|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.97
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health SBD |
$175.40
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna Medicare |
$139.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.97
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health SBD |
$175.40
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Cofinity Commercial |
$52.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health SBD |
$47.19
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.77
|
| Rate for Payer: UHC Medicare Advantage |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$23.52
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health SBD |
$47.19
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health SBD |
$54.75
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.77
|
| Rate for Payer: UHC Medicare Advantage |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$23.52
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.49
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health SBD |
$54.75
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,552.14
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$977.85 |
| Max. Negotiated Rate |
$1,396.93 |
| Rate for Payer: Aetna Commercial |
$1,319.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.89
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,086.50
|
| Rate for Payer: Cofinity Commercial |
$1,334.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,086.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Healthscope Commercial |
$1,396.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: PHP Commercial |
$1,319.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: Priority Health SBD |
$977.85
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,552.14
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$1,319.32
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,334.84
|
| Rate for Payer: Cofinity Commercial |
$1,086.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,086.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,396.93
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$1,319.32
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$977.85
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$610.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$610.91
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$520.10 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health SBD |
$520.10
|
|
|
HC 2 PIECE WAFER
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
27100001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna Medicare |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.72
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.72
|
| Rate for Payer: Priority Health SBD |
$8.45
|
|
|
HC 2 PIECE WAFER
|
Facility
|
IP
|
$13.42
|
|
| Hospital Charge Code |
27100001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.72
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.72
|
| Rate for Payer: Priority Health SBD |
$8.45
|
|
|
HC 3D ECHO RENDERING
|
Facility
|
IP
|
$669.19
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$421.59 |
| Max. Negotiated Rate |
$602.27 |
| Rate for Payer: Aetna Commercial |
$568.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.97
|
| Rate for Payer: Cash Price |
$535.35
|
| Rate for Payer: Cofinity Commercial |
$468.43
|
| Rate for Payer: Cofinity Commercial |
$575.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.35
|
| Rate for Payer: Healthscope Commercial |
$602.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.81
|
| Rate for Payer: PHP Commercial |
$568.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.97
|
| Rate for Payer: Priority Health SBD |
$421.59
|
|
|
HC 3D ECHO RENDERING
|
Facility
|
OP
|
$669.19
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.68 |
| Max. Negotiated Rate |
$602.27 |
| Rate for Payer: Aetna Commercial |
$568.81
|
| Rate for Payer: Aetna Medicare |
$334.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.97
|
| Rate for Payer: BCBS Complete |
$267.68
|
| Rate for Payer: Cash Price |
$535.35
|
| Rate for Payer: Cofinity Commercial |
$468.43
|
| Rate for Payer: Cofinity Commercial |
$575.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$468.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.35
|
| Rate for Payer: Healthscope Commercial |
$602.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.81
|
| Rate for Payer: PHP Commercial |
$568.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.97
|
| Rate for Payer: Priority Health SBD |
$421.59
|
| Rate for Payer: UHC Core |
$495.20
|
| Rate for Payer: UHC Exchange |
$495.20
|
|
|
HC 3D ECHO REND W/WORKSTATION
|
Facility
|
OP
|
$637.87
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.15 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$542.19
|
| Rate for Payer: Aetna Medicare |
$318.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.62
|
| Rate for Payer: BCBS Complete |
$255.15
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cofinity Commercial |
$446.51
|
| Rate for Payer: Cofinity Commercial |
$548.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$446.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.30
|
| Rate for Payer: Healthscope Commercial |
$574.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.19
|
| Rate for Payer: PHP Commercial |
$542.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.62
|
| Rate for Payer: Priority Health SBD |
$401.86
|
| Rate for Payer: UHC Core |
$472.02
|
| Rate for Payer: UHC Exchange |
$472.02
|
|
|
HC 3D ECHO REND W/WORKSTATION
|
Facility
|
IP
|
$637.87
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$542.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.62
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cofinity Commercial |
$446.51
|
| Rate for Payer: Cofinity Commercial |
$548.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$446.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.30
|
| Rate for Payer: Healthscope Commercial |
$574.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.19
|
| Rate for Payer: PHP Commercial |
$542.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.62
|
| Rate for Payer: Priority Health SBD |
$401.86
|
|
|
HC 4X4 WAFER
|
Facility
|
OP
|
$24.51
|
|
| Hospital Charge Code |
27000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$12.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health SBD |
$15.44
|
|
|
HC 4X4 WAFER
|
Facility
|
IP
|
$24.51
|
|
| Hospital Charge Code |
27000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.93
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$17.16
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health SBD |
$15.44
|
|
|
HC 5 FR SOLO 3CG POWER PICC
|
Facility
|
IP
|
$1,126.57
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$709.74 |
| Max. Negotiated Rate |
$1,013.91 |
| Rate for Payer: Aetna Commercial |
$957.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.27
|
| Rate for Payer: Cash Price |
$901.26
|
| Rate for Payer: Cofinity Commercial |
$788.60
|
| Rate for Payer: Cofinity Commercial |
$968.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$788.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.26
|
| Rate for Payer: Healthscope Commercial |
$1,013.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.58
|
| Rate for Payer: PHP Commercial |
$957.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.27
|
| Rate for Payer: Priority Health SBD |
$709.74
|
|
|
HC 5 FR SOLO 3CG POWER PICC
|
Facility
|
OP
|
$1,126.57
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.63 |
| Max. Negotiated Rate |
$1,013.91 |
| Rate for Payer: Aetna Commercial |
$957.58
|
| Rate for Payer: Aetna Medicare |
$563.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.27
|
| Rate for Payer: BCBS Complete |
$450.63
|
| Rate for Payer: Cash Price |
$901.26
|
| Rate for Payer: Cofinity Commercial |
$788.60
|
| Rate for Payer: Cofinity Commercial |
$968.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$788.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.26
|
| Rate for Payer: Healthscope Commercial |
$1,013.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.58
|
| Rate for Payer: PHP Commercial |
$957.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.27
|
| Rate for Payer: Priority Health SBD |
$709.74
|
|
|
HC 5FR SOLO POWER PICC
|
Facility
|
OP
|
$976.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.50 |
| Max. Negotiated Rate |
$878.63 |
| Rate for Payer: Aetna Commercial |
$829.82
|
| Rate for Payer: Aetna Medicare |
$488.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.57
|
| Rate for Payer: BCBS Complete |
$390.50
|
| Rate for Payer: Cash Price |
$781.01
|
| Rate for Payer: Cofinity Commercial |
$683.38
|
| Rate for Payer: Cofinity Commercial |
$839.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$683.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.01
|
| Rate for Payer: Healthscope Commercial |
$878.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.82
|
| Rate for Payer: PHP Commercial |
$829.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.57
|
| Rate for Payer: Priority Health SBD |
$615.04
|
|
|
HC 5FR SOLO POWER PICC
|
Facility
|
IP
|
$976.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.04 |
| Max. Negotiated Rate |
$878.63 |
| Rate for Payer: Aetna Commercial |
$829.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.57
|
| Rate for Payer: Cash Price |
$781.01
|
| Rate for Payer: Cofinity Commercial |
$683.38
|
| Rate for Payer: Cofinity Commercial |
$839.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$683.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.01
|
| Rate for Payer: Healthscope Commercial |
$878.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.82
|
| Rate for Payer: PHP Commercial |
$829.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.57
|
| Rate for Payer: Priority Health SBD |
$615.04
|
|
|
HC 5 FR TL 3CG MAX POWER PICC
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.27 |
| Max. Negotiated Rate |
$1,106.10 |
| Rate for Payer: Aetna Commercial |
$1,044.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.85
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,056.94
|
| Rate for Payer: Cofinity Commercial |
$860.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$860.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.20
|
| Rate for Payer: Healthscope Commercial |
$1,106.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.65
|
| Rate for Payer: PHP Commercial |
$1,044.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health SBD |
$774.27
|
|
|
HC 5 FR TL 3CG MAX POWER PICC
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$1,106.10 |
| Rate for Payer: Aetna Commercial |
$1,044.65
|
| Rate for Payer: Aetna Medicare |
$614.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.85
|
| Rate for Payer: BCBS Complete |
$491.60
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,056.94
|
| Rate for Payer: Cofinity Commercial |
$860.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$860.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.20
|
| Rate for Payer: Healthscope Commercial |
$1,106.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.65
|
| Rate for Payer: PHP Commercial |
$1,044.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health SBD |
$774.27
|
|
|
HC 5 FR TL SOLO MAX POWER PICC
|
Facility
|
IP
|
$1,065.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.96 |
| Max. Negotiated Rate |
$958.51 |
| Rate for Payer: Aetna Commercial |
$905.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.26
|
| Rate for Payer: Cash Price |
$852.01
|
| Rate for Payer: Cofinity Commercial |
$745.51
|
| Rate for Payer: Cofinity Commercial |
$915.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$745.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.01
|
| Rate for Payer: Healthscope Commercial |
$958.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.26
|
| Rate for Payer: PHP Commercial |
$905.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.26
|
| Rate for Payer: Priority Health SBD |
$670.96
|
|
