|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$250.57
|
| Rate for Payer: Aetna Medicare |
$139.20
|
| Rate for Payer: ASR ASR |
$270.06
|
| Rate for Payer: ASR Commercial |
$270.06
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: BCBS Trust/PPO |
$227.99
|
| Rate for Payer: BCN Commercial |
$215.85
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$261.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$278.41
|
| Rate for Payer: Healthscope Whirlpool |
$270.06
|
| Rate for Payer: Mclaren Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: Nomi Health Commercial |
$228.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.94
|
| Rate for Payer: Priority Health Narrow Network |
$195.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.00
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: ASR Commercial |
$72.66
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.34
|
| Rate for Payer: BCN Commercial |
$58.08
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Healthscope Whirlpool |
$72.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicaid |
$22.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.64
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$52.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.77
|
| Rate for Payer: UHC Exchange |
$64.74
|
| Rate for Payer: UHC Medicare Advantage |
$41.77
|
| Rate for Payer: UHCCP DNSP |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$22.39
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: ASR ASR |
$72.66
|
| Rate for Payer: ASR Commercial |
$72.66
|
| Rate for Payer: BCBS Trust/PPO |
$61.04
|
| Rate for Payer: BCN Commercial |
$58.08
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Healthscope Whirlpool |
$72.66
|
| Rate for Payer: Mclaren Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.92
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$71.17
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicaid |
$22.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.15
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$60.92
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.77
|
| Rate for Payer: UHC Exchange |
$64.74
|
| Rate for Payer: UHC Medicare Advantage |
$41.77
|
| Rate for Payer: UHCCP DNSP |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$22.39
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$86.91 |
| Rate for Payer: Aetna Commercial |
$78.22
|
| Rate for Payer: ASR ASR |
$84.30
|
| Rate for Payer: ASR Commercial |
$84.30
|
| Rate for Payer: BCBS Trust/PPO |
$70.82
|
| Rate for Payer: BCN Commercial |
$67.38
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$86.91
|
| Rate for Payer: Healthscope Whirlpool |
$84.30
|
| Rate for Payer: Mclaren Commercial |
$78.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.48
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,552.14
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,008.89 |
| Max. Negotiated Rate |
$1,552.14 |
| Rate for Payer: Aetna Commercial |
$1,396.93
|
| Rate for Payer: ASR ASR |
$1,505.58
|
| Rate for Payer: ASR Commercial |
$1,505.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,264.84
|
| Rate for Payer: BCN Commercial |
$1,203.37
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,459.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Healthscope Commercial |
$1,552.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,505.58
|
| Rate for Payer: Mclaren Commercial |
$1,396.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: Nomi Health Commercial |
$1,272.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,365.88
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,552.14
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,552.14 |
| Rate for Payer: Aetna Commercial |
$1,396.93
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$1,505.58
|
| Rate for Payer: ASR Commercial |
$1,505.58
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.05
|
| Rate for Payer: BCN Commercial |
$1,203.37
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,459.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,552.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,505.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$1,396.93
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: Nomi Health Commercial |
$1,272.75
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,359.99
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.05
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,365.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna Commercial |
$743.00
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$800.78
|
| Rate for Payer: ASR Commercial |
$800.78
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$676.04
|
| Rate for Payer: BCN Commercial |
$640.05
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$776.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$825.55
|
| Rate for Payer: Healthscope Whirlpool |
$800.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$743.00
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.27
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$437.02
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
IP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$536.61 |
| Max. Negotiated Rate |
$825.55 |
| Rate for Payer: Aetna Commercial |
$743.00
|
| Rate for Payer: ASR ASR |
$800.78
|
| Rate for Payer: ASR Commercial |
$800.78
|
| Rate for Payer: BCBS Trust/PPO |
$672.74
|
| Rate for Payer: BCN Commercial |
$640.05
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$776.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Healthscope Commercial |
$825.55
|
| Rate for Payer: Healthscope Whirlpool |
$800.78
|
| Rate for Payer: Mclaren Commercial |
$743.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$676.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.48
|
|
|
HC 2 PIECE WAFER
|
Facility
|
IP
|
$13.42
|
|
| Hospital Charge Code |
27100001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: ASR ASR |
$13.02
|
| Rate for Payer: ASR Commercial |
$13.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.94
|
| Rate for Payer: BCN Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$12.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$13.42
|
| Rate for Payer: Healthscope Whirlpool |
$13.02
|
| Rate for Payer: Mclaren Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.41
|
| Rate for Payer: Nomi Health Commercial |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.81
|
|
|
HC 2 PIECE WAFER
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
27100001
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna Medicare |
$6.71
|
| Rate for Payer: ASR ASR |
$13.02
|
| Rate for Payer: ASR Commercial |
$13.02
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.99
|
| Rate for Payer: BCN Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$12.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$13.42
|
| Rate for Payer: Healthscope Whirlpool |
$13.02
|
| Rate for Payer: Mclaren Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.41
|
| Rate for Payer: Nomi Health Commercial |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.76
|
| Rate for Payer: Priority Health Narrow Network |
$9.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.81
|
|
|
HC 3D ECHO RENDERING
|
Facility
|
IP
|
$669.19
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$434.97 |
| Max. Negotiated Rate |
$669.19 |
| Rate for Payer: Aetna Commercial |
$602.27
|
| Rate for Payer: ASR ASR |
$649.11
|
| Rate for Payer: ASR Commercial |
$649.11
|
| Rate for Payer: BCBS Trust/PPO |
$545.32
|
| Rate for Payer: BCN Commercial |
$518.82
|
| Rate for Payer: Cash Price |
$535.35
|
| Rate for Payer: Cofinity Commercial |
$629.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.35
|
| Rate for Payer: Healthscope Commercial |
$669.19
|
| Rate for Payer: Healthscope Whirlpool |
$649.11
|
| Rate for Payer: Mclaren Commercial |
$602.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.81
|
| Rate for Payer: Nomi Health Commercial |
$548.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.89
|
|
|
HC 3D ECHO RENDERING
|
Facility
|
OP
|
$669.19
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
32000282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$669.19 |
| Rate for Payer: Aetna Commercial |
$602.27
|
| Rate for Payer: Aetna Medicare |
$334.60
|
| Rate for Payer: ASR ASR |
$649.11
|
| Rate for Payer: ASR Commercial |
$649.11
|
| Rate for Payer: BCBS Complete |
$267.68
|
| Rate for Payer: BCBS Trust/PPO |
$548.00
|
| Rate for Payer: BCN Commercial |
$518.82
|
| Rate for Payer: Cash Price |
$535.35
|
| Rate for Payer: Cash Price |
$535.35
|
| Rate for Payer: Cofinity Commercial |
$629.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.35
|
| Rate for Payer: Healthscope Commercial |
$669.19
|
| Rate for Payer: Healthscope Whirlpool |
$649.11
|
| Rate for Payer: Mclaren Commercial |
$602.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.81
|
| Rate for Payer: Nomi Health Commercial |
$548.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.96
|
| Rate for Payer: Priority Health Narrow Network |
$17.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$588.89
|
|
|
HC 3D ECHO REND W/WORKSTATION
|
Facility
|
OP
|
$637.87
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$637.87 |
| Rate for Payer: Aetna Commercial |
$574.08
|
| Rate for Payer: Aetna Medicare |
$318.94
|
| Rate for Payer: ASR ASR |
$618.73
|
| Rate for Payer: ASR Commercial |
$618.73
|
| Rate for Payer: BCBS Complete |
$255.15
|
| Rate for Payer: BCBS Trust/PPO |
$522.35
|
| Rate for Payer: BCN Commercial |
$494.54
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cofinity Commercial |
$599.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.30
|
| Rate for Payer: Healthscope Commercial |
$637.87
|
| Rate for Payer: Healthscope Whirlpool |
$618.73
|
| Rate for Payer: Mclaren Commercial |
$574.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.19
|
| Rate for Payer: Nomi Health Commercial |
$523.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.19
|
| Rate for Payer: Priority Health Narrow Network |
$91.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$561.33
|
|
|
HC 3D ECHO REND W/WORKSTATION
|
Facility
|
IP
|
$637.87
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
32000283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$414.62 |
| Max. Negotiated Rate |
$637.87 |
| Rate for Payer: Aetna Commercial |
$574.08
|
| Rate for Payer: ASR ASR |
$618.73
|
| Rate for Payer: ASR Commercial |
$618.73
|
| Rate for Payer: BCBS Trust/PPO |
$519.80
|
| Rate for Payer: BCN Commercial |
$494.54
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cofinity Commercial |
$599.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.30
|
| Rate for Payer: Healthscope Commercial |
$637.87
|
| Rate for Payer: Healthscope Whirlpool |
$618.73
|
| Rate for Payer: Mclaren Commercial |
$574.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.19
|
| Rate for Payer: Nomi Health Commercial |
$523.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$561.33
|
|
|
HC 4X4 WAFER
|
Facility
|
IP
|
$24.51
|
|
| Hospital Charge Code |
27000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$24.51 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$24.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Mclaren Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.57
|
|
|
HC 4X4 WAFER
|
Facility
|
OP
|
$24.51
|
|
| Hospital Charge Code |
27000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$24.51 |
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: Aetna Medicare |
$12.26
|
| Rate for Payer: ASR ASR |
$23.77
|
| Rate for Payer: ASR Commercial |
$23.77
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: BCBS Trust/PPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$24.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.77
|
| Rate for Payer: Mclaren Commercial |
$22.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.48
|
| Rate for Payer: Priority Health Narrow Network |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.57
|
|
|
HC 5 FR SOLO 3CG POWER PICC
|
Facility
|
OP
|
$1,126.57
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.63 |
| Max. Negotiated Rate |
$1,126.57 |
| Rate for Payer: Aetna Commercial |
$1,013.91
|
| Rate for Payer: Aetna Medicare |
$563.28
|
| Rate for Payer: ASR ASR |
$1,092.77
|
| Rate for Payer: ASR Commercial |
$1,092.77
|
| Rate for Payer: BCBS Complete |
$450.63
|
| Rate for Payer: BCBS Trust/PPO |
$922.55
|
| Rate for Payer: BCN Commercial |
$873.43
|
| Rate for Payer: Cash Price |
$901.26
|
| Rate for Payer: Cofinity Commercial |
$1,058.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.26
|
| Rate for Payer: Healthscope Commercial |
$1,126.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.77
|
| Rate for Payer: Mclaren Commercial |
$1,013.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.58
|
| Rate for Payer: Nomi Health Commercial |
$923.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$987.10
|
| Rate for Payer: Priority Health Narrow Network |
$789.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$991.38
|
|
|
HC 5 FR SOLO 3CG POWER PICC
|
Facility
|
IP
|
$1,126.57
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.27 |
| Max. Negotiated Rate |
$1,126.57 |
| Rate for Payer: Aetna Commercial |
$1,013.91
|
| Rate for Payer: ASR ASR |
$1,092.77
|
| Rate for Payer: ASR Commercial |
$1,092.77
|
| Rate for Payer: BCBS Trust/PPO |
$918.04
|
| Rate for Payer: BCN Commercial |
$873.43
|
| Rate for Payer: Cash Price |
$901.26
|
| Rate for Payer: Cofinity Commercial |
$1,058.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.26
|
| Rate for Payer: Healthscope Commercial |
$1,126.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.77
|
| Rate for Payer: Mclaren Commercial |
$1,013.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$957.58
|
| Rate for Payer: Nomi Health Commercial |
$923.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$991.38
|
|
|
HC 5FR SOLO POWER PICC
|
Facility
|
IP
|
$976.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$634.57 |
| Max. Negotiated Rate |
$976.26 |
| Rate for Payer: Aetna Commercial |
$878.63
|
| Rate for Payer: ASR ASR |
$946.97
|
| Rate for Payer: ASR Commercial |
$946.97
|
| Rate for Payer: BCBS Trust/PPO |
$795.55
|
| Rate for Payer: BCN Commercial |
$756.89
|
| Rate for Payer: Cash Price |
$781.01
|
| Rate for Payer: Cofinity Commercial |
$917.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.01
|
| Rate for Payer: Healthscope Commercial |
$976.26
|
| Rate for Payer: Healthscope Whirlpool |
$946.97
|
| Rate for Payer: Mclaren Commercial |
$878.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.82
|
| Rate for Payer: Nomi Health Commercial |
$800.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$859.11
|
|
|
HC 5FR SOLO POWER PICC
|
Facility
|
OP
|
$976.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.50 |
| Max. Negotiated Rate |
$976.26 |
| Rate for Payer: Aetna Commercial |
$878.63
|
| Rate for Payer: Aetna Medicare |
$488.13
|
| Rate for Payer: ASR ASR |
$946.97
|
| Rate for Payer: ASR Commercial |
$946.97
|
| Rate for Payer: BCBS Complete |
$390.50
|
| Rate for Payer: BCBS Trust/PPO |
$799.46
|
| Rate for Payer: BCN Commercial |
$756.89
|
| Rate for Payer: Cash Price |
$781.01
|
| Rate for Payer: Cofinity Commercial |
$917.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.01
|
| Rate for Payer: Healthscope Commercial |
$976.26
|
| Rate for Payer: Healthscope Whirlpool |
$946.97
|
| Rate for Payer: Mclaren Commercial |
$878.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.82
|
| Rate for Payer: Nomi Health Commercial |
$800.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$855.40
|
| Rate for Payer: Priority Health Narrow Network |
$684.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$859.11
|
|
|
HC 5 FR TL 3CG MAX POWER PICC
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: Aetna Commercial |
$1,106.10
|
| Rate for Payer: Aetna Medicare |
$614.50
|
| Rate for Payer: ASR ASR |
$1,192.13
|
| Rate for Payer: ASR Commercial |
$1,192.13
|
| Rate for Payer: BCBS Complete |
$491.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.43
|
| Rate for Payer: BCN Commercial |
$952.84
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.20
|
| Rate for Payer: Healthscope Commercial |
$1,229.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,192.13
|
| Rate for Payer: Mclaren Commercial |
$1,106.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.65
|
| Rate for Payer: Nomi Health Commercial |
$1,007.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.85
|
| Rate for Payer: Priority Health Narrow Network |
$861.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,081.52
|
|
|
HC 5 FR TL 3CG MAX POWER PICC
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.85 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: Aetna Commercial |
$1,106.10
|
| Rate for Payer: ASR ASR |
$1,192.13
|
| Rate for Payer: ASR Commercial |
$1,192.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.51
|
| Rate for Payer: BCN Commercial |
$952.84
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.20
|
| Rate for Payer: Healthscope Commercial |
$1,229.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,192.13
|
| Rate for Payer: Mclaren Commercial |
$1,106.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.65
|
| Rate for Payer: Nomi Health Commercial |
$1,007.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,081.52
|
|
|
HC 5 FR TL SOLO MAX POWER PICC
|
Facility
|
IP
|
$1,065.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$692.26 |
| Max. Negotiated Rate |
$1,065.01 |
| Rate for Payer: Aetna Commercial |
$958.51
|
| Rate for Payer: ASR ASR |
$1,033.06
|
| Rate for Payer: ASR Commercial |
$1,033.06
|
| Rate for Payer: BCBS Trust/PPO |
$867.88
|
| Rate for Payer: BCN Commercial |
$825.70
|
| Rate for Payer: Cash Price |
$852.01
|
| Rate for Payer: Cofinity Commercial |
$1,001.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.01
|
| Rate for Payer: Healthscope Commercial |
$1,065.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,033.06
|
| Rate for Payer: Mclaren Commercial |
$958.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.26
|
| Rate for Payer: Nomi Health Commercial |
$873.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$937.21
|
|
|
HC 5 FR TL SOLO MAX POWER PICC
|
Facility
|
OP
|
$1,065.01
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$1,065.01 |
| Rate for Payer: Aetna Commercial |
$958.51
|
| Rate for Payer: Aetna Medicare |
$532.50
|
| Rate for Payer: ASR ASR |
$1,033.06
|
| Rate for Payer: ASR Commercial |
$1,033.06
|
| Rate for Payer: BCBS Complete |
$426.00
|
| Rate for Payer: BCBS Trust/PPO |
$872.14
|
| Rate for Payer: BCN Commercial |
$825.70
|
| Rate for Payer: Cash Price |
$852.01
|
| Rate for Payer: Cofinity Commercial |
$1,001.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$852.01
|
| Rate for Payer: Healthscope Commercial |
$1,065.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,033.06
|
| Rate for Payer: Mclaren Commercial |
$958.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.26
|
| Rate for Payer: Nomi Health Commercial |
$873.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$933.16
|
| Rate for Payer: Priority Health Narrow Network |
$746.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$937.21
|
|
