|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.23
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: PHP Commercial |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health SBD |
$10.89
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$15.55 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$8.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.23
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: PHP Commercial |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health SBD |
$10.89
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$101.58 |
| Rate for Payer: Aetna Commercial |
$95.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.37
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$101.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: PHP Commercial |
$95.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health SBD |
$71.11
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$101.58 |
| Rate for Payer: Aetna Commercial |
$95.94
|
| Rate for Payer: Aetna Medicare |
$56.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.37
|
| Rate for Payer: BCBS Complete |
$45.15
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$101.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: PHP Commercial |
$95.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health SBD |
$71.11
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna Medicare |
$15.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health SBD |
$19.18
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health SBD |
$19.18
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna Medicare |
$19.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health SBD |
$25.07
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health SBD |
$25.07
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$28.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.87
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health SBD |
$35.74
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.87
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health SBD |
$35.74
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.69
|
| Rate for Payer: BCBS Complete |
$41.04
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health SBD |
$64.64
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.64 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.69
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health SBD |
$64.64
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna Medicare |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health SBD |
$16.18
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health SBD |
$16.18
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.08 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Medicare |
$276.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.25
|
| Rate for Payer: BCBS Complete |
$221.08
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$386.89
|
| Rate for Payer: Cofinity Commercial |
$475.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$497.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: PHP Commercial |
$469.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.25
|
| Rate for Payer: Priority Health SBD |
$348.20
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.20 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.25
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$386.89
|
| Rate for Payer: Cofinity Commercial |
$475.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$497.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: PHP Commercial |
$469.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.25
|
| Rate for Payer: Priority Health SBD |
$348.20
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.16
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health SBD |
$24.39
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.16
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health SBD |
$24.39
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.93 |
| Max. Negotiated Rate |
$484.18 |
| Rate for Payer: Aetna Commercial |
$457.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.69
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$376.59
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$484.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: PHP Commercial |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health SBD |
$338.93
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$484.18 |
| Rate for Payer: Aetna Commercial |
$457.28
|
| Rate for Payer: Aetna Medicare |
$268.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.69
|
| Rate for Payer: BCBS Complete |
$215.19
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$376.59
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$484.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: PHP Commercial |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health SBD |
$338.93
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,470.75 |
| Max. Negotiated Rate |
$28,730.64 |
| Rate for Payer: Aetna Commercial |
$10,092.13
|
| Rate for Payer: Aetna Medicare |
$10,614.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,717.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,758.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,758.29
|
| Rate for Payer: BCBS Complete |
$5,744.29
|
| Rate for Payer: BCBS MAPPO |
$10,206.63
|
| Rate for Payer: BCN Medicare Advantage |
$10,206.63
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$8,311.16
|
| Rate for Payer: Cofinity Commercial |
$10,210.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,311.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,206.63
|
| Rate for Payer: Healthscope Commercial |
$10,685.78
|
| Rate for Payer: Mclaren Medicaid |
$5,470.75
|
| Rate for Payer: Mclaren Medicare |
$10,206.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,716.96
|
| Rate for Payer: Meridian Medicaid |
$5,744.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,737.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: PACE Medicare |
$9,696.30
|
| Rate for Payer: PACE SWMI |
$10,206.63
|
| Rate for Payer: PHP Commercial |
$10,092.13
|
| Rate for Payer: PHP Medicare Advantage |
$10,206.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,470.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: Priority Health Medicare |
$10,206.63
|
| Rate for Payer: Priority Health SBD |
$7,480.05
|
| Rate for Payer: Railroad Medicare Medicare |
$10,206.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,730.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,206.63
|
| Rate for Payer: UHC Medicare Advantage |
$10,206.63
|
| Rate for Payer: UHCCP Medicaid |
$5,746.33
|
| Rate for Payer: VA VA |
$10,206.63
|
|
