.53
|
| Rate for Payer: BCBS Trust/PPO |
$150.54
|
| Rate for Payer: BCN Commercial |
$142.52
|
| Rate for Payer: Cash Price |
$147.06
|
| Rate for Payer: Cofinity Commercial |
$172.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.06
|
| Rate for Payer: Healthscope Commercial |
$183.83
|
| Rate for Payer: Healthscope Whirlpool |
$178.32
|
| Rate for Payer: Mclaren Commercial |
$165.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.26
|
| Rate for Payer: Nomi Health Commercial |
$150.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.07
|
| Rate for Payer: Priority Health Narrow Network |
$128.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.77
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
IP
|
$183.83
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$183.83 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: ASR ASR |
$178.32
|
| Rate for Payer: ASR Commercial |
$178.32
|
| Rate for Payer: BCBS Trust/PPO |
$149.80
|
| Rate for Payer: BCN Commercial |
$142.52
|
| Rate for Payer: Cash Price |
$147.06
|
| Rate for Payer: Cofinity Commercial |
$172.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.06
|
| Rate for Payer: Healthscope Commercial |
$183.83
|
| Rate for Payer: Healthscope Whirlpool |
$178.32
|
| Rate for Payer: Mclaren Commercial |
$165.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.26
|
| Rate for Payer: Nomi Health Commercial |
$150.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.77
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
IP
|
$331.57
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$215.52 |
| Max. Negotiated Rate |
$331.57 |
| Rate for Payer: Aetna Commercial |
$298.41
|
| Rate for Payer: ASR ASR |
$321.62
|
| Rate for Payer: ASR Commercial |
$321.62
|
| Rate for Payer: BCBS Trust/PPO |
$270.20
|
| Rate for Payer: BCN Commercial |
$257.07
|
| Rate for Payer: Cash Price |
$265.26
|
| Rate for Payer: Cofinity Commercial |
$311.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.26
|
| Rate for Payer: Healthscope Commercial |
$331.57
|
| Rate for Payer: Healthscope Whirlpool |
$321.62
|
| Rate for Payer: Mclaren Commercial |
$298.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.83
|
| Rate for Payer: Nomi Health Commercial |
$271.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.78
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
OP
|
$331.57
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$331.57 |
| Rate for Payer: Aetna Commercial |
$298.41
|
| Rate for Payer: Aetna Medicare |
$165.78
|
| Rate for Payer: ASR ASR |
$321.62
|
| Rate for Payer: ASR Commercial |
$321.62
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS Trust/PPO |
$271.52
|
| Rate for Payer: BCN Commercial |
$257.07
|
| Rate for Payer: Cash Price |
$265.26
|
| Rate for Payer: Cofinity Commercial |
$311.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.26
|
| Rate for Payer: Healthscope Commercial |
$331.57
|
| Rate for Payer: Healthscope Whirlpool |
$321.62
|
| Rate for Payer: Mclaren Commercial |
$298.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.83
|
| Rate for Payer: Nomi Health Commercial |
$271.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.52
|
| Rate for Payer: Priority Health Narrow Network |
$232.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.78
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
OP
|
$102.17
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$102.17 |
| Rate for Payer: Aetna Commercial |
$91.95
|
| Rate for Payer: Aetna Medicare |
$51.08
|
| Rate for Payer: ASR ASR |
$99.10
|
| Rate for Payer: ASR Commercial |
$99.10
|
| Rate for Payer: BCBS Complete |
$40.87
|
| Rate for Payer: BCBS Trust/PPO |
$83.67
|
| Rate for Payer: BCN Commercial |
$79.21
|
| Rate for Payer: Cash Price |
$81.74
|
| Rate for Payer: Cofinity Commercial |
$96.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.74
|
| Rate for Payer: Healthscope Commercial |
$102.17
|
| Rate for Payer: Healthscope Whirlpool |
$99.10
|
| Rate for Payer: Mclaren Commercial |
$91.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.84
|
| Rate for Payer: Nomi Health Commercial |
$83.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.52
|
| Rate for Payer: Priority Health Narrow Network |
$71.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.91
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
IP
|
$102.17
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$66.41 |
| Max. Negotiated Rate |
$102.17 |
| Rate for Payer: Aetna Commercial |
$91.95
|
| Rate for Payer: ASR ASR |
$99.10
|
| Rate for Payer: ASR Commercial |
$99.10
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$79.21
|
| Rate for Payer: Cash Price |
$81.74
|
| Rate for Payer: Cofinity Commercial |
$96.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.74
|
| Rate for Payer: Healthscope Commercial |
$102.17
|
| Rate for Payer: Healthscope Whirlpool |
$99.10
|
| Rate for Payer: Mclaren Commercial |
$91.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.84
|
| Rate for Payer: Nomi Health Commercial |
$83.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.91
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
IP
|
$206.43
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$206.43 |
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: ASR ASR |
$200.24
|
| Rate for Payer: ASR Commercial |
$200.24
|
| Rate for Payer: BCBS Trust/PPO |
$168.22
|
| Rate for Payer: BCN Commercial |
$160.05
|
| Rate for Payer: Cash Price |
$165.14
|
| Rate for Payer: Cofinity Commercial |
$194.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.14
|
| Rate for Payer: Healthscope Commercial |
$206.43
|
| Rate for Payer: Healthscope Whirlpool |
$200.24
|
| Rate for Payer: Mclaren Commercial |
$185.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.47
|
| Rate for Payer: Nomi Health Commercial |
$169.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.66
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
OP
|
$206.43
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$82.57 |
| Max. Negotiated Rate |
$206.43 |
| Rate for Payer: Aetna Commercial |
$185.79
|
| Rate for Payer: Aetna Medicare |
$103.22
|
| Rate for Payer: ASR ASR |
$200.24
|
| Rate for Payer: ASR Commercial |
$200.24
|
| Rate for Payer: BCBS Complete |
$82.57
|
| Rate for Payer: BCBS Trust/PPO |
$169.05
|
| Rate for Payer: BCN Commercial |
$160.05
|
| Rate for Payer: Cash Price |
$165.14
|
| Rate for Payer: Cofinity Commercial |
$194.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.14
|
| Rate for Payer: Healthscope Commercial |
$206.43
|
| Rate for Payer: Healthscope Whirlpool |
$200.24
|
| Rate for Payer: Mclaren Commercial |
$185.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.47
|
| Rate for Payer: Nomi Health Commercial |
$169.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.87
|
| Rate for Payer: Priority Health Narrow Network |
$144.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.66
|
|
|
HC RECOVERY PHASE 1 COMPLEX BASE CHARGE
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
71000039
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: ASR ASR |
$112.52
|
| Rate for Payer: ASR Commercial |
$112.52
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS Trust/PPO |
$94.99
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$109.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.80
|
| Rate for Payer: Healthscope Commercial |
$116.00
|
| Rate for Payer: Healthscope Whirlpool |
$112.52
|
| Rate for Payer: Mclaren Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.60
|
| Rate for Payer: Nomi Health Commercial |
$95.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.64
|
| Rate for Payer: Priority Health Narrow Network |
$81.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.08
|
|
|
HC RECOVERY PHASE 1 COMPLEX BASE CHARGE
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
71000039
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: ASR ASR |
$112.52
|
| Rate for Payer: ASR Commercial |
$112.52
|
| Rate for Payer: BCBS Trust/PPO |
$94.53
|
| Rate for Payer: BCN Commercial |
$89.93
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$109.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.80
|
| Rate for Payer: Healthscope Commercial |
$116.00
|
| Rate for Payer: Healthscope Whirlpool |
$112.52
|
| Rate for Payer: Mclaren Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.60
|
| Rate for Payer: Nomi Health Commercial |
$95.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.08
|
|
|
HC RECOVERY PHASE 1 COMPLEX EA MIN CHARGE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
71000034
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: ASR ASR |
$14.55
|
| Rate for Payer: ASR Commercial |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCN Commercial |
$11.63
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$15.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.20
|
|
|
HC RECOVERY PHASE 1 COMPLEX EA MIN CHARGE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
71000034
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Aetna Commercial |
$13.50
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: ASR ASR |
$14.55
|
| Rate for Payer: ASR Commercial |
$14.55
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.28
|
| Rate for Payer: BCN Commercial |
$11.63
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$15.00
|
| Rate for Payer: Healthscope Whirlpool |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.75
|
| Rate for Payer: Nomi Health Commercial |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.14
|
| Rate for Payer: Priority Health Narrow Network |
$10.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.20
|
|
|
HC RECOVERY PHASE 1 STANDARD BASE CHARGE
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
71000035
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: ASR ASR |
$94.09
|
| Rate for Payer: ASR Commercial |
$94.09
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Trust/PPO |
$79.43
|
| Rate for Payer: BCN Commercial |
$75.20
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Healthscope Whirlpool |
$94.09
|
| Rate for Payer: Mclaren Commercial |
$87.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.99
|
| Rate for Payer: Priority Health Narrow Network |
$68.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.36
|
|
|
HC RECOVERY PHASE 1 STANDARD BASE CHARGE
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
71000035
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: ASR ASR |
$94.09
|
| Rate for Payer: ASR Commercial |
$94.09
|
| Rate for Payer: BCBS Trust/PPO |
$79.05
|
| Rate for Payer: BCN Commercial |
$75.20
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.60
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Healthscope Whirlpool |
$94.09
|
| Rate for Payer: Mclaren Commercial |
$87.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.45
|
| Rate for Payer: Nomi Health Commercial |
$79.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.36
|
|
|
HC RECOVERY PHASE 1 STANDARD EA MIN CHARGE
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
71000036
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: ASR Commercial |
$11.64
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.30
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$12.00
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.51
|
| Rate for Payer: Priority Health Narrow Network |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
HC RECOVERY PHASE 1 STANDARD EA MIN CHARGE
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
71000036
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: ASR Commercial |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.78
|
| Rate for Payer: BCN Commercial |
$9.30
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$12.00
|
| Rate for Payer: Healthscope Whirlpool |
$11.64
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
HC RECOVERY PHASE 2 EA MIN CHARGE
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: ASR ASR |
$8.73
|
| Rate for Payer: ASR Commercial |
$8.73
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$7.37
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Whirlpool |
$8.73
|
| Rate for Payer: Mclaren Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.65
|
| Rate for Payer: Nomi Health Commercial |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.89
|
| Rate for Payer: Priority Health Narrow Network |
$6.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.92
|
|
|
HC RECOVERY PHASE 2 EA MIN CHARGE
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
71000037
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: ASR ASR |
$8.73
|
| Rate for Payer: ASR Commercial |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$7.33
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Whirlpool |
$8.73
|
| Rate for Payer: Mclaren Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.65
|
| Rate for Payer: Nomi Health Commercial |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.92
|
|
