|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$319.94
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$319.94 |
| Rate for Payer: Aetna Commercial |
$287.95
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$310.34
|
| Rate for Payer: ASR Commercial |
$310.34
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$262.00
|
| Rate for Payer: BCN Commercial |
$248.05
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cofinity Commercial |
$300.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$319.94
|
| Rate for Payer: Healthscope Whirlpool |
$310.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$287.95
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.95
|
| Rate for Payer: Nomi Health Commercial |
$262.35
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.84
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$141.47
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$8.13
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: ASR ASR |
$7.89
|
| Rate for Payer: ASR Commercial |
$7.89
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$6.66
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$8.13
|
| Rate for Payer: Healthscope Whirlpool |
$7.89
|
| Rate for Payer: Mclaren Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.91
|
| Rate for Payer: Nomi Health Commercial |
$6.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.12
|
| Rate for Payer: Priority Health Narrow Network |
$5.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.15
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$8.13
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: ASR ASR |
$7.89
|
| Rate for Payer: ASR Commercial |
$7.89
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$8.13
|
| Rate for Payer: Healthscope Whirlpool |
$7.89
|
| Rate for Payer: Mclaren Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.91
|
| Rate for Payer: Nomi Health Commercial |
$6.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.15
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$30.98
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$30.98 |
| Rate for Payer: Aetna Commercial |
$27.88
|
| Rate for Payer: ASR ASR |
$30.05
|
| Rate for Payer: ASR Commercial |
$30.05
|
| Rate for Payer: BCBS Trust/PPO |
$25.25
|
| Rate for Payer: BCN Commercial |
$24.02
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$30.98
|
| Rate for Payer: Healthscope Whirlpool |
$30.05
|
| Rate for Payer: Mclaren Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.33
|
| Rate for Payer: Nomi Health Commercial |
$25.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.26
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
OP
|
$30.98
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$30.98 |
| Rate for Payer: Aetna Commercial |
$27.88
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: ASR ASR |
$30.05
|
| Rate for Payer: ASR Commercial |
$30.05
|
| Rate for Payer: BCBS Complete |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.37
|
| Rate for Payer: BCN Commercial |
$24.02
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$30.98
|
| Rate for Payer: Healthscope Whirlpool |
$30.05
|
| Rate for Payer: Mclaren Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.33
|
| Rate for Payer: Nomi Health Commercial |
$25.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.14
|
| Rate for Payer: Priority Health Narrow Network |
$21.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.26
|
|
|
HC BACK SCREEN
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC BACK SCREEN
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: Aetna Medicare |
$34.17
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: ASR Commercial |
$66.29
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.88
|
| Rate for Payer: Priority Health Narrow Network |
$47.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
IP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: ASR Commercial |
$66.29
|
| Rate for Payer: BCBS Trust/PPO |
$55.69
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$125.29
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: ASR ASR |
$148.41
|
| Rate for Payer: ASR Commercial |
$148.41
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$143.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Healthscope Whirlpool |
$148.41
|
| Rate for Payer: Mclaren Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.64
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
OP
|
$8.87
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: ASR ASR |
$8.60
|
| Rate for Payer: ASR Commercial |
$8.60
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS Trust/PPO |
$7.26
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$8.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Whirlpool |
$8.60
|
| Rate for Payer: Mclaren Commercial |
$7.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.54
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.77
|
| Rate for Payer: Priority Health Narrow Network |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.81
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
IP
|
$8.87
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$7.98
|
| Rate for Payer: ASR ASR |
$8.60
|
| Rate for Payer: ASR Commercial |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$7.23
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$8.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Whirlpool |
$8.60
|
| Rate for Payer: Mclaren Commercial |
$7.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.54
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.81
|
|
|
HC BAG WASTE
|
Facility
|
OP
|
$64.26
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$57.83
|
| Rate for Payer: Aetna Medicare |
$32.13
|
| Rate for Payer: ASR ASR |
$62.33
|
| Rate for Payer: ASR Commercial |
$62.33
|
| Rate for Payer: BCBS Complete |
$25.70
|
| Rate for Payer: BCBS Trust/PPO |
$52.62
|
| Rate for Payer: BCN Commercial |
$49.82
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Healthscope Whirlpool |
$62.33
|
| Rate for Payer: Mclaren Commercial |
$57.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: Nomi Health Commercial |
$52.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.30
|
| Rate for Payer: Priority Health Narrow Network |
$45.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.55
|
|
|
HC BAG WASTE
|
Facility
|
IP
|
$64.26
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$57.83
|
| Rate for Payer: ASR ASR |
$62.33
|
| Rate for Payer: ASR Commercial |
$62.33
|
| Rate for Payer: BCBS Trust/PPO |
$52.37
|
| Rate for Payer: BCN Commercial |
$49.82
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Healthscope Whirlpool |
$62.33
|
| Rate for Payer: Mclaren Commercial |
$57.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: Nomi Health Commercial |
$52.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.55
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
IP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.92 |
| Max. Negotiated Rate |
$1,041.42 |
| Rate for Payer: Aetna Commercial |
$937.28
|
| Rate for Payer: ASR ASR |
$1,010.18
|
| Rate for Payer: ASR Commercial |
$1,010.18
|
| Rate for Payer: BCBS Trust/PPO |
$848.65
|
| Rate for Payer: BCN Commercial |
$807.41
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Commercial |
$978.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$1,041.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,010.18
|
| Rate for Payer: Mclaren Commercial |
$937.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: Nomi Health Commercial |
$853.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.45
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
OP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.57 |
| Max. Negotiated Rate |
$1,041.42 |
| Rate for Payer: Aetna Commercial |
$937.28
|
| Rate for Payer: Aetna Medicare |
$520.71
|
| Rate for Payer: ASR ASR |
$1,010.18
|
| Rate for Payer: ASR Commercial |
$1,010.18
|
| Rate for Payer: BCBS Complete |
$416.57
|
| Rate for Payer: BCBS Trust/PPO |
$852.82
|
| Rate for Payer: BCN Commercial |
$807.41
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Commercial |
$978.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$1,041.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,010.18
|
| Rate for Payer: Mclaren Commercial |
$937.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: Nomi Health Commercial |
$853.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$912.49
|
| Rate for Payer: Priority Health Narrow Network |
$730.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.45
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
OP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.66 |
| Max. Negotiated Rate |
$1,289.14 |
| Rate for Payer: Aetna Commercial |
$1,160.23
|
| Rate for Payer: Aetna Medicare |
$644.57
|
| Rate for Payer: ASR ASR |
$1,250.47
|
| Rate for Payer: ASR Commercial |
$1,250.47
|
| Rate for Payer: BCBS Complete |
$515.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.68
|
| Rate for Payer: BCN Commercial |
$999.47
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,211.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,289.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.47
|
| Rate for Payer: Mclaren Commercial |
$1,160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: Nomi Health Commercial |
$1,057.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.54
|
| Rate for Payer: Priority Health Narrow Network |
$903.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.44
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
IP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.94 |
| Max. Negotiated Rate |
$1,289.14 |
| Rate for Payer: Aetna Commercial |
$1,160.23
|
| Rate for Payer: ASR ASR |
$1,250.47
|
| Rate for Payer: ASR Commercial |
$1,250.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.52
|
| Rate for Payer: BCN Commercial |
$999.47
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,211.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,289.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.47
|
| Rate for Payer: Mclaren Commercial |
$1,160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: Nomi Health Commercial |
$1,057.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.44
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
IP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,009.67 |
| Max. Negotiated Rate |
$1,553.34 |
| Rate for Payer: Aetna Commercial |
$1,398.01
|
| Rate for Payer: ASR ASR |
$1,506.74
|
| Rate for Payer: ASR Commercial |
$1,506.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,265.82
|
| Rate for Payer: BCN Commercial |
$1,204.30
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Commercial |
$1,460.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,553.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,506.74
|
| Rate for Payer: Mclaren Commercial |
$1,398.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: Nomi Health Commercial |
$1,273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,366.94
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
OP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.34 |
| Max. Negotiated Rate |
$1,553.34 |
| Rate for Payer: Aetna Commercial |
$1,398.01
|
| Rate for Payer: Aetna Medicare |
$776.67
|
| Rate for Payer: ASR ASR |
$1,506.74
|
| Rate for Payer: ASR Commercial |
$1,506.74
|
| Rate for Payer: BCBS Complete |
$621.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,272.03
|
| Rate for Payer: BCN Commercial |
$1,204.30
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Commercial |
$1,460.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,553.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,506.74
|
| Rate for Payer: Mclaren Commercial |
$1,398.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: Nomi Health Commercial |
$1,273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,361.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,366.94
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,591.20 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: ASR ASR |
$2,374.56
|
| Rate for Payer: ASR Commercial |
$2,374.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,994.88
|
| Rate for Payer: BCN Commercial |
$1,897.93
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$2,301.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,374.56
|
| Rate for Payer: Mclaren Commercial |
$2,203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: Nomi Health Commercial |
$2,007.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,154.24
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Aetna Medicare |
$1,224.00
|
| Rate for Payer: ASR ASR |
$2,374.56
|
| Rate for Payer: ASR Commercial |
$2,374.56
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,004.67
|
| Rate for Payer: BCN Commercial |
$1,897.93
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$2,301.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,448.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,374.56
|
| Rate for Payer: Mclaren Commercial |
$2,203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: Nomi Health Commercial |
$2,007.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,144.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,716.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,154.24
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$421.04 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: ASR ASR |
$408.41
|
| Rate for Payer: ASR Commercial |
$408.41
|
| Rate for Payer: BCBS Trust/PPO |
$343.11
|
| Rate for Payer: BCN Commercial |
$326.43
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$421.04
|
| Rate for Payer: Healthscope Whirlpool |
$408.41
|
| Rate for Payer: Mclaren Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.52
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$421.04 |
| Rate for Payer: Aetna Commercial |
$378.94
|
| Rate for Payer: Aetna Medicare |
$210.52
|
| Rate for Payer: ASR ASR |
$408.41
|
| Rate for Payer: ASR Commercial |
$408.41
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS Trust/PPO |
$344.79
|
| Rate for Payer: BCN Commercial |
$326.43
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$421.04
|
| Rate for Payer: Healthscope Whirlpool |
$408.41
|
| Rate for Payer: Mclaren Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.92
|
| Rate for Payer: Priority Health Narrow Network |
$295.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.52
|
|
