|
HC CATHETER NOS LVL 2
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: ASR ASR |
$339.50
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$271.36
|
| Rate for Payer: BCN Commercial |
$271.36
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$350.00
|
| Rate for Payer: Healthscope Whirlpool |
$339.50
|
| Rate for Payer: Mclaren Commercial |
$315.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.50
|
| Rate for Payer: Priority Health Narrow Network |
$248.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.00
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: ASR ASR |
$339.50
|
| Rate for Payer: BCBS Trust/PPO |
$271.36
|
| Rate for Payer: BCN Commercial |
$271.36
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$350.00
|
| Rate for Payer: Healthscope Whirlpool |
$339.50
|
| Rate for Payer: Mclaren Commercial |
$315.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.00
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
IP
|
$11,625.00
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Aetna Commercial |
$10,462.50
|
| Rate for Payer: ASR ASR |
$11,276.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,012.86
|
| Rate for Payer: BCN Commercial |
$9,012.86
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$10,927.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$11,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,276.25
|
| Rate for Payer: Mclaren Commercial |
$10,462.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,230.00
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
OP
|
$11,625.00
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Aetna Commercial |
$10,462.50
|
| Rate for Payer: ASR ASR |
$11,276.25
|
| Rate for Payer: BCBS Complete |
$4,650.00
|
| Rate for Payer: BCBS Trust/PPO |
$9,012.86
|
| Rate for Payer: BCN Commercial |
$9,012.86
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$10,927.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$11,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$11,276.25
|
| Rate for Payer: Mclaren Commercial |
$10,462.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,578.75
|
| Rate for Payer: Priority Health Narrow Network |
$8,253.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,230.00
|
|
|
HC CATHETER SINGLE
|
Facility
|
IP
|
$186.82
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.77 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$168.14
|
| Rate for Payer: ASR ASR |
$181.22
|
| Rate for Payer: BCBS Trust/PPO |
$144.84
|
| Rate for Payer: BCN Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$175.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Healthscope Whirlpool |
$181.22
|
| Rate for Payer: Mclaren Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.40
|
|
|
HC CATHETER SINGLE
|
Facility
|
OP
|
$186.82
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.73 |
| Max. Negotiated Rate |
$186.82 |
| Rate for Payer: Aetna Commercial |
$168.14
|
| Rate for Payer: ASR ASR |
$181.22
|
| Rate for Payer: BCBS Complete |
$74.73
|
| Rate for Payer: BCBS Trust/PPO |
$144.84
|
| Rate for Payer: BCN Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$175.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$186.82
|
| Rate for Payer: Healthscope Whirlpool |
$181.22
|
| Rate for Payer: Mclaren Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.01
|
| Rate for Payer: Priority Health Narrow Network |
$132.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.40
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
OP
|
$1,606.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$1,606.50 |
| Rate for Payer: Aetna Commercial |
$1,445.85
|
| Rate for Payer: ASR ASR |
$1,558.30
|
| Rate for Payer: BCBS Complete |
$642.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.52
|
| Rate for Payer: BCN Commercial |
$1,245.52
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,510.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,606.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.30
|
| Rate for Payer: Mclaren Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,461.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,413.72
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
IP
|
$1,606.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,124.55 |
| Max. Negotiated Rate |
$1,606.50 |
| Rate for Payer: Aetna Commercial |
$1,445.85
|
| Rate for Payer: ASR ASR |
$1,558.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.52
|
| Rate for Payer: BCN Commercial |
$1,245.52
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,510.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,606.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.30
|
| Rate for Payer: Mclaren Commercial |
$1,445.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,413.72
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
IP
|
$7,545.17
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,281.62 |
| Max. Negotiated Rate |
$7,545.17 |
| Rate for Payer: Aetna Commercial |
$6,790.65
|
| Rate for Payer: ASR ASR |
$7,318.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,849.77
|
| Rate for Payer: BCN Commercial |
$5,849.77
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$7,092.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,036.14
|
| Rate for Payer: Healthscope Commercial |
$7,545.17
|
| Rate for Payer: Healthscope Whirlpool |
$7,318.81
|
| Rate for Payer: Mclaren Commercial |
$6,790.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,639.75
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
OP
|
$7,545.17
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,018.07 |
| Max. Negotiated Rate |
$7,545.17 |
| Rate for Payer: Aetna Commercial |
$6,790.65
|
| Rate for Payer: ASR ASR |
$7,318.81
|
| Rate for Payer: BCBS Complete |
$3,018.07
|
| Rate for Payer: BCBS Trust/PPO |
$5,849.77
|
| Rate for Payer: BCN Commercial |
$5,849.77
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$7,092.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,036.14
|
| Rate for Payer: Healthscope Commercial |
$7,545.17
|
| Rate for Payer: Healthscope Whirlpool |
$7,318.81
|
| Rate for Payer: Mclaren Commercial |
$6,790.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,866.10
|
| Rate for Payer: Priority Health Narrow Network |
$5,357.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,639.75
|
|
|
HC CATHETER, TRANSLUMIN NON-LASER
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: ASR ASR |
$2,328.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,860.72
|
| Rate for Payer: BCN Commercial |
$1,860.72
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,920.00
|
| Rate for Payer: Healthscope Commercial |
$2,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,328.00
|
| Rate for Payer: Mclaren Commercial |
$2,160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,112.00
|
|
|
HC CATHETER, TRANSLUMIN NON-LASER
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$2,160.00
|
| Rate for Payer: ASR ASR |
$2,328.00
|
| Rate for Payer: BCBS Complete |
$960.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,860.72
|
| Rate for Payer: BCN Commercial |
$1,860.72
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,920.00
|
| Rate for Payer: Healthscope Commercial |
$2,400.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,328.00
|
| Rate for Payer: Mclaren Commercial |
$2,160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,184.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,704.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,112.00
|
|
|
HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY
|
Facility
|
IP
|
$9,520.00
|
|
|
Service Code
|
CPT C1761
|
| Hospital Charge Code |
27200350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,664.00 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Aetna Commercial |
$8,568.00
|
| Rate for Payer: ASR ASR |
$9,234.40
|
| Rate for Payer: BCBS Trust/PPO |
$7,380.86
|
| Rate for Payer: BCN Commercial |
$7,380.86
|
| Rate for Payer: Cash Price |
$7,616.00
|
| Rate for Payer: Cofinity Commercial |
$8,948.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,616.00
|
| Rate for Payer: Healthscope Commercial |
$9,520.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,234.40
|
| Rate for Payer: Mclaren Commercial |
$8,568.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,092.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,664.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,377.60
|
|
|
HC CATHETER TRANSLUM INTRAVAS LITHOTRIPSY CORONARY
|
Facility
|
OP
|
$9,520.00
|
|
|
Service Code
|
CPT C1761
|
| Hospital Charge Code |
27200350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,808.00 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Aetna Commercial |
$8,568.00
|
| Rate for Payer: ASR ASR |
$9,234.40
|
| Rate for Payer: BCBS Complete |
$3,808.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,380.86
|
| Rate for Payer: BCN Commercial |
$7,380.86
|
| Rate for Payer: Cash Price |
$7,616.00
|
| Rate for Payer: Cofinity Commercial |
$8,948.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,616.00
|
| Rate for Payer: Healthscope Commercial |
$9,520.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,234.40
|
| Rate for Payer: Mclaren Commercial |
$8,568.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,092.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,664.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,663.20
|
| Rate for Payer: Priority Health Narrow Network |
$6,759.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,377.60
|
|
|
HC CATH LAB STANDBY
|
Facility
|
OP
|
$489.91
|
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.96 |
| Max. Negotiated Rate |
$489.91 |
| Rate for Payer: Aetna Commercial |
$440.92
|
| Rate for Payer: ASR ASR |
$475.21
|
| Rate for Payer: BCBS Complete |
$195.96
|
| Rate for Payer: BCBS Trust/PPO |
$379.83
|
| Rate for Payer: BCN Commercial |
$379.83
|
| Rate for Payer: Cash Price |
$391.93
|
| Rate for Payer: Cofinity Commercial |
$460.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.93
|
| Rate for Payer: Healthscope Commercial |
$489.91
|
| Rate for Payer: Healthscope Whirlpool |
$475.21
|
| Rate for Payer: Mclaren Commercial |
$440.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.82
|
| Rate for Payer: Priority Health Narrow Network |
$347.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.12
|
|
|
HC CATH LAB STANDBY
|
Facility
|
IP
|
$489.91
|
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$342.94 |
| Max. Negotiated Rate |
$489.91 |
| Rate for Payer: Aetna Commercial |
$440.92
|
| Rate for Payer: ASR ASR |
$475.21
|
| Rate for Payer: BCBS Trust/PPO |
$379.83
|
| Rate for Payer: BCN Commercial |
$379.83
|
| Rate for Payer: Cash Price |
$391.93
|
| Rate for Payer: Cofinity Commercial |
$460.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.93
|
| Rate for Payer: Healthscope Commercial |
$489.91
|
| Rate for Payer: Healthscope Whirlpool |
$475.21
|
| Rate for Payer: Mclaren Commercial |
$440.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.12
|
|
|
HC CATH PULM ART VENT 14FR
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC CATH PULM ART VENT 14FR
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: ASR ASR |
$145.50
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$116.30
|
| Rate for Payer: BCN Commercial |
$116.30
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$141.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Whirlpool |
$145.50
|
| Rate for Payer: Mclaren Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.50
|
| Rate for Payer: Priority Health Narrow Network |
$106.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.00
|
|
|
HC CATHTER NOS LVL 7
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$648.00
|
| Rate for Payer: ASR ASR |
$698.40
|
| Rate for Payer: BCBS Trust/PPO |
$558.22
|
| Rate for Payer: BCN Commercial |
$558.22
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$676.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$720.00
|
| Rate for Payer: Healthscope Whirlpool |
$698.40
|
| Rate for Payer: Mclaren Commercial |
$648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.60
|
|
|
HC CATHTER NOS LVL 7
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$648.00
|
| Rate for Payer: ASR ASR |
$698.40
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS Trust/PPO |
$558.22
|
| Rate for Payer: BCN Commercial |
$558.22
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$676.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$720.00
|
| Rate for Payer: Healthscope Whirlpool |
$698.40
|
| Rate for Payer: Mclaren Commercial |
$648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.20
|
| Rate for Payer: Priority Health Narrow Network |
$511.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.60
|
|
|
HC CAT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200031
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC CAT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200031
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CBC INCLUDES DIFF & PLATELETS
|
Facility
|
OP
|
$29.85
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
30500007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$46.69 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.71
|
| Rate for Payer: ASR ASR |
$28.95
|
| Rate for Payer: BCBS Complete |
$4.46
|
| Rate for Payer: BCBS MAPPO |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$23.14
|
| Rate for Payer: BCN Commercial |
$23.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.77
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$28.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.77
|
| Rate for Payer: Mclaren Commercial |
$26.86
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Mclaren Medicare |
$7.77
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: PACE Medicare |
$7.38
|
| Rate for Payer: PACE SWMI |
$7.77
|
| Rate for Payer: PHP Commercial |
$8.55
|
| Rate for Payer: PHP Medicaid |
$4.25
|
| Rate for Payer: PHP Medicare Advantage |
$7.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.69
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow Network |
$37.35
|
| Rate for Payer: Railroad Medicare Medicare |
$7.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.27
|
| Rate for Payer: UHC Medicare Advantage |
$8.00
|
| Rate for Payer: VA VA |
$7.77
|
|
|
HC CBC INCLUDES DIFF & PLATELETS
|
Facility
|
IP
|
$29.85
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
30500007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: ASR ASR |
$28.95
|
| Rate for Payer: BCBS Trust/PPO |
$23.14
|
| Rate for Payer: BCN Commercial |
$23.14
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$28.95
|
| Rate for Payer: Mclaren Commercial |
$26.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.27
|
|
|
HC CBC NO DIFF INCLUDES PLATELETS
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
30500008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$34.89 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: ASR ASR |
$17.81
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Whirlpool |
$17.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.47
|
| Rate for Payer: Mclaren Commercial |
$16.52
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.12
|
| Rate for Payer: PHP Medicaid |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.16
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
