|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
IP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.16 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Advantage |
$902.40
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.86
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health SBD |
$812.16
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
OP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna Medicare |
$644.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: BCBS Complete |
$515.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Advantage |
$902.40
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,031.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.86
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health SBD |
$812.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$837.94
|
| Rate for Payer: UHC Core |
$671.64
|
| Rate for Payer: UHC Exchange |
$506.63
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
OP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,398.01 |
| Rate for Payer: Aetna Commercial |
$1,320.34
|
| Rate for Payer: Aetna Medicare |
$776.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.67
|
| Rate for Payer: BCBS Complete |
$621.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Advantage |
$1,087.34
|
| Rate for Payer: Cofinity Commercial |
$1,335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,242.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,165.01
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: Priority Health SBD |
$978.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,009.67
|
| Rate for Payer: UHC Core |
$809.29
|
| Rate for Payer: UHC Exchange |
$610.46
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
IP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.60 |
| Max. Negotiated Rate |
$1,398.01 |
| Rate for Payer: Aetna Commercial |
$1,320.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.67
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Advantage |
$1,087.34
|
| Rate for Payer: Cofinity Commercial |
$1,335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,165.01
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: Priority Health SBD |
$978.60
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 16
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,023.75 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna Commercial |
$1,381.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.25
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cofinity Advantage |
$1,137.50
|
| Rate for Payer: Cofinity Commercial |
$1,397.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,300.00
|
| Rate for Payer: Healthscope Commercial |
$1,462.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,381.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.75
|
| Rate for Payer: PHP Commercial |
$1,381.25
|
| Rate for Payer: Priority Health SBD |
$1,023.75
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 16
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,462.50 |
| Rate for Payer: Aetna Commercial |
$1,381.25
|
| Rate for Payer: Aetna Medicare |
$812.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,056.25
|
| Rate for Payer: BCBS Complete |
$650.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cofinity Advantage |
$1,137.50
|
| Rate for Payer: Cofinity Commercial |
$1,397.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,300.00
|
| Rate for Payer: Healthscope Commercial |
$1,462.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,381.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.75
|
| Rate for Payer: PHP Commercial |
$1,381.25
|
| Rate for Payer: Priority Health SBD |
$1,023.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.25
|
| Rate for Payer: UHC Core |
$846.62
|
| Rate for Payer: UHC Exchange |
$638.62
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2,203.20 |
| Rate for Payer: Aetna Commercial |
$2,080.80
|
| Rate for Payer: Aetna Medicare |
$1,224.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.20
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Advantage |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$2,105.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,203.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,958.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.00
|
| Rate for Payer: PHP Commercial |
$2,080.80
|
| Rate for Payer: Priority Health SBD |
$1,542.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,591.20
|
| Rate for Payer: UHC Core |
$1,275.41
|
| Rate for Payer: UHC Exchange |
$962.06
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,542.24 |
| Max. Negotiated Rate |
$2,203.20 |
| Rate for Payer: Aetna Commercial |
$2,080.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Advantage |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$2,105.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,836.00
|
| Rate for Payer: PHP Commercial |
$2,080.80
|
| Rate for Payer: Priority Health SBD |
$1,542.24
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna Medicare |
$210.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Advantage |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.78
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health SBD |
$265.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.68
|
| Rate for Payer: UHC Core |
$219.36
|
| Rate for Payer: UHC Exchange |
$165.47
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.26 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Advantage |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.78
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health SBD |
$265.26
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.51 |
| Max. Negotiated Rate |
$529.30 |
| Rate for Payer: Aetna Commercial |
$499.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.27
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Advantage |
$411.68
|
| Rate for Payer: Cofinity Commercial |
$505.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$529.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.08
|
| Rate for Payer: PHP Commercial |
$499.89
|
| Rate for Payer: Priority Health SBD |
$370.51
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$529.30 |
| Rate for Payer: Aetna Commercial |
$499.89
|
| Rate for Payer: Aetna Medicare |
$294.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.27
|
| Rate for Payer: BCBS Complete |
$235.24
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Advantage |
$411.68
|
| Rate for Payer: Cofinity Commercial |
$505.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$529.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$470.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.08
|
| Rate for Payer: PHP Commercial |
$499.89
|
| Rate for Payer: Priority Health SBD |
$370.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.27
|
| Rate for Payer: UHC Core |
$306.41
|
| Rate for Payer: UHC Exchange |
$231.13
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Aetna Commercial |
$587.83
|
| Rate for Payer: Aetna Medicare |
$345.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.51
|
| Rate for Payer: BCBS Complete |
$276.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Advantage |
$484.09
|
| Rate for Payer: Cofinity Commercial |
$594.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$622.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$518.67
|
| Rate for Payer: PHP Commercial |
$587.83
|
| Rate for Payer: Priority Health SBD |
$435.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.51
|
| Rate for Payer: UHC Core |
$360.30
|
| Rate for Payer: UHC Exchange |
$271.78
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Aetna Commercial |
$587.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.51
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Advantage |
$484.09
|
| Rate for Payer: Cofinity Commercial |
$594.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$622.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$518.67
|
| Rate for Payer: PHP Commercial |
$587.83
|
| Rate for Payer: Priority Health SBD |
$435.68
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,370.75 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna Commercial |
$5,897.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.51
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Advantage |
$4,856.39
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,203.27
|
| Rate for Payer: PHP Commercial |
$5,897.05
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna Commercial |
$5,897.05
|
| Rate for Payer: Aetna Medicare |
$3,468.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.51
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Advantage |
$4,856.39
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,550.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,203.27
|
| Rate for Payer: PHP Commercial |
$5,897.05
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,509.51
|
| Rate for Payer: UHC Core |
$3,614.54
|
| Rate for Payer: UHC Exchange |
$2,726.52
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.67 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Advantage |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.80
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health SBD |
$462.67
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna Medicare |
$367.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Advantage |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$587.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.80
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health SBD |
$462.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.36
|
| Rate for Payer: UHC Core |
$382.62
|
| Rate for Payer: UHC Exchange |
$288.62
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$558.68 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.41
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Advantage |
$620.75
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$665.09
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health SBD |
$558.68
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna Medicare |
$443.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.41
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Advantage |
$620.75
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$709.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$665.09
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health SBD |
$558.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$576.41
|
| Rate for Payer: UHC Core |
$462.02
|
| Rate for Payer: UHC Exchange |
$348.51
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$763.51
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$2,019.20 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna Medicare |
$381.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.28
|
| Rate for Payer: BCBS Complete |
$305.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,019.20
|
| Rate for Payer: BCN Commercial |
$2,019.20
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Advantage |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$610.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health SBD |
$481.01
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$763.51
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$481.01 |
| Max. Negotiated Rate |
$687.16 |
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.28
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Advantage |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health SBD |
$481.01
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,963.53
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$771.67 |
| Max. Negotiated Rate |
$1,767.18 |
| Rate for Payer: Aetna Commercial |
$1,669.00
|
| Rate for Payer: Aetna Medicare |
$981.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.29
|
| Rate for Payer: BCBS Complete |
$785.41
|
| Rate for Payer: Cash Price |
$1,570.82
|
| Rate for Payer: Cofinity Advantage |
$1,374.47
|
| Rate for Payer: Cofinity Commercial |
$1,688.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Commercial |
$1,767.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,570.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,472.65
|
| Rate for Payer: PHP Commercial |
$1,669.00
|
| Rate for Payer: Priority Health SBD |
$1,237.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.29
|
| Rate for Payer: UHC Core |
$1,023.00
|
| Rate for Payer: UHC Exchange |
$771.67
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,963.53
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,237.02 |
| Max. Negotiated Rate |
$1,767.18 |
| Rate for Payer: Aetna Commercial |
$1,669.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.29
|
| Rate for Payer: Cash Price |
$1,570.82
|
| Rate for Payer: Cofinity Advantage |
$1,374.47
|
| Rate for Payer: Cofinity Commercial |
$1,688.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Commercial |
$1,767.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,472.65
|
| Rate for Payer: PHP Commercial |
$1,669.00
|
| Rate for Payer: Priority Health SBD |
$1,237.02
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna Medicare |
$41.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.61
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Advantage |
$57.73
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.85
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health SBD |
$51.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.61
|
| Rate for Payer: UHC Core |
$42.97
|
| Rate for Payer: UHC Exchange |
$32.41
|
|
