|
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 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 |
$267.68 |
| 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: 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 |
$586.34
|
| Rate for Payer: Priority Health Narrow Network |
$469.10
|
| 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 |
$255.15 |
| 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: 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 |
$558.90
|
| Rate for Payer: Priority Health Narrow Network |
$447.15
|
| 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
|
|
|
HC 6 FR SOLO 3CG POWER PICC
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200168
|
|
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 6 FR SOLO 3CG POWER PICC
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200168
|
|
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 6FR SOLO POWER PICC
|
Facility
|
OP
|
$1,065.01
|
|
| Hospital Charge Code |
27200109
|
|
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
|
|
|
HC 6FR SOLO POWER PICC
|
Facility
|
IP
|
$1,065.01
|
|
| Hospital Charge Code |
27200109
|
|
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 8X8 WAFER
|
Facility
|
OP
|
$74.04
|
|
| Hospital Charge Code |
27000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$66.64
|
| Rate for Payer: Aetna Medicare |
$37.02
|
| Rate for Payer: ASR ASR |
$71.82
|
| Rate for Payer: ASR Commercial |
$71.82
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS Trust/PPO |
$60.63
|
| Rate for Payer: BCN Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Cofinity Commercial |
$69.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.23
|
| Rate for Payer: Healthscope Commercial |
$74.04
|
| Rate for Payer: Healthscope Whirlpool |
$71.82
|
| Rate for Payer: Mclaren Commercial |
$66.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.93
|
| Rate for Payer: Nomi Health Commercial |
$60.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.87
|
| Rate for Payer: Priority Health Narrow Network |
$51.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.16
|
|
|
HC 8X8 WAFER
|
Facility
|
IP
|
$74.04
|
|
| Hospital Charge Code |
27000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$66.64
|
| Rate for Payer: ASR ASR |
$71.82
|
| Rate for Payer: ASR Commercial |
$71.82
|
| Rate for Payer: BCBS Trust/PPO |
$60.34
|
| Rate for Payer: BCN Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Cofinity Commercial |
$69.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.23
|
| Rate for Payer: Healthscope Commercial |
$74.04
|
| Rate for Payer: Healthscope Whirlpool |
$71.82
|
| Rate for Payer: Mclaren Commercial |
$66.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.93
|
| Rate for Payer: Nomi Health Commercial |
$60.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.16
|
|
|
HC A1AT PROTEOTYPE
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.85
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
|
|
HC A1AT PROTEOTYPE
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$40.04
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.85
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$34.28
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC A1AT PROTEOTYPE CMPT
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
30100611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: ASR Commercial |
$20.78
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
|
|
HC A1AT PROTEOTYPE CMPT
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
30100611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: ASR Commercial |
$20.78
|
| Rate for Payer: BCBS Complete |
$7.56
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.44
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Mclaren Medicaid |
$7.20
|
| Rate for Payer: Mclaren Medicare |
$13.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: Meridian Medicaid |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: PACE Medicare |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$14.78
|
| Rate for Payer: PHP Medicaid |
$7.20
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$13.44
|
| Rate for Payer: Priority Health Narrow Network |
$15.02
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Exchange |
$20.83
|
| Rate for Payer: UHC Medicare Advantage |
$13.44
|
| Rate for Payer: UHCCP DNSP |
$13.44
|
| Rate for Payer: UHCCP Medicaid |
$7.20
|
| Rate for Payer: VA VA |
$13.44
|
|
