|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
OP
|
$1,754.30
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$3,441.80 |
| Rate for Payer: Aetna Commercial |
$1,578.87
|
| Rate for Payer: Aetna Medicare |
$1,048.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: ASR ASR |
$1,701.67
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.11
|
| Rate for Payer: BCN Commercial |
$1,360.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cofinity Commercial |
$1,649.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,403.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,701.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,048.94
|
| Rate for Payer: Mclaren Commercial |
$1,578.87
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,491.16
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Commercial |
$1,153.83
|
| Rate for Payer: PHP Medicaid |
$573.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,441.80
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,753.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,543.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
|
HC ABSCESS ISHIO/PERIRECTAL
|
Facility
|
IP
|
$1,754.30
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
36100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,228.01 |
| Max. Negotiated Rate |
$1,754.30 |
| Rate for Payer: Aetna Commercial |
$1,578.87
|
| Rate for Payer: ASR ASR |
$1,701.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.11
|
| Rate for Payer: BCN Commercial |
$1,360.11
|
| Rate for Payer: Cash Price |
$1,403.44
|
| Rate for Payer: Cofinity Commercial |
$1,649.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,403.44
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,701.67
|
| Rate for Payer: Mclaren Commercial |
$1,578.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,491.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,228.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,543.78
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
OP
|
$192.14
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$192.14 |
| Rate for Payer: Aetna Commercial |
$172.93
|
| Rate for Payer: ASR ASR |
$186.38
|
| Rate for Payer: BCBS Complete |
$76.86
|
| Rate for Payer: BCBS Trust/PPO |
$148.97
|
| Rate for Payer: BCN Commercial |
$148.97
|
| Rate for Payer: Cash Price |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$180.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.71
|
| Rate for Payer: Healthscope Commercial |
$192.14
|
| Rate for Payer: Healthscope Whirlpool |
$186.38
|
| Rate for Payer: Mclaren Commercial |
$172.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.85
|
| Rate for Payer: Priority Health Narrow Network |
$136.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.08
|
|
|
HC ACAPELLA SUPPLY
|
Facility
|
IP
|
$192.14
|
|
| Hospital Charge Code |
27000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.50 |
| Max. Negotiated Rate |
$192.14 |
| Rate for Payer: Aetna Commercial |
$172.93
|
| Rate for Payer: ASR ASR |
$186.38
|
| Rate for Payer: BCBS Trust/PPO |
$148.97
|
| Rate for Payer: BCN Commercial |
$148.97
|
| Rate for Payer: Cash Price |
$153.71
|
| Rate for Payer: Cofinity Commercial |
$180.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.71
|
| Rate for Payer: Healthscope Commercial |
$192.14
|
| Rate for Payer: Healthscope Whirlpool |
$186.38
|
| Rate for Payer: Mclaren Commercial |
$172.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.08
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
IP
|
$92.44
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.71 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna Commercial |
$83.20
|
| Rate for Payer: ASR ASR |
$89.67
|
| Rate for Payer: BCBS Trust/PPO |
$71.67
|
| Rate for Payer: BCN Commercial |
$71.67
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$86.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.95
|
| Rate for Payer: Healthscope Commercial |
$92.44
|
| Rate for Payer: Healthscope Whirlpool |
$89.67
|
| Rate for Payer: Mclaren Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.35
|
|
|
HC ACB APLIGRAF PER SQ CM
|
Facility
|
OP
|
$92.44
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.98 |
| Max. Negotiated Rate |
$92.44 |
| Rate for Payer: Aetna Commercial |
$83.20
|
| Rate for Payer: ASR ASR |
$89.67
|
| Rate for Payer: BCBS Complete |
$36.98
|
| Rate for Payer: BCBS Trust/PPO |
$71.67
|
| Rate for Payer: BCN Commercial |
$71.67
|
| Rate for Payer: Cash Price |
$73.95
|
| Rate for Payer: Cofinity Commercial |
$86.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.95
|
| Rate for Payer: Healthscope Commercial |
$92.44
|
| Rate for Payer: Healthscope Whirlpool |
$89.67
|
| Rate for Payer: Mclaren Commercial |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.12
|
| Rate for Payer: Priority Health Narrow Network |
$65.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.35
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
OP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$355.31 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: ASR ASR |
$344.65
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS Trust/PPO |
$275.47
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$275.47
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$333.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$355.31
|
| Rate for Payer: Healthscope Whirlpool |
$344.65
|
| Rate for Payer: Mclaren Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.67
|
|
|
HC ACB ESTABLISHED PT LEVEL 1
|
Facility
|
IP
|
$355.31
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$248.72 |
| Max. Negotiated Rate |
$355.31 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: ASR ASR |
$344.65
|
| Rate for Payer: BCBS Trust/PPO |
$275.47
|
| Rate for Payer: BCN Commercial |
$275.47
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cofinity Commercial |
$333.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.25
|
| Rate for Payer: Healthscope Commercial |
$355.31
|
| Rate for Payer: Healthscope Whirlpool |
$344.65
|
| Rate for Payer: Mclaren Commercial |
$319.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.67
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$346.10 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Trust/PPO |
$383.33
|
| Rate for Payer: BCN Commercial |
$383.33
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$494.43
|
| Rate for Payer: Healthscope Whirlpool |
$479.60
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
HC ACB ESTABLISHED PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$383.33
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$383.33
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$494.43
|
| Rate for Payer: Healthscope Whirlpool |
$479.60
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.52
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.96
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$534.07
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$534.07
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$647.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$688.85
|
| Rate for Payer: Healthscope Whirlpool |
$668.18
|
| Rate for Payer: Mclaren Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.06
|
| Rate for Payer: Priority Health Narrow Network |
$158.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
HC ACB ESTABLISHED PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$482.20 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.96
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: BCBS Trust/PPO |
$534.07
|
| Rate for Payer: BCN Commercial |
$534.07
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$647.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$688.85
|
| Rate for Payer: Healthscope Whirlpool |
$668.18
|
| Rate for Payer: Mclaren Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$874.52 |
| Rate for Payer: Aetna Commercial |
$787.07
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS Trust/PPO |
$678.02
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$678.02
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$874.52
|
| Rate for Payer: Healthscope Whirlpool |
$848.28
|
| Rate for Payer: Mclaren Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.58
|
| Rate for Payer: Priority Health Narrow Network |
$174.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
HC ACB ESTABLISHED PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000075
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$612.16 |
| Max. Negotiated Rate |
$874.52 |
| Rate for Payer: Aetna Commercial |
$787.07
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: BCBS Trust/PPO |
$678.02
|
| Rate for Payer: BCN Commercial |
$678.02
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$874.52
|
| Rate for Payer: Healthscope Whirlpool |
$848.28
|
| Rate for Payer: Mclaren Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$730.02 |
| Max. Negotiated Rate |
$1,042.88 |
| Rate for Payer: Aetna Commercial |
$938.59
|
| Rate for Payer: ASR ASR |
$1,011.59
|
| Rate for Payer: BCBS Trust/PPO |
$808.54
|
| Rate for Payer: BCN Commercial |
$808.54
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$980.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$1,042.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.59
|
| Rate for Payer: Mclaren Commercial |
$938.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.73
|
|
|
HC ACB ESTABLISHED PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$417.15 |
| Max. Negotiated Rate |
$1,042.88 |
| Rate for Payer: Aetna Commercial |
$938.59
|
| Rate for Payer: ASR ASR |
$1,011.59
|
| Rate for Payer: BCBS Complete |
$417.15
|
| Rate for Payer: BCBS Trust/PPO |
$808.54
|
| Rate for Payer: BCN Commercial |
$808.54
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cofinity Commercial |
$980.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$834.30
|
| Rate for Payer: Healthscope Commercial |
$1,042.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,011.59
|
| Rate for Payer: Mclaren Commercial |
$938.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$886.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.02
|
| Rate for Payer: Priority Health Narrow Network |
$740.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$917.73
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
IP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna Commercial |
$335.47
|
| Rate for Payer: ASR ASR |
$361.56
|
| Rate for Payer: BCBS Trust/PPO |
$288.99
|
| Rate for Payer: BCN Commercial |
$288.99
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$372.74
|
| Rate for Payer: Healthscope Whirlpool |
$361.56
|
| Rate for Payer: Mclaren Commercial |
$335.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.01
|
|
|
HC ACB GARMENT MEASURE VISIT
|
Facility
|
OP
|
$372.74
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna Commercial |
$335.47
|
| Rate for Payer: ASR ASR |
$361.56
|
| Rate for Payer: BCBS Complete |
$149.10
|
| Rate for Payer: BCBS Trust/PPO |
$288.99
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$288.99
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cash Price |
$298.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.19
|
| Rate for Payer: Healthscope Commercial |
$372.74
|
| Rate for Payer: Healthscope Whirlpool |
$361.56
|
| Rate for Payer: Mclaren Commercial |
$335.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.01
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
IP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: Aetna Commercial |
$148.64
|
| Rate for Payer: ASR ASR |
$160.21
|
| Rate for Payer: BCBS Trust/PPO |
$128.05
|
| Rate for Payer: BCN Commercial |
$128.05
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$165.16
|
| Rate for Payer: Healthscope Whirlpool |
$160.21
|
| Rate for Payer: Mclaren Commercial |
$148.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.34
|
|
|
HC ACB NEW PATIENT VISIT
|
Facility
|
OP
|
$165.16
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$165.16 |
| Rate for Payer: Aetna Commercial |
$148.64
|
| Rate for Payer: ASR ASR |
$160.21
|
| Rate for Payer: BCBS Complete |
$66.06
|
| Rate for Payer: BCBS Trust/PPO |
$128.05
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$128.05
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cofinity Commercial |
$155.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$165.16
|
| Rate for Payer: Healthscope Whirlpool |
$160.21
|
| Rate for Payer: Mclaren Commercial |
$148.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.34
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
IP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$346.10 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Trust/PPO |
$383.33
|
| Rate for Payer: BCN Commercial |
$383.33
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$494.43
|
| Rate for Payer: Healthscope Whirlpool |
$479.60
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
HC ACB NEW PT LEVEL 2
|
Facility
|
OP
|
$494.43
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$494.43 |
| Rate for Payer: Aetna Commercial |
$444.99
|
| Rate for Payer: ASR ASR |
$479.60
|
| Rate for Payer: BCBS Complete |
$197.77
|
| Rate for Payer: BCBS Trust/PPO |
$383.33
|
| Rate for Payer: BCCCP Commercial |
$45.00
|
| Rate for Payer: BCN Commercial |
$383.33
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cash Price |
$395.54
|
| Rate for Payer: Cofinity Commercial |
$464.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.54
|
| Rate for Payer: Healthscope Commercial |
$494.43
|
| Rate for Payer: Healthscope Whirlpool |
$479.60
|
| Rate for Payer: Mclaren Commercial |
$444.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.52
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.10
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
IP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$482.20 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.96
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: BCBS Trust/PPO |
$534.07
|
| Rate for Payer: BCN Commercial |
$534.07
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$647.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$688.85
|
| Rate for Payer: Healthscope Whirlpool |
$668.18
|
| Rate for Payer: Mclaren Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
HC ACB NEW PT LEVEL 3
|
Facility
|
OP
|
$688.85
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$688.85 |
| Rate for Payer: Aetna Commercial |
$619.96
|
| Rate for Payer: ASR ASR |
$668.18
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS Trust/PPO |
$534.07
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$534.07
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cofinity Commercial |
$647.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$688.85
|
| Rate for Payer: Healthscope Whirlpool |
$668.18
|
| Rate for Payer: Mclaren Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.21
|
| Rate for Payer: Priority Health Narrow Network |
$163.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$606.19
|
|
|
HC ACB NEW PT LEVEL 4
|
Facility
|
IP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$612.16 |
| Max. Negotiated Rate |
$874.52 |
| Rate for Payer: Aetna Commercial |
$787.07
|
| Rate for Payer: ASR ASR |
$848.28
|
| Rate for Payer: BCBS Trust/PPO |
$678.02
|
| Rate for Payer: BCN Commercial |
$678.02
|
| Rate for Payer: Cash Price |
$699.62
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.62
|
| Rate for Payer: Healthscope Commercial |
$874.52
|
| Rate for Payer: Healthscope Whirlpool |
$848.28
|
| Rate for Payer: Mclaren Commercial |
$787.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
