|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
IP
|
$61.85
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Aetna Commercial |
$55.66
|
| Rate for Payer: ASR ASR |
$59.99
|
| Rate for Payer: BCBS Trust/PPO |
$47.95
|
| Rate for Payer: BCN Commercial |
$47.95
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$58.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$61.85
|
| Rate for Payer: Healthscope Whirlpool |
$59.99
|
| Rate for Payer: Mclaren Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.43
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
IP
|
$105.11
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$94.60
|
| Rate for Payer: ASR ASR |
$101.96
|
| Rate for Payer: BCBS Trust/PPO |
$81.49
|
| Rate for Payer: BCN Commercial |
$81.49
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cofinity Commercial |
$98.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.09
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Mclaren Commercial |
$94.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.50
|
|
|
HC GROUP THERAPEUTIC PROCEDURES
|
Facility
|
OP
|
$105.11
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna Commercial |
$94.60
|
| Rate for Payer: ASR ASR |
$101.96
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$81.49
|
| Rate for Payer: BCN Commercial |
$81.49
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cash Price |
$84.09
|
| Rate for Payer: Cofinity Commercial |
$98.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.09
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Mclaren Commercial |
$94.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.96
|
| Rate for Payer: Priority Health Narrow Network |
$30.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.50
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$100.57 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$16.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.84
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$16.67
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: BCN Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.67
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$9.12
|
| Rate for Payer: Mclaren Medicare |
$16.67
|
| Rate for Payer: Meridian Medicaid |
$9.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$15.84
|
| Rate for Payer: PACE SWMI |
$16.67
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Medicaid |
$9.12
|
| Rate for Payer: PHP Medicare Advantage |
$16.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.57
|
| Rate for Payer: Priority Health Medicare |
$16.67
|
| Rate for Payer: Priority Health Narrow Network |
$80.46
|
| Rate for Payer: Railroad Medicare Medicare |
$16.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
| Rate for Payer: UHC Medicare Advantage |
$17.17
|
| Rate for Payer: VA VA |
$16.67
|
|
|
HC GROWTH HORMONE HGH
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
30100752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$514.02
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC GROWTH HORMONE STIMULATION TEST
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: BCBS Trust/PPO |
$514.02
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC GSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200011
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$120.90
|
| Rate for Payer: ASR ASR |
$130.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.15
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$130.30
|
| Rate for Payer: Mclaren Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.21
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
IP
|
$565.20
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$395.64 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Aetna Commercial |
$508.68
|
| Rate for Payer: ASR ASR |
$548.24
|
| Rate for Payer: BCBS Trust/PPO |
$438.20
|
| Rate for Payer: BCN Commercial |
$438.20
|
| Rate for Payer: Cash Price |
$452.16
|
| Rate for Payer: Cofinity Commercial |
$531.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.16
|
| Rate for Payer: Healthscope Commercial |
$565.20
|
| Rate for Payer: Healthscope Whirlpool |
$548.24
|
| Rate for Payer: Mclaren Commercial |
$508.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.38
|
|
|
HC G TUBE REPLACEMENT
|
Facility
|
OP
|
$565.20
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.08 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Aetna Commercial |
$508.68
|
| Rate for Payer: ASR ASR |
$548.24
|
| Rate for Payer: BCBS Complete |
$226.08
|
| Rate for Payer: BCBS Trust/PPO |
$438.20
|
| Rate for Payer: BCN Commercial |
$438.20
|
| Rate for Payer: Cash Price |
$452.16
|
| Rate for Payer: Cofinity Commercial |
$531.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.16
|
| Rate for Payer: Healthscope Commercial |
$565.20
|
| Rate for Payer: Healthscope Whirlpool |
$548.24
|
| Rate for Payer: Mclaren Commercial |
$508.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$514.33
|
| Rate for Payer: Priority Health Narrow Network |
$401.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.38
|
|
|
HC GUIDANT / ABBOTT PERIPHERAL ST
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.47 |
| Max. Negotiated Rate |
$2,989.24 |
| Rate for Payer: Aetna Commercial |
$2,690.32
|
| Rate for Payer: ASR ASR |
$2,899.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.56
|
| Rate for Payer: BCN Commercial |
$2,317.56
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,809.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,989.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,899.56
|
| Rate for Payer: Mclaren Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.53
|
|
|
HC GUIDANT / ABBOTT PERIPHERAL ST
|
Facility
|
OP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.70 |
| Max. Negotiated Rate |
$2,989.24 |
| Rate for Payer: Aetna Commercial |
$2,690.32
|
| Rate for Payer: ASR ASR |
$2,899.56
|
| Rate for Payer: BCBS Complete |
$1,195.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.56
|
| Rate for Payer: BCN Commercial |
$2,317.56
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,809.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,989.24
|
| Rate for Payer: Healthscope Whirlpool |
$2,899.56
|
| Rate for Payer: Mclaren Commercial |
$2,690.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,720.21
|
| Rate for Payer: Priority Health Narrow Network |
$2,122.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,630.53
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
IP
|
$5,707.26
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.08 |
| Max. Negotiated Rate |
$5,707.26 |
| Rate for Payer: Aetna Commercial |
$5,136.53
|
| Rate for Payer: ASR ASR |
$5,536.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,424.84
|
| Rate for Payer: BCN Commercial |
$4,424.84
|
| Rate for Payer: Cash Price |
$4,565.81
|
| Rate for Payer: Cofinity Commercial |
$5,364.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,565.81
|
| Rate for Payer: Healthscope Commercial |
$5,707.26
|
| Rate for Payer: Healthscope Whirlpool |
$5,536.04
|
| Rate for Payer: Mclaren Commercial |
$5,136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,851.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,995.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,022.39
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
OP
|
$5,707.26
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.90 |
| Max. Negotiated Rate |
$5,707.26 |
| Rate for Payer: Aetna Commercial |
$5,136.53
|
| Rate for Payer: ASR ASR |
$5,536.04
|
| Rate for Payer: BCBS Complete |
$2,282.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,424.84
|
| Rate for Payer: BCN Commercial |
$4,424.84
|
| Rate for Payer: Cash Price |
$4,565.81
|
| Rate for Payer: Cofinity Commercial |
$5,364.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,565.81
|
| Rate for Payer: Healthscope Commercial |
$5,707.26
|
| Rate for Payer: Healthscope Whirlpool |
$5,536.04
|
| Rate for Payer: Mclaren Commercial |
$5,136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,851.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,995.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,193.61
|
| Rate for Payer: Priority Health Narrow Network |
$4,052.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,022.39
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
OP
|
$10,150.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,060.00 |
| Max. Negotiated Rate |
$10,150.00 |
| Rate for Payer: Aetna Commercial |
$9,135.00
|
| Rate for Payer: ASR ASR |
$9,845.50
|
| Rate for Payer: BCBS Complete |
$4,060.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,869.30
|
| Rate for Payer: BCN Commercial |
$7,869.30
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cofinity Commercial |
$9,541.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,120.00
|
| Rate for Payer: Healthscope Commercial |
$10,150.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,845.50
|
| Rate for Payer: Mclaren Commercial |
$9,135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,236.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,206.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,932.00
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
IP
|
$10,150.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,105.00 |
| Max. Negotiated Rate |
$10,150.00 |
| Rate for Payer: Aetna Commercial |
$9,135.00
|
| Rate for Payer: ASR ASR |
$9,845.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,869.30
|
| Rate for Payer: BCN Commercial |
$7,869.30
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cofinity Commercial |
$9,541.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,120.00
|
| Rate for Payer: Healthscope Commercial |
$10,150.00
|
| Rate for Payer: Healthscope Whirlpool |
$9,845.50
|
| Rate for Payer: Mclaren Commercial |
$9,135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,932.00
|
|
|
HC GUIDANT PERIPHERAL BALLOON
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$648.00
|
| Rate for Payer: ASR ASR |
$698.40
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS Trust/PPO |
$558.22
|
| Rate for Payer: BCN Commercial |
$558.22
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$676.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$720.00
|
| Rate for Payer: Healthscope Whirlpool |
$698.40
|
| Rate for Payer: Mclaren Commercial |
$648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.20
|
| Rate for Payer: Priority Health Narrow Network |
$511.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.60
|
|
|
HC GUIDANT PERIPHERAL BALLOON
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$648.00
|
| Rate for Payer: ASR ASR |
$698.40
|
| Rate for Payer: BCBS Trust/PPO |
$558.22
|
| Rate for Payer: BCN Commercial |
$558.22
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$676.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$720.00
|
| Rate for Payer: Healthscope Whirlpool |
$698.40
|
| Rate for Payer: Mclaren Commercial |
$648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.60
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
IP
|
$12,993.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,095.10 |
| Max. Negotiated Rate |
$12,993.00 |
| Rate for Payer: Aetna Commercial |
$11,693.70
|
| Rate for Payer: ASR ASR |
$12,603.21
|
| Rate for Payer: BCBS Trust/PPO |
$10,073.47
|
| Rate for Payer: BCN Commercial |
$10,073.47
|
| Rate for Payer: Cash Price |
$10,394.40
|
| Rate for Payer: Cofinity Commercial |
$12,213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,394.40
|
| Rate for Payer: Healthscope Commercial |
$12,993.00
|
| Rate for Payer: Healthscope Whirlpool |
$12,603.21
|
| Rate for Payer: Mclaren Commercial |
$11,693.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,044.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,095.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,433.84
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
OP
|
$12,993.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,197.20 |
| Max. Negotiated Rate |
$12,993.00 |
| Rate for Payer: Aetna Commercial |
$11,693.70
|
| Rate for Payer: ASR ASR |
$12,603.21
|
| Rate for Payer: BCBS Complete |
$5,197.20
|
| Rate for Payer: BCBS Trust/PPO |
$10,073.47
|
| Rate for Payer: BCN Commercial |
$10,073.47
|
| Rate for Payer: Cash Price |
$10,394.40
|
| Rate for Payer: Cofinity Commercial |
$12,213.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,394.40
|
| Rate for Payer: Healthscope Commercial |
$12,993.00
|
| Rate for Payer: Healthscope Whirlpool |
$12,603.21
|
| Rate for Payer: Mclaren Commercial |
$11,693.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,044.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,095.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,823.63
|
| Rate for Payer: Priority Health Narrow Network |
$9,225.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,433.84
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
IP
|
$524.10
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.87 |
| Max. Negotiated Rate |
$524.10 |
| Rate for Payer: Aetna Commercial |
$471.69
|
| Rate for Payer: ASR ASR |
$508.38
|
| Rate for Payer: BCBS Trust/PPO |
$406.33
|
| Rate for Payer: BCN Commercial |
$406.33
|
| Rate for Payer: Cash Price |
$419.28
|
| Rate for Payer: Cofinity Commercial |
$492.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.28
|
| Rate for Payer: Healthscope Commercial |
$524.10
|
| Rate for Payer: Healthscope Whirlpool |
$508.38
|
| Rate for Payer: Mclaren Commercial |
$471.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.21
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
OP
|
$524.10
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.64 |
| Max. Negotiated Rate |
$524.10 |
| Rate for Payer: Aetna Commercial |
$471.69
|
| Rate for Payer: ASR ASR |
$508.38
|
| Rate for Payer: BCBS Complete |
$209.64
|
| Rate for Payer: BCBS Trust/PPO |
$406.33
|
| Rate for Payer: BCN Commercial |
$406.33
|
| Rate for Payer: Cash Price |
$419.28
|
| Rate for Payer: Cash Price |
$419.28
|
| Rate for Payer: Cofinity Commercial |
$492.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.28
|
| Rate for Payer: Healthscope Commercial |
$524.10
|
| Rate for Payer: Healthscope Whirlpool |
$508.38
|
| Rate for Payer: Mclaren Commercial |
$471.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.95
|
| Rate for Payer: Priority Health Narrow Network |
$233.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.21
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
OP
|
$1,718.55
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$687.42 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Aetna Commercial |
$1,546.70
|
| Rate for Payer: ASR ASR |
$1,666.99
|
| Rate for Payer: BCBS Complete |
$687.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.39
|
| Rate for Payer: BCN Commercial |
$1,332.39
|
| Rate for Payer: Cash Price |
$1,374.84
|
| Rate for Payer: Cofinity Commercial |
$1,615.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.84
|
| Rate for Payer: Healthscope Commercial |
$1,718.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,666.99
|
| Rate for Payer: Mclaren Commercial |
$1,546.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,460.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,202.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,563.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,220.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,512.32
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
IP
|
$1,718.55
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,202.98 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Aetna Commercial |
$1,546.70
|
| Rate for Payer: ASR ASR |
$1,666.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.39
|
| Rate for Payer: BCN Commercial |
$1,332.39
|
| Rate for Payer: Cash Price |
$1,374.84
|
| Rate for Payer: Cofinity Commercial |
$1,615.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.84
|
| Rate for Payer: Healthscope Commercial |
$1,718.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,666.99
|
| Rate for Payer: Mclaren Commercial |
$1,546.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,460.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,202.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,512.32
|
|
