|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
IP
|
$63.09
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.01
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.47
|
| Rate for Payer: Healthscope Commercial |
$56.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.63
|
| Rate for Payer: PHP Commercial |
$53.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.01
|
| Rate for Payer: Priority Health SBD |
$39.75
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
IP
|
$107.21
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$96.49 |
| Rate for Payer: Aetna Commercial |
$91.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.69
|
| Rate for Payer: Cash Price |
$85.77
|
| Rate for Payer: Cofinity Commercial |
$75.05
|
| Rate for Payer: Cofinity Commercial |
$92.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.77
|
| Rate for Payer: Healthscope Commercial |
$96.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.13
|
| Rate for Payer: PHP Commercial |
$91.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.69
|
| Rate for Payer: Priority Health SBD |
$67.54
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
OP
|
$107.21
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$91.13
|
| Rate for Payer: Aetna Medicare |
$53.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.69
|
| Rate for Payer: BCBS Complete |
$42.88
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$85.77
|
| Rate for Payer: Cash Price |
$85.77
|
| Rate for Payer: Cash Price |
$85.77
|
| Rate for Payer: Cofinity Commercial |
$75.05
|
| Rate for Payer: Cofinity Commercial |
$92.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.77
|
| Rate for Payer: Healthscope Commercial |
$96.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.13
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$91.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.00
|
| Rate for Payer: Priority Health Narrow Network |
$14.40
|
| Rate for Payer: Priority Health SBD |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.74
|
| Rate for Payer: UHC Exchange |
$79.34
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$9.38
|
| Rate for Payer: BCBS MAPPO |
$16.67
|
| Rate for Payer: BCBS Trust/PPO |
$14.75
|
| Rate for Payer: BCN Commercial |
$14.75
|
| Rate for Payer: BCN Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.50
|
| Rate for Payer: Meridian Medicaid |
$9.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$25.00
|
| Rate for Payer: PACE Medicare |
$15.84
|
| Rate for Payer: PACE SWMI |
$16.67
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.15
|
| Rate for Payer: Priority Health Medicare |
$16.67
|
| Rate for Payer: Priority Health Narrow Network |
$13.72
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.67
|
| Rate for Payer: UHC Medicare Advantage |
$16.67
|
| Rate for Payer: UHCCP Medicaid |
$9.39
|
| Rate for Payer: VA VA |
$16.67
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
IP
|
$676.26
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.04 |
| Max. Negotiated Rate |
$608.63 |
| Rate for Payer: Aetna Commercial |
$574.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.57
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Commercial |
$473.38
|
| Rate for Payer: Cofinity Commercial |
$581.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Healthscope Commercial |
$608.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: PHP Commercial |
$574.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.57
|
| Rate for Payer: Priority Health SBD |
$426.04
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
OP
|
$676.26
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna Commercial |
$574.82
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$251.71
|
| Rate for Payer: BCN Commercial |
$251.71
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Commercial |
$581.58
|
| Rate for Payer: Cofinity Commercial |
$473.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$608.63
|
| Rate for Payer: Mclaren Medicaid |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Nomi Health Commercial |
$619.29
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$574.82
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.80
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$519.04
|
| Rate for Payer: Priority Health SBD |
$426.04
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$116.22
|
| Rate for Payer: VA VA |
$206.43
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$108.07
|
| Rate for Payer: BCN Commercial |
$108.07
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
IP
|
$576.50
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$518.85 |
| Rate for Payer: Aetna Commercial |
$490.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.72
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Cofinity Commercial |
$403.55
|
| Rate for Payer: Cofinity Commercial |
$495.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.20
|
| Rate for Payer: Healthscope Commercial |
$518.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.02
|
| Rate for Payer: PHP Commercial |
$490.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.72
|
| Rate for Payer: Priority Health SBD |
$363.20
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
OP
|
$576.50
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$518.85 |
| Rate for Payer: Aetna Commercial |
$490.02
|
| Rate for Payer: Aetna Medicare |
$288.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.72
|
| Rate for Payer: BCBS Complete |
$230.60
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Cofinity Commercial |
$403.55
|
| Rate for Payer: Cofinity Commercial |
$495.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.20
|
| Rate for Payer: Healthscope Commercial |
$518.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.02
|
| Rate for Payer: PHP Commercial |
$490.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.72
|
| Rate for Payer: Priority Health SBD |
$363.20
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
IP
|
$5,821.41
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,667.49 |
| Max. Negotiated Rate |
$5,239.27 |
| Rate for Payer: Aetna Commercial |
$4,948.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,783.92
|
| Rate for Payer: Cash Price |
$4,657.13
|
| Rate for Payer: Cofinity Commercial |
$4,074.99
|
| Rate for Payer: Cofinity Commercial |
$5,006.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,074.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,657.13
|
| Rate for Payer: Healthscope Commercial |
$5,239.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,948.20
|
| Rate for Payer: PHP Commercial |
$4,948.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,783.92
|
| Rate for Payer: Priority Health SBD |
$3,667.49
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
OP
|
$5,821.41
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.56 |
| Max. Negotiated Rate |
$5,239.27 |
| Rate for Payer: Aetna Commercial |
$4,948.20
|
| Rate for Payer: Aetna Medicare |
$2,910.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,783.92
|
| Rate for Payer: BCBS Complete |
$2,328.56
|
| Rate for Payer: Cash Price |
$4,657.13
|
| Rate for Payer: Cofinity Commercial |
$4,074.99
|
| Rate for Payer: Cofinity Commercial |
$5,006.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,074.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,657.13
|
| Rate for Payer: Healthscope Commercial |
$5,239.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,948.20
|
| Rate for Payer: PHP Commercial |
$4,948.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,783.92
|
| Rate for Payer: Priority Health SBD |
$3,667.49
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
IP
|
$10,353.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,522.39 |
| Max. Negotiated Rate |
$9,317.70 |
| Rate for Payer: Aetna Commercial |
$8,800.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,729.45
|
| Rate for Payer: Cash Price |
$8,282.40
|
| Rate for Payer: Cofinity Commercial |
$7,247.10
|
| Rate for Payer: Cofinity Commercial |
$8,903.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,247.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,282.40
|
| Rate for Payer: Healthscope Commercial |
$9,317.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,800.05
|
| Rate for Payer: PHP Commercial |
$8,800.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,729.45
|
| Rate for Payer: Priority Health SBD |
$6,522.39
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
OP
|
$10,353.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$9,317.70 |
| Rate for Payer: Aetna Commercial |
$8,800.05
|
| Rate for Payer: Aetna Medicare |
$5,176.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,729.45
|
| Rate for Payer: BCBS Complete |
$4,141.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$8,282.40
|
| Rate for Payer: Cash Price |
$8,282.40
|
| Rate for Payer: Cofinity Commercial |
$7,247.10
|
| Rate for Payer: Cofinity Commercial |
$8,903.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,247.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,282.40
|
| Rate for Payer: Healthscope Commercial |
$9,317.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,800.05
|
| Rate for Payer: PHP Commercial |
$8,800.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,729.45
|
| Rate for Payer: Priority Health SBD |
$6,522.39
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
OP
|
$13,252.86
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,301.14 |
| Max. Negotiated Rate |
$11,927.57 |
| Rate for Payer: Aetna Commercial |
$11,264.93
|
| Rate for Payer: Aetna Medicare |
$6,626.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,614.36
|
| Rate for Payer: BCBS Complete |
$5,301.14
|
| Rate for Payer: Cash Price |
$10,602.29
|
| Rate for Payer: Cofinity Commercial |
$11,397.46
|
| Rate for Payer: Cofinity Commercial |
$9,277.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,277.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,602.29
|
| Rate for Payer: Healthscope Commercial |
$11,927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,264.93
|
| Rate for Payer: PHP Commercial |
$11,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,614.36
|
| Rate for Payer: Priority Health SBD |
$8,349.30
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
IP
|
$13,252.86
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,349.30 |
| Max. Negotiated Rate |
$11,927.57 |
| Rate for Payer: Aetna Commercial |
$11,264.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,614.36
|
| Rate for Payer: Cash Price |
$10,602.29
|
| Rate for Payer: Cofinity Commercial |
$11,397.46
|
| Rate for Payer: Cofinity Commercial |
$9,277.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,277.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,602.29
|
| Rate for Payer: Healthscope Commercial |
$11,927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,264.93
|
| Rate for Payer: PHP Commercial |
$11,264.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,614.36
|
| Rate for Payer: Priority Health SBD |
$8,349.30
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
IP
|
$534.58
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.79 |
| Max. Negotiated Rate |
$481.12 |
| Rate for Payer: Aetna Commercial |
$454.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.48
|
| Rate for Payer: Cash Price |
$427.66
|
| Rate for Payer: Cofinity Commercial |
$374.21
|
| Rate for Payer: Cofinity Commercial |
$459.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.66
|
| Rate for Payer: Healthscope Commercial |
$481.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.39
|
| Rate for Payer: PHP Commercial |
$454.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.48
|
| Rate for Payer: Priority Health SBD |
$336.79
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
OP
|
$534.58
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.49 |
| Max. Negotiated Rate |
$481.12 |
| Rate for Payer: Aetna Commercial |
$454.39
|
| Rate for Payer: Aetna Medicare |
$267.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.48
|
| Rate for Payer: BCBS Complete |
$213.83
|
| Rate for Payer: BCBS Trust/PPO |
$107.49
|
| Rate for Payer: BCN Commercial |
$107.49
|
| Rate for Payer: Cash Price |
$427.66
|
| Rate for Payer: Cash Price |
$427.66
|
| Rate for Payer: Cofinity Commercial |
$374.21
|
| Rate for Payer: Cofinity Commercial |
$459.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.66
|
| Rate for Payer: Healthscope Commercial |
$481.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.39
|
| Rate for Payer: PHP Commercial |
$454.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.48
|
| Rate for Payer: Priority Health SBD |
$336.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.26
|
| Rate for Payer: UHC Exchange |
$395.59
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
OP
|
$1,752.92
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.17 |
| Max. Negotiated Rate |
$1,577.63 |
| Rate for Payer: Aetna Commercial |
$1,489.98
|
| Rate for Payer: Aetna Medicare |
$876.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,139.40
|
| Rate for Payer: BCBS Complete |
$701.17
|
| Rate for Payer: Cash Price |
$1,402.34
|
| Rate for Payer: Cofinity Commercial |
$1,227.04
|
| Rate for Payer: Cofinity Commercial |
$1,507.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,227.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,402.34
|
| Rate for Payer: Healthscope Commercial |
$1,577.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.98
|
| Rate for Payer: PHP Commercial |
$1,489.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,139.40
|
| Rate for Payer: Priority Health SBD |
$1,104.34
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
IP
|
$1,752.92
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,104.34 |
| Max. Negotiated Rate |
$1,577.63 |
| Rate for Payer: Aetna Commercial |
$1,489.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,139.40
|
| Rate for Payer: Cash Price |
$1,402.34
|
| Rate for Payer: Cofinity Commercial |
$1,227.04
|
| Rate for Payer: Cofinity Commercial |
$1,507.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,227.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,402.34
|
| Rate for Payer: Healthscope Commercial |
$1,577.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.98
|
| Rate for Payer: PHP Commercial |
$1,489.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,139.40
|
| Rate for Payer: Priority Health SBD |
$1,104.34
|
|
|
HC GUIDEWIRE
|
Facility
|
OP
|
$49.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$44.44 |
| Rate for Payer: Aetna Commercial |
$41.97
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.10
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cofinity Commercial |
$34.57
|
| Rate for Payer: Cofinity Commercial |
$42.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.50
|
| Rate for Payer: Healthscope Commercial |
$44.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.97
|
| Rate for Payer: PHP Commercial |
$41.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.10
|
| Rate for Payer: Priority Health SBD |
$31.11
|
|
|
HC GUIDEWIRE
|
Facility
|
IP
|
$49.38
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$44.44 |
| Rate for Payer: Aetna Commercial |
$41.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.10
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cofinity Commercial |
$34.57
|
| Rate for Payer: Cofinity Commercial |
$42.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.50
|
| Rate for Payer: Healthscope Commercial |
$44.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.97
|
| Rate for Payer: PHP Commercial |
$41.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.10
|
| Rate for Payer: Priority Health SBD |
$31.11
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
OP
|
$1,345.45
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$538.18 |
| Max. Negotiated Rate |
$1,210.90 |
| Rate for Payer: Aetna Commercial |
$1,143.63
|
| Rate for Payer: Aetna Medicare |
$672.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.54
|
| Rate for Payer: BCBS Complete |
$538.18
|
| Rate for Payer: Cash Price |
$1,076.36
|
| Rate for Payer: Cofinity Commercial |
$1,157.09
|
| Rate for Payer: Cofinity Commercial |
$941.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$941.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.36
|
| Rate for Payer: Healthscope Commercial |
$1,210.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.63
|
| Rate for Payer: PHP Commercial |
$1,143.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.54
|
| Rate for Payer: Priority Health SBD |
$847.63
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
IP
|
$1,345.45
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.63 |
| Max. Negotiated Rate |
$1,210.90 |
| Rate for Payer: Aetna Commercial |
$1,143.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.54
|
| Rate for Payer: Cash Price |
$1,076.36
|
| Rate for Payer: Cofinity Commercial |
$1,157.09
|
| Rate for Payer: Cofinity Commercial |
$941.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$941.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.36
|
| Rate for Payer: Healthscope Commercial |
$1,210.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.63
|
| Rate for Payer: PHP Commercial |
$1,143.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.54
|
| Rate for Payer: Priority Health SBD |
$847.63
|
|
