|
HC INFRARED THERAPY
|
Facility
|
IP
|
$57.48
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$57.48 |
| Rate for Payer: Aetna Commercial |
$51.73
|
| Rate for Payer: ASR ASR |
$55.76
|
| Rate for Payer: BCBS Trust/PPO |
$44.56
|
| Rate for Payer: BCN Commercial |
$44.56
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$54.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Healthscope Commercial |
$57.48
|
| Rate for Payer: Healthscope Whirlpool |
$55.76
|
| Rate for Payer: Mclaren Commercial |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.58
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: ASR ASR |
$152.78
|
| Rate for Payer: BCBS Trust/PPO |
$122.11
|
| Rate for Payer: BCN Commercial |
$122.11
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Whirlpool |
$152.78
|
| Rate for Payer: Mclaren Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.60
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: ASR ASR |
$152.78
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$122.11
|
| Rate for Payer: BCN Commercial |
$122.11
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Whirlpool |
$152.78
|
| Rate for Payer: Mclaren Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.32
|
| Rate for Payer: Priority Health Narrow Network |
$111.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.60
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
IP
|
$237.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: ASR ASR |
$230.01
|
| Rate for Payer: BCBS Trust/PPO |
$183.84
|
| Rate for Payer: BCN Commercial |
$183.84
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$222.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.70
|
| Rate for Payer: Healthscope Commercial |
$237.12
|
| Rate for Payer: Healthscope Whirlpool |
$230.01
|
| Rate for Payer: Mclaren Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.67
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$237.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: ASR ASR |
$230.01
|
| Rate for Payer: BCBS Complete |
$94.85
|
| Rate for Payer: BCBS Trust/PPO |
$183.84
|
| Rate for Payer: BCN Commercial |
$183.84
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$222.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.70
|
| Rate for Payer: Healthscope Commercial |
$237.12
|
| Rate for Payer: Healthscope Whirlpool |
$230.01
|
| Rate for Payer: Mclaren Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.78
|
| Rate for Payer: Priority Health Narrow Network |
$168.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.67
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
IP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$357.21
|
| Rate for Payer: ASR ASR |
$384.99
|
| Rate for Payer: BCBS Trust/PPO |
$307.72
|
| Rate for Payer: BCN Commercial |
$307.72
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$373.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Healthscope Whirlpool |
$384.99
|
| Rate for Payer: Mclaren Commercial |
$357.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.27
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
OP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$357.21
|
| Rate for Payer: ASR ASR |
$384.99
|
| Rate for Payer: BCBS Complete |
$158.76
|
| Rate for Payer: BCBS Trust/PPO |
$307.72
|
| Rate for Payer: BCN Commercial |
$307.72
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$373.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Healthscope Whirlpool |
$384.99
|
| Rate for Payer: Mclaren Commercial |
$357.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.18
|
| Rate for Payer: Priority Health Narrow Network |
$281.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.27
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
IP
|
$662.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.00 |
| Max. Negotiated Rate |
$662.86 |
| Rate for Payer: Aetna Commercial |
$596.57
|
| Rate for Payer: ASR ASR |
$642.97
|
| Rate for Payer: BCBS Trust/PPO |
$513.92
|
| Rate for Payer: BCN Commercial |
$513.92
|
| Rate for Payer: Cash Price |
$530.29
|
| Rate for Payer: Cofinity Commercial |
$623.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.29
|
| Rate for Payer: Healthscope Commercial |
$662.86
|
| Rate for Payer: Healthscope Whirlpool |
$642.97
|
| Rate for Payer: Mclaren Commercial |
$596.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.32
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
OP
|
$662.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.14 |
| Max. Negotiated Rate |
$662.86 |
| Rate for Payer: Aetna Commercial |
$596.57
|
| Rate for Payer: ASR ASR |
$642.97
|
| Rate for Payer: BCBS Complete |
$265.14
|
| Rate for Payer: BCBS Trust/PPO |
$513.92
|
| Rate for Payer: BCN Commercial |
$513.92
|
| Rate for Payer: Cash Price |
$530.29
|
| Rate for Payer: Cofinity Commercial |
$623.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.29
|
| Rate for Payer: Healthscope Commercial |
$662.86
|
| Rate for Payer: Healthscope Whirlpool |
$642.97
|
| Rate for Payer: Mclaren Commercial |
$596.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$603.20
|
| Rate for Payer: Priority Health Narrow Network |
$470.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.32
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
IP
|
$740.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$518.27 |
| Max. Negotiated Rate |
$740.38 |
| Rate for Payer: Aetna Commercial |
$666.34
|
| Rate for Payer: ASR ASR |
$718.17
|
| Rate for Payer: BCBS Trust/PPO |
$574.02
|
| Rate for Payer: BCN Commercial |
$574.02
|
| Rate for Payer: Cash Price |
$592.30
|
| Rate for Payer: Cofinity Commercial |
$695.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.30
|
| Rate for Payer: Healthscope Commercial |
$740.38
|
| Rate for Payer: Healthscope Whirlpool |
$718.17
|
| Rate for Payer: Mclaren Commercial |
$666.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$651.53
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
OP
|
$740.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.15 |
| Max. Negotiated Rate |
$740.38 |
| Rate for Payer: Aetna Commercial |
$666.34
|
| Rate for Payer: ASR ASR |
$718.17
|
| Rate for Payer: BCBS Complete |
$296.15
|
| Rate for Payer: BCBS Trust/PPO |
$574.02
|
| Rate for Payer: BCN Commercial |
$574.02
|
| Rate for Payer: Cash Price |
$592.30
|
| Rate for Payer: Cofinity Commercial |
$695.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.30
|
| Rate for Payer: Healthscope Commercial |
$740.38
|
| Rate for Payer: Healthscope Whirlpool |
$718.17
|
| Rate for Payer: Mclaren Commercial |
$666.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$673.75
|
| Rate for Payer: Priority Health Narrow Network |
$525.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$651.53
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
IP
|
$904.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$632.93 |
| Max. Negotiated Rate |
$904.18 |
| Rate for Payer: Aetna Commercial |
$813.76
|
| Rate for Payer: ASR ASR |
$877.05
|
| Rate for Payer: BCBS Trust/PPO |
$701.01
|
| Rate for Payer: BCN Commercial |
$701.01
|
| Rate for Payer: Cash Price |
$723.34
|
| Rate for Payer: Cofinity Commercial |
$849.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.34
|
| Rate for Payer: Healthscope Commercial |
$904.18
|
| Rate for Payer: Healthscope Whirlpool |
$877.05
|
| Rate for Payer: Mclaren Commercial |
$813.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.68
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
OP
|
$904.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$904.18 |
| Rate for Payer: Aetna Commercial |
$813.76
|
| Rate for Payer: ASR ASR |
$877.05
|
| Rate for Payer: BCBS Complete |
$361.67
|
| Rate for Payer: BCBS Trust/PPO |
$701.01
|
| Rate for Payer: BCN Commercial |
$701.01
|
| Rate for Payer: Cash Price |
$723.34
|
| Rate for Payer: Cofinity Commercial |
$849.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.34
|
| Rate for Payer: Healthscope Commercial |
$904.18
|
| Rate for Payer: Healthscope Whirlpool |
$877.05
|
| Rate for Payer: Mclaren Commercial |
$813.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.80
|
| Rate for Payer: Priority Health Narrow Network |
$641.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$795.68
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
OP
|
$1,006.71
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.68 |
| Max. Negotiated Rate |
$1,006.71 |
| Rate for Payer: Aetna Commercial |
$906.04
|
| Rate for Payer: ASR ASR |
$976.51
|
| Rate for Payer: BCBS Complete |
$402.68
|
| Rate for Payer: BCBS Trust/PPO |
$780.50
|
| Rate for Payer: BCN Commercial |
$780.50
|
| Rate for Payer: Cash Price |
$805.37
|
| Rate for Payer: Cofinity Commercial |
$946.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.37
|
| Rate for Payer: Healthscope Commercial |
$1,006.71
|
| Rate for Payer: Healthscope Whirlpool |
$976.51
|
| Rate for Payer: Mclaren Commercial |
$906.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.11
|
| Rate for Payer: Priority Health Narrow Network |
$714.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$885.90
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
IP
|
$1,006.71
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.70 |
| Max. Negotiated Rate |
$1,006.71 |
| Rate for Payer: Aetna Commercial |
$906.04
|
| Rate for Payer: ASR ASR |
$976.51
|
| Rate for Payer: BCBS Trust/PPO |
$780.50
|
| Rate for Payer: BCN Commercial |
$780.50
|
| Rate for Payer: Cash Price |
$805.37
|
| Rate for Payer: Cofinity Commercial |
$946.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.37
|
| Rate for Payer: Healthscope Commercial |
$1,006.71
|
| Rate for Payer: Healthscope Whirlpool |
$976.51
|
| Rate for Payer: Mclaren Commercial |
$906.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$885.90
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
OP
|
$1,120.87
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$1,120.87 |
| Rate for Payer: Aetna Commercial |
$1,008.78
|
| Rate for Payer: ASR ASR |
$1,087.24
|
| Rate for Payer: BCBS Complete |
$448.35
|
| Rate for Payer: BCBS Trust/PPO |
$869.01
|
| Rate for Payer: BCN Commercial |
$869.01
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cofinity Commercial |
$1,053.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.70
|
| Rate for Payer: Healthscope Commercial |
$1,120.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.24
|
| Rate for Payer: Mclaren Commercial |
$1,008.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,019.99
|
| Rate for Payer: Priority Health Narrow Network |
$795.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$986.37
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
IP
|
$1,120.87
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.61 |
| Max. Negotiated Rate |
$1,120.87 |
| Rate for Payer: Aetna Commercial |
$1,008.78
|
| Rate for Payer: ASR ASR |
$1,087.24
|
| Rate for Payer: BCBS Trust/PPO |
$869.01
|
| Rate for Payer: BCN Commercial |
$869.01
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cofinity Commercial |
$1,053.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.70
|
| Rate for Payer: Healthscope Commercial |
$1,120.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,087.24
|
| Rate for Payer: Mclaren Commercial |
$1,008.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$986.37
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
OP
|
$1,247.97
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.19 |
| Max. Negotiated Rate |
$1,247.97 |
| Rate for Payer: Aetna Commercial |
$1,123.17
|
| Rate for Payer: ASR ASR |
$1,210.53
|
| Rate for Payer: BCBS Complete |
$499.19
|
| Rate for Payer: BCBS Trust/PPO |
$967.55
|
| Rate for Payer: BCN Commercial |
$967.55
|
| Rate for Payer: Cash Price |
$998.38
|
| Rate for Payer: Cofinity Commercial |
$1,173.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.38
|
| Rate for Payer: Healthscope Commercial |
$1,247.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,210.53
|
| Rate for Payer: Mclaren Commercial |
$1,123.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,060.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.65
|
| Rate for Payer: Priority Health Narrow Network |
$886.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,098.21
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
IP
|
$1,247.97
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$873.58 |
| Max. Negotiated Rate |
$1,247.97 |
| Rate for Payer: Aetna Commercial |
$1,123.17
|
| Rate for Payer: ASR ASR |
$1,210.53
|
| Rate for Payer: BCBS Trust/PPO |
$967.55
|
| Rate for Payer: BCN Commercial |
$967.55
|
| Rate for Payer: Cash Price |
$998.38
|
| Rate for Payer: Cofinity Commercial |
$1,173.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.38
|
| Rate for Payer: Healthscope Commercial |
$1,247.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,210.53
|
| Rate for Payer: Mclaren Commercial |
$1,123.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,060.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,098.21
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,353.00 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: ASR ASR |
$1,312.41
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.98
|
| Rate for Payer: BCN Commercial |
$1,048.98
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,271.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.40
|
| Rate for Payer: Healthscope Commercial |
$1,353.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.41
|
| Rate for Payer: Mclaren Commercial |
$1,217.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.23
|
| Rate for Payer: Priority Health Narrow Network |
$960.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.64
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.10 |
| Max. Negotiated Rate |
$1,353.00 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: ASR ASR |
$1,312.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.98
|
| Rate for Payer: BCN Commercial |
$1,048.98
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,271.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.40
|
| Rate for Payer: Healthscope Commercial |
$1,353.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.41
|
| Rate for Payer: Mclaren Commercial |
$1,217.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.64
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
IP
|
$1,446.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,012.83 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Aetna Commercial |
$1,302.21
|
| Rate for Payer: ASR ASR |
$1,403.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.78
|
| Rate for Payer: BCN Commercial |
$1,121.78
|
| Rate for Payer: Cash Price |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,360.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.52
|
| Rate for Payer: Healthscope Commercial |
$1,446.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,403.49
|
| Rate for Payer: Mclaren Commercial |
$1,302.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,229.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,273.27
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
OP
|
$1,446.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.76 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Aetna Commercial |
$1,302.21
|
| Rate for Payer: ASR ASR |
$1,403.49
|
| Rate for Payer: BCBS Complete |
$578.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.78
|
| Rate for Payer: BCN Commercial |
$1,121.78
|
| Rate for Payer: Cash Price |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,360.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.52
|
| Rate for Payer: Healthscope Commercial |
$1,446.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,403.49
|
| Rate for Payer: Mclaren Commercial |
$1,302.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,229.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,316.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,027.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,273.27
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.50
|
| Rate for Payer: Priority Health Narrow Network |
$319.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$348.88
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
