|
HC ACB NEW PT LEVEL 4
|
Facility
|
OP
|
$874.52
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.15 |
| 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 |
$107.15
|
| 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 |
$795.81
|
| Rate for Payer: Priority Health Narrow Network |
$620.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.58
|
|
|
HC ACB NEW PT LEVEL 5
|
Facility
|
OP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.15 |
| 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: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$808.54
|
| Rate for Payer: Cash Price |
$834.30
|
| 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 NEW PT LEVEL 5
|
Facility
|
IP
|
$1,042.88
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000104
|
|
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 ACCESS AORTA
|
Facility
|
OP
|
$3,843.44
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,537.38 |
| Max. Negotiated Rate |
$3,843.44 |
| Rate for Payer: Aetna Commercial |
$3,459.10
|
| Rate for Payer: ASR ASR |
$3,728.14
|
| Rate for Payer: BCBS Complete |
$1,537.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,979.82
|
| Rate for Payer: BCN Commercial |
$2,979.82
|
| Rate for Payer: Cash Price |
$3,074.75
|
| Rate for Payer: Cofinity Commercial |
$3,612.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.75
|
| Rate for Payer: Healthscope Commercial |
$3,843.44
|
| Rate for Payer: Healthscope Whirlpool |
$3,728.14
|
| Rate for Payer: Mclaren Commercial |
$3,459.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,266.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,690.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,497.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,728.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,382.23
|
|
|
HC ACCESS AORTA
|
Facility
|
IP
|
$3,843.44
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
36100105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,690.41 |
| Max. Negotiated Rate |
$3,843.44 |
| Rate for Payer: Aetna Commercial |
$3,459.10
|
| Rate for Payer: ASR ASR |
$3,728.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,979.82
|
| Rate for Payer: BCN Commercial |
$2,979.82
|
| Rate for Payer: Cash Price |
$3,074.75
|
| Rate for Payer: Cofinity Commercial |
$3,612.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.75
|
| Rate for Payer: Healthscope Commercial |
$3,843.44
|
| Rate for Payer: Healthscope Whirlpool |
$3,728.14
|
| Rate for Payer: Mclaren Commercial |
$3,459.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,266.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,690.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,382.23
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
IP
|
$491.10
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.77 |
| Max. Negotiated Rate |
$491.10 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: ASR ASR |
$476.37
|
| Rate for Payer: BCBS Trust/PPO |
$380.75
|
| Rate for Payer: BCN Commercial |
$380.75
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$461.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Whirlpool |
$476.37
|
| Rate for Payer: Mclaren Commercial |
$441.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.17
|
|
|
HC ACCESS EXTREMITY ARTERY
|
Facility
|
OP
|
$491.10
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
36100102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.44 |
| Max. Negotiated Rate |
$491.10 |
| Rate for Payer: Aetna Commercial |
$441.99
|
| Rate for Payer: ASR ASR |
$476.37
|
| Rate for Payer: BCBS Complete |
$196.44
|
| Rate for Payer: BCBS Trust/PPO |
$380.75
|
| Rate for Payer: BCN Commercial |
$380.75
|
| Rate for Payer: Cash Price |
$392.88
|
| Rate for Payer: Cofinity Commercial |
$461.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.88
|
| Rate for Payer: Healthscope Commercial |
$491.10
|
| Rate for Payer: Healthscope Whirlpool |
$476.37
|
| Rate for Payer: Mclaren Commercial |
$441.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.90
|
| Rate for Payer: Priority Health Narrow Network |
$348.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.17
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
IP
|
$419.20
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$419.20 |
| Rate for Payer: Aetna Commercial |
$377.28
|
| Rate for Payer: ASR ASR |
$406.62
|
| Rate for Payer: BCBS Trust/PPO |
$325.01
|
| Rate for Payer: BCN Commercial |
$325.01
|
| Rate for Payer: Cash Price |
$335.36
|
| Rate for Payer: Cofinity Commercial |
$394.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.36
|
| Rate for Payer: Healthscope Commercial |
$419.20
|
| Rate for Payer: Healthscope Whirlpool |
$406.62
|
| Rate for Payer: Mclaren Commercial |
$377.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.90
|
|
|
HC ACCESS MAIN PULMONARY
|
Facility
|
OP
|
$419.20
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.68 |
| Max. Negotiated Rate |
$419.20 |
| Rate for Payer: Aetna Commercial |
$377.28
|
| Rate for Payer: ASR ASR |
$406.62
|
| Rate for Payer: BCBS Complete |
$167.68
|
| Rate for Payer: BCBS Trust/PPO |
$325.01
|
| Rate for Payer: BCN Commercial |
$325.01
|
| Rate for Payer: Cash Price |
$335.36
|
| Rate for Payer: Cofinity Commercial |
$394.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.36
|
| Rate for Payer: Healthscope Commercial |
$419.20
|
| Rate for Payer: Healthscope Whirlpool |
$406.62
|
| Rate for Payer: Mclaren Commercial |
$377.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.47
|
| Rate for Payer: Priority Health Narrow Network |
$297.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$368.90
|
|
|
HC ACCESS VEIN
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC ACCESS VEIN
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.79
|
| Rate for Payer: Priority Health Narrow Network |
$270.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
OP
|
$1,048.38
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.35 |
| Max. Negotiated Rate |
$1,048.38 |
| Rate for Payer: Aetna Commercial |
$943.54
|
| Rate for Payer: ASR ASR |
$1,016.93
|
| Rate for Payer: BCBS Complete |
$419.35
|
| Rate for Payer: BCBS Trust/PPO |
$812.81
|
| Rate for Payer: BCN Commercial |
$812.81
|
| Rate for Payer: Cash Price |
$838.70
|
| Rate for Payer: Cofinity Commercial |
$985.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.70
|
| Rate for Payer: Healthscope Commercial |
$1,048.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.93
|
| Rate for Payer: Mclaren Commercial |
$943.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$954.03
|
| Rate for Payer: Priority Health Narrow Network |
$744.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.57
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
IP
|
$1,048.38
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$733.87 |
| Max. Negotiated Rate |
$1,048.38 |
| Rate for Payer: Aetna Commercial |
$943.54
|
| Rate for Payer: ASR ASR |
$1,016.93
|
| Rate for Payer: BCBS Trust/PPO |
$812.81
|
| Rate for Payer: BCN Commercial |
$812.81
|
| Rate for Payer: Cash Price |
$838.70
|
| Rate for Payer: Cofinity Commercial |
$985.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.70
|
| Rate for Payer: Healthscope Commercial |
$1,048.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.93
|
| Rate for Payer: Mclaren Commercial |
$943.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.57
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
OP
|
$3,067.24
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,226.90 |
| Max. Negotiated Rate |
$3,067.24 |
| Rate for Payer: Aetna Commercial |
$2,760.52
|
| Rate for Payer: ASR ASR |
$2,975.22
|
| Rate for Payer: BCBS Complete |
$1,226.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.03
|
| Rate for Payer: BCN Commercial |
$2,378.03
|
| Rate for Payer: Cash Price |
$2,453.79
|
| Rate for Payer: Cofinity Commercial |
$2,883.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,453.79
|
| Rate for Payer: Healthscope Commercial |
$3,067.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,975.22
|
| Rate for Payer: Mclaren Commercial |
$2,760.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,607.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,147.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,791.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,177.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,699.17
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
IP
|
$3,067.24
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,147.07 |
| Max. Negotiated Rate |
$3,067.24 |
| Rate for Payer: Aetna Commercial |
$2,760.52
|
| Rate for Payer: ASR ASR |
$2,975.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.03
|
| Rate for Payer: BCN Commercial |
$2,378.03
|
| Rate for Payer: Cash Price |
$2,453.79
|
| Rate for Payer: Cofinity Commercial |
$2,883.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,453.79
|
| Rate for Payer: Healthscope Commercial |
$3,067.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,975.22
|
| Rate for Payer: Mclaren Commercial |
$2,760.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,607.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,147.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,699.17
|
|
|
HC ACCESS WINDOW
|
Facility
|
OP
|
$38.17
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$38.17 |
| Rate for Payer: Aetna Commercial |
$34.35
|
| Rate for Payer: ASR ASR |
$37.02
|
| Rate for Payer: BCBS Complete |
$15.27
|
| Rate for Payer: BCBS Trust/PPO |
$29.59
|
| Rate for Payer: BCN Commercial |
$29.59
|
| Rate for Payer: Cash Price |
$30.54
|
| Rate for Payer: Cofinity Commercial |
$35.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.54
|
| Rate for Payer: Healthscope Commercial |
$38.17
|
| Rate for Payer: Healthscope Whirlpool |
$37.02
|
| Rate for Payer: Mclaren Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.73
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.59
|
|
|
HC ACCESS WINDOW
|
Facility
|
IP
|
$38.17
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.72 |
| Max. Negotiated Rate |
$38.17 |
| Rate for Payer: Aetna Commercial |
$34.35
|
| Rate for Payer: ASR ASR |
$37.02
|
| Rate for Payer: BCBS Trust/PPO |
$29.59
|
| Rate for Payer: BCN Commercial |
$29.59
|
| Rate for Payer: Cash Price |
$30.54
|
| Rate for Payer: Cofinity Commercial |
$35.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.54
|
| Rate for Payer: Healthscope Commercial |
$38.17
|
| Rate for Payer: Healthscope Whirlpool |
$37.02
|
| Rate for Payer: Mclaren Commercial |
$34.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.59
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
OP
|
$3,932.93
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,573.17 |
| Max. Negotiated Rate |
$3,932.93 |
| Rate for Payer: Aetna Commercial |
$3,539.64
|
| Rate for Payer: ASR ASR |
$3,814.94
|
| Rate for Payer: BCBS Complete |
$1,573.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,049.20
|
| Rate for Payer: BCN Commercial |
$3,049.20
|
| Rate for Payer: Cash Price |
$3,146.34
|
| Rate for Payer: Cofinity Commercial |
$3,696.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,146.34
|
| Rate for Payer: Healthscope Commercial |
$3,932.93
|
| Rate for Payer: Healthscope Whirlpool |
$3,814.94
|
| Rate for Payer: Mclaren Commercial |
$3,539.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,342.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,578.97
|
| Rate for Payer: Priority Health Narrow Network |
$2,792.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,460.98
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
IP
|
$3,932.93
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,753.05 |
| Max. Negotiated Rate |
$3,932.93 |
| Rate for Payer: Aetna Commercial |
$3,539.64
|
| Rate for Payer: ASR ASR |
$3,814.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,049.20
|
| Rate for Payer: BCN Commercial |
$3,049.20
|
| Rate for Payer: Cash Price |
$3,146.34
|
| Rate for Payer: Cofinity Commercial |
$3,696.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,146.34
|
| Rate for Payer: Healthscope Commercial |
$3,932.93
|
| Rate for Payer: Healthscope Whirlpool |
$3,814.94
|
| Rate for Payer: Mclaren Commercial |
$3,539.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,342.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,460.98
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
IP
|
$126.58
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$126.58 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: ASR ASR |
$122.78
|
| Rate for Payer: BCBS Trust/PPO |
$98.14
|
| Rate for Payer: BCN Commercial |
$98.14
|
| Rate for Payer: Cash Price |
$101.26
|
| Rate for Payer: Cofinity Commercial |
$118.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.26
|
| Rate for Payer: Healthscope Commercial |
$126.58
|
| Rate for Payer: Healthscope Whirlpool |
$122.78
|
| Rate for Payer: Mclaren Commercial |
$113.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.39
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
OP
|
$126.58
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$126.58 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$122.78
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$98.14
|
| Rate for Payer: BCN Commercial |
$98.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$101.26
|
| Rate for Payer: Cash Price |
$101.26
|
| Rate for Payer: Cofinity Commercial |
$118.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$126.58
|
| Rate for Payer: Healthscope Whirlpool |
$122.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$113.92
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.59
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.19
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$89.87
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.39
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$39.58
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$31.63
|
| Rate for Payer: BCN Commercial |
$31.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Healthscope Whirlpool |
$39.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$10.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$28.97
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$67.93
|
| Rate for Payer: ASR ASR |
$73.22
|
| Rate for Payer: BCBS Trust/PPO |
$58.52
|
| Rate for Payer: BCN Commercial |
$58.52
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Healthscope Whirlpool |
$73.22
|
| Rate for Payer: Mclaren Commercial |
$67.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.42
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$67.93
|
| Rate for Payer: ASR ASR |
$73.22
|
| Rate for Payer: BCBS Complete |
$30.19
|
| Rate for Payer: BCBS Trust/PPO |
$58.52
|
| Rate for Payer: BCN Commercial |
$58.52
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$70.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Healthscope Whirlpool |
$73.22
|
| Rate for Payer: Mclaren Commercial |
$67.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.69
|
| Rate for Payer: Priority Health Narrow Network |
$53.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.42
|
|
