|
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 |
$4.43
|
| 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
|
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 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 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
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$588.11 |
| Rate for Payer: Aetna Commercial |
$529.30
|
| Rate for Payer: Aetna Medicare |
$294.06
|
| Rate for Payer: ASR ASR |
$570.47
|
| Rate for Payer: ASR Commercial |
$570.47
|
| Rate for Payer: BCBS Complete |
$235.24
|
| Rate for Payer: BCBS Trust/PPO |
$481.60
|
| Rate for Payer: BCN Commercial |
$455.96
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Commercial |
$552.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$588.11
|
| Rate for Payer: Healthscope Whirlpool |
$570.47
|
| Rate for Payer: Mclaren Commercial |
$529.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: Nomi Health Commercial |
$482.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$515.30
|
| Rate for Payer: Priority Health Narrow Network |
$412.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.54
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.27 |
| Max. Negotiated Rate |
$588.11 |
| Rate for Payer: Aetna Commercial |
$529.30
|
| Rate for Payer: ASR ASR |
$570.47
|
| Rate for Payer: ASR Commercial |
$570.47
|
| Rate for Payer: BCBS Trust/PPO |
$479.25
|
| Rate for Payer: BCN Commercial |
$455.96
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Commercial |
$552.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$588.11
|
| Rate for Payer: Healthscope Whirlpool |
$570.47
|
| Rate for Payer: Mclaren Commercial |
$529.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: Nomi Health Commercial |
$482.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.54
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.62 |
| Max. Negotiated Rate |
$691.56 |
| Rate for Payer: Aetna Commercial |
$622.40
|
| Rate for Payer: Aetna Medicare |
$345.78
|
| Rate for Payer: ASR ASR |
$670.81
|
| Rate for Payer: ASR Commercial |
$670.81
|
| Rate for Payer: BCBS Complete |
$276.62
|
| Rate for Payer: BCBS Trust/PPO |
$566.32
|
| Rate for Payer: BCN Commercial |
$536.17
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Commercial |
$650.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$691.56
|
| Rate for Payer: Healthscope Whirlpool |
$670.81
|
| Rate for Payer: Mclaren Commercial |
$622.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: Nomi Health Commercial |
$567.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.94
|
| Rate for Payer: Priority Health Narrow Network |
$484.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.57
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.51 |
| Max. Negotiated Rate |
$691.56 |
| Rate for Payer: Aetna Commercial |
$622.40
|
| Rate for Payer: ASR ASR |
$670.81
|
| Rate for Payer: ASR Commercial |
$670.81
|
| Rate for Payer: BCBS Trust/PPO |
$563.55
|
| Rate for Payer: BCN Commercial |
$536.17
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Commercial |
$650.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$691.56
|
| Rate for Payer: Healthscope Whirlpool |
$670.81
|
| Rate for Payer: Mclaren Commercial |
$622.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: Nomi Health Commercial |
$567.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.57
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,509.51 |
| Max. Negotiated Rate |
$6,937.70 |
| Rate for Payer: Aetna Commercial |
$6,243.93
|
| Rate for Payer: ASR ASR |
$6,729.57
|
| Rate for Payer: ASR Commercial |
$6,729.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,653.53
|
| Rate for Payer: BCN Commercial |
$5,378.80
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$6,521.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,937.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,729.57
|
| Rate for Payer: Mclaren Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,105.18
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$6,937.70 |
| Rate for Payer: Aetna Commercial |
$6,243.93
|
| Rate for Payer: Aetna Medicare |
$3,468.85
|
| Rate for Payer: ASR ASR |
$6,729.57
|
| Rate for Payer: ASR Commercial |
$6,729.57
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,681.28
|
| Rate for Payer: BCN Commercial |
$5,378.80
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$6,521.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,937.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,729.57
|
| Rate for Payer: Mclaren Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.05
|
| Rate for Payer: Nomi Health Commercial |
$5,688.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,078.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,863.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,105.18
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.76 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$660.96
|
| Rate for Payer: Aetna Medicare |
$367.20
|
| Rate for Payer: ASR ASR |
$712.37
|
| Rate for Payer: ASR Commercial |
$712.37
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$601.40
|
| Rate for Payer: BCN Commercial |
$569.38
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$690.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$734.40
|
| Rate for Payer: Healthscope Whirlpool |
$712.37
|
| Rate for Payer: Mclaren Commercial |
$660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.48
|
| Rate for Payer: Priority Health Narrow Network |
$514.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$646.27
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$660.96
|
| Rate for Payer: ASR ASR |
$712.37
|
| Rate for Payer: ASR Commercial |
$712.37
|
| Rate for Payer: BCBS Trust/PPO |
$598.46
|
| Rate for Payer: BCN Commercial |
$569.38
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$690.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$734.40
|
| Rate for Payer: Healthscope Whirlpool |
$712.37
|
| Rate for Payer: Mclaren Commercial |
$660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$646.27
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.72 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$798.11
|
| Rate for Payer: Aetna Medicare |
$443.39
|
| Rate for Payer: ASR ASR |
$860.19
|
| Rate for Payer: ASR Commercial |
$860.19
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS Trust/PPO |
$726.19
|
| Rate for Payer: BCN Commercial |
$687.53
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$833.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$886.79
|
| Rate for Payer: Healthscope Whirlpool |
$860.19
|
| Rate for Payer: Mclaren Commercial |
$798.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.01
|
| Rate for Payer: Priority Health Narrow Network |
$621.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.38
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.41 |
| Max. Negotiated Rate |
$886.79 |
| Rate for Payer: Aetna Commercial |
$798.11
|
| Rate for Payer: ASR ASR |
$860.19
|
| Rate for Payer: ASR Commercial |
$860.19
|
| Rate for Payer: BCBS Trust/PPO |
$722.65
|
| Rate for Payer: BCN Commercial |
$687.53
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$833.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$886.79
|
| Rate for Payer: Healthscope Whirlpool |
$860.19
|
| Rate for Payer: Mclaren Commercial |
$798.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$780.38
|
|
