|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
OP
|
$18,535.04
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,955.64 |
| Max. Negotiated Rate |
$18,535.04 |
| Rate for Payer: Aetna Commercial |
$16,681.54
|
| Rate for Payer: Aetna Medicare |
$11,111.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: ASR ASR |
$17,978.99
|
| Rate for Payer: ASR Commercial |
$17,978.99
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$15,178.34
|
| Rate for Payer: BCN Commercial |
$14,370.22
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cofinity Commercial |
$17,422.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,828.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$18,535.04
|
| Rate for Payer: Healthscope Whirlpool |
$17,978.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,111.26
|
| Rate for Payer: Mclaren Commercial |
$16,681.54
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,754.78
|
| Rate for Payer: Nomi Health Commercial |
$15,198.73
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$12,222.39
|
| Rate for Payer: PHP Medicaid |
$5,955.64
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,047.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,240.40
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$12,993.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,310.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$17,222.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP DNSP |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
IP
|
$18,535.04
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,047.78 |
| Max. Negotiated Rate |
$18,535.04 |
| Rate for Payer: Aetna Commercial |
$16,681.54
|
| Rate for Payer: ASR ASR |
$17,978.99
|
| Rate for Payer: ASR Commercial |
$17,978.99
|
| Rate for Payer: BCBS Trust/PPO |
$15,104.20
|
| Rate for Payer: BCN Commercial |
$14,370.22
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cofinity Commercial |
$17,422.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,828.03
|
| Rate for Payer: Healthscope Commercial |
$18,535.04
|
| Rate for Payer: Healthscope Whirlpool |
$17,978.99
|
| Rate for Payer: Mclaren Commercial |
$16,681.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,754.78
|
| Rate for Payer: Nomi Health Commercial |
$15,198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,047.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,310.84
|
|
|
HC DIALYSIS CATH LVL 10 LONG TERM
|
Facility
|
OP
|
$1,047.44
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.98 |
| Max. Negotiated Rate |
$1,047.44 |
| Rate for Payer: Aetna Commercial |
$942.70
|
| Rate for Payer: Aetna Medicare |
$523.72
|
| Rate for Payer: ASR ASR |
$1,016.02
|
| Rate for Payer: ASR Commercial |
$1,016.02
|
| Rate for Payer: BCBS Complete |
$418.98
|
| Rate for Payer: BCBS Trust/PPO |
$857.75
|
| Rate for Payer: BCN Commercial |
$812.08
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$984.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$1,047.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.02
|
| Rate for Payer: Mclaren Commercial |
$942.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.77
|
| Rate for Payer: Priority Health Narrow Network |
$734.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$921.75
|
|
|
HC DIALYSIS CATH LVL 10 LONG TERM
|
Facility
|
IP
|
$1,047.44
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.84 |
| Max. Negotiated Rate |
$1,047.44 |
| Rate for Payer: Aetna Commercial |
$942.70
|
| Rate for Payer: ASR ASR |
$1,016.02
|
| Rate for Payer: ASR Commercial |
$1,016.02
|
| Rate for Payer: BCBS Trust/PPO |
$853.56
|
| Rate for Payer: BCN Commercial |
$812.08
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$984.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$1,047.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.02
|
| Rate for Payer: Mclaren Commercial |
$942.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: Nomi Health Commercial |
$858.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$921.75
|
|
|
HC DIALYSIS CATH LVL 11 LONG TERM
|
Facility
|
OP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.79 |
| Max. Negotiated Rate |
$1,171.97 |
| Rate for Payer: Aetna Commercial |
$1,054.77
|
| Rate for Payer: Aetna Medicare |
$585.98
|
| Rate for Payer: ASR ASR |
$1,136.81
|
| Rate for Payer: ASR Commercial |
$1,136.81
|
| Rate for Payer: BCBS Complete |
$468.79
|
| Rate for Payer: BCBS Trust/PPO |
$959.73
|
| Rate for Payer: BCN Commercial |
$908.63
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,171.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,136.81
|
| Rate for Payer: Mclaren Commercial |
$1,054.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,026.88
|
| Rate for Payer: Priority Health Narrow Network |
$821.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,031.33
|
|
|
HC DIALYSIS CATH LVL 11 LONG TERM
|
Facility
|
IP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.78 |
| Max. Negotiated Rate |
$1,171.97 |
| Rate for Payer: Aetna Commercial |
$1,054.77
|
| Rate for Payer: ASR ASR |
$1,136.81
|
| Rate for Payer: ASR Commercial |
$1,136.81
|
| Rate for Payer: BCBS Trust/PPO |
$955.04
|
| Rate for Payer: BCN Commercial |
$908.63
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,171.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,136.81
|
| Rate for Payer: Mclaren Commercial |
$1,054.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: Nomi Health Commercial |
$961.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,031.33
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Aetna Commercial |
$1,242.05
|
| Rate for Payer: Aetna Medicare |
$690.03
|
| Rate for Payer: ASR ASR |
$1,338.66
|
| Rate for Payer: ASR Commercial |
$1,338.66
|
| Rate for Payer: BCBS Complete |
$552.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.13
|
| Rate for Payer: BCN Commercial |
$1,069.96
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,380.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.66
|
| Rate for Payer: Mclaren Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,209.21
|
| Rate for Payer: Priority Health Narrow Network |
$967.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.45
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$897.04 |
| Max. Negotiated Rate |
$1,380.06 |
| Rate for Payer: Aetna Commercial |
$1,242.05
|
| Rate for Payer: ASR ASR |
$1,338.66
|
| Rate for Payer: ASR Commercial |
$1,338.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.61
|
| Rate for Payer: BCN Commercial |
$1,069.96
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,297.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,380.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,338.66
|
| Rate for Payer: Mclaren Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Nomi Health Commercial |
$1,131.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.45
|
|
|
HC DIALYSIS CATH LVL 2 SHORT TERM
|
Facility
|
IP
|
$208.07
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.25 |
| Max. Negotiated Rate |
$208.07 |
| Rate for Payer: Aetna Commercial |
$187.26
|
| Rate for Payer: ASR ASR |
$201.83
|
| Rate for Payer: ASR Commercial |
$201.83
|
| Rate for Payer: BCBS Trust/PPO |
$169.56
|
| Rate for Payer: BCN Commercial |
$161.32
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$208.07
|
| Rate for Payer: Healthscope Whirlpool |
$201.83
|
| Rate for Payer: Mclaren Commercial |
$187.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.10
|
|
|
HC DIALYSIS CATH LVL 2 SHORT TERM
|
Facility
|
OP
|
$208.07
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.23 |
| Max. Negotiated Rate |
$208.07 |
| Rate for Payer: Aetna Commercial |
$187.26
|
| Rate for Payer: Aetna Medicare |
$104.04
|
| Rate for Payer: ASR ASR |
$201.83
|
| Rate for Payer: ASR Commercial |
$201.83
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$170.39
|
| Rate for Payer: BCN Commercial |
$161.32
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$208.07
|
| Rate for Payer: Healthscope Whirlpool |
$201.83
|
| Rate for Payer: Mclaren Commercial |
$187.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: Nomi Health Commercial |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.31
|
| Rate for Payer: Priority Health Narrow Network |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.10
|
|
|
HC DIALYSIS CATH LVL 3 SHORT TERM
|
Facility
|
IP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.86 |
| Max. Negotiated Rate |
$315.17 |
| Rate for Payer: Aetna Commercial |
$283.65
|
| Rate for Payer: ASR ASR |
$305.71
|
| Rate for Payer: ASR Commercial |
$305.71
|
| Rate for Payer: BCBS Trust/PPO |
$256.83
|
| Rate for Payer: BCN Commercial |
$244.35
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$296.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$315.17
|
| Rate for Payer: Healthscope Whirlpool |
$305.71
|
| Rate for Payer: Mclaren Commercial |
$283.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.35
|
|
|
HC DIALYSIS CATH LVL 3 SHORT TERM
|
Facility
|
OP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.07 |
| Max. Negotiated Rate |
$315.17 |
| Rate for Payer: Aetna Commercial |
$283.65
|
| Rate for Payer: Aetna Medicare |
$157.58
|
| Rate for Payer: ASR ASR |
$305.71
|
| Rate for Payer: ASR Commercial |
$305.71
|
| Rate for Payer: BCBS Complete |
$126.07
|
| Rate for Payer: BCBS Trust/PPO |
$258.09
|
| Rate for Payer: BCN Commercial |
$244.35
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$296.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$315.17
|
| Rate for Payer: Healthscope Whirlpool |
$305.71
|
| Rate for Payer: Mclaren Commercial |
$283.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: Nomi Health Commercial |
$258.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.15
|
| Rate for Payer: Priority Health Narrow Network |
$220.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$277.35
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
IP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.48 |
| Max. Negotiated Rate |
$422.27 |
| Rate for Payer: Aetna Commercial |
$380.04
|
| Rate for Payer: ASR ASR |
$409.60
|
| Rate for Payer: ASR Commercial |
$409.60
|
| Rate for Payer: BCBS Trust/PPO |
$344.11
|
| Rate for Payer: BCN Commercial |
$327.39
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$396.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$422.27
|
| Rate for Payer: Healthscope Whirlpool |
$409.60
|
| Rate for Payer: Mclaren Commercial |
$380.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.60
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
OP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$422.27 |
| Rate for Payer: Aetna Commercial |
$380.04
|
| Rate for Payer: Aetna Medicare |
$211.14
|
| Rate for Payer: ASR ASR |
$409.60
|
| Rate for Payer: ASR Commercial |
$409.60
|
| Rate for Payer: BCBS Complete |
$168.91
|
| Rate for Payer: BCBS Trust/PPO |
$345.80
|
| Rate for Payer: BCN Commercial |
$327.39
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$396.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$422.27
|
| Rate for Payer: Healthscope Whirlpool |
$409.60
|
| Rate for Payer: Mclaren Commercial |
$380.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: Nomi Health Commercial |
$346.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.99
|
| Rate for Payer: Priority Health Narrow Network |
$296.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$371.60
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
OP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$529.37 |
| Rate for Payer: Aetna Commercial |
$476.43
|
| Rate for Payer: Aetna Medicare |
$264.68
|
| Rate for Payer: ASR ASR |
$513.49
|
| Rate for Payer: ASR Commercial |
$513.49
|
| Rate for Payer: BCBS Complete |
$211.75
|
| Rate for Payer: BCBS Trust/PPO |
$433.50
|
| Rate for Payer: BCN Commercial |
$410.42
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$497.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$529.37
|
| Rate for Payer: Healthscope Whirlpool |
$513.49
|
| Rate for Payer: Mclaren Commercial |
$476.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.83
|
| Rate for Payer: Priority Health Narrow Network |
$371.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.85
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
IP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$529.37 |
| Rate for Payer: Aetna Commercial |
$476.43
|
| Rate for Payer: ASR ASR |
$513.49
|
| Rate for Payer: ASR Commercial |
$513.49
|
| Rate for Payer: BCBS Trust/PPO |
$431.38
|
| Rate for Payer: BCN Commercial |
$410.42
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$497.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$529.37
|
| Rate for Payer: Healthscope Whirlpool |
$513.49
|
| Rate for Payer: Mclaren Commercial |
$476.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: Nomi Health Commercial |
$434.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$465.85
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
OP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$743.57 |
| Rate for Payer: Aetna Commercial |
$669.21
|
| Rate for Payer: Aetna Medicare |
$371.78
|
| Rate for Payer: ASR ASR |
$721.26
|
| Rate for Payer: ASR Commercial |
$721.26
|
| Rate for Payer: BCBS Complete |
$297.43
|
| Rate for Payer: BCBS Trust/PPO |
$608.91
|
| Rate for Payer: BCN Commercial |
$576.49
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$698.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$743.57
|
| Rate for Payer: Healthscope Whirlpool |
$721.26
|
| Rate for Payer: Mclaren Commercial |
$669.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$651.52
|
| Rate for Payer: Priority Health Narrow Network |
$521.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.34
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
IP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.32 |
| Max. Negotiated Rate |
$743.57 |
| Rate for Payer: Aetna Commercial |
$669.21
|
| Rate for Payer: ASR ASR |
$721.26
|
| Rate for Payer: ASR Commercial |
$721.26
|
| Rate for Payer: BCBS Trust/PPO |
$605.94
|
| Rate for Payer: BCN Commercial |
$576.49
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$698.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$743.57
|
| Rate for Payer: Healthscope Whirlpool |
$721.26
|
| Rate for Payer: Mclaren Commercial |
$669.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: Nomi Health Commercial |
$609.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$654.34
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
OP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.32 |
| Max. Negotiated Rate |
$793.31 |
| Rate for Payer: Aetna Commercial |
$713.98
|
| Rate for Payer: Aetna Medicare |
$396.66
|
| Rate for Payer: ASR ASR |
$769.51
|
| Rate for Payer: ASR Commercial |
$769.51
|
| Rate for Payer: BCBS Complete |
$317.32
|
| Rate for Payer: BCBS Trust/PPO |
$649.64
|
| Rate for Payer: BCN Commercial |
$615.05
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$745.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$793.31
|
| Rate for Payer: Healthscope Whirlpool |
$769.51
|
| Rate for Payer: Mclaren Commercial |
$713.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$695.10
|
| Rate for Payer: Priority Health Narrow Network |
$556.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.11
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
IP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.65 |
| Max. Negotiated Rate |
$793.31 |
| Rate for Payer: Aetna Commercial |
$713.98
|
| Rate for Payer: ASR ASR |
$769.51
|
| Rate for Payer: ASR Commercial |
$769.51
|
| Rate for Payer: BCBS Trust/PPO |
$646.47
|
| Rate for Payer: BCN Commercial |
$615.05
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$745.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$793.31
|
| Rate for Payer: Healthscope Whirlpool |
$769.51
|
| Rate for Payer: Mclaren Commercial |
$713.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: Nomi Health Commercial |
$650.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$698.11
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
IP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.94 |
| Max. Negotiated Rate |
$850.67 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: ASR ASR |
$825.15
|
| Rate for Payer: ASR Commercial |
$825.15
|
| Rate for Payer: BCBS Trust/PPO |
$693.21
|
| Rate for Payer: BCN Commercial |
$659.52
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$799.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$850.67
|
| Rate for Payer: Healthscope Whirlpool |
$825.15
|
| Rate for Payer: Mclaren Commercial |
$765.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.59
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
OP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.27 |
| Max. Negotiated Rate |
$850.67 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: Aetna Medicare |
$425.34
|
| Rate for Payer: ASR ASR |
$825.15
|
| Rate for Payer: ASR Commercial |
$825.15
|
| Rate for Payer: BCBS Complete |
$340.27
|
| Rate for Payer: BCBS Trust/PPO |
$696.61
|
| Rate for Payer: BCN Commercial |
$659.52
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$799.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$850.67
|
| Rate for Payer: Healthscope Whirlpool |
$825.15
|
| Rate for Payer: Mclaren Commercial |
$765.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: Nomi Health Commercial |
$697.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.36
|
| Rate for Payer: Priority Health Narrow Network |
$596.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$748.59
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
IP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.55 |
| Max. Negotiated Rate |
$957.77 |
| Rate for Payer: Aetna Commercial |
$861.99
|
| Rate for Payer: ASR ASR |
$929.04
|
| Rate for Payer: ASR Commercial |
$929.04
|
| Rate for Payer: BCBS Trust/PPO |
$780.49
|
| Rate for Payer: BCN Commercial |
$742.56
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$900.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$957.77
|
| Rate for Payer: Healthscope Whirlpool |
$929.04
|
| Rate for Payer: Mclaren Commercial |
$861.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.84
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
OP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$383.11 |
| Max. Negotiated Rate |
$957.77 |
| Rate for Payer: Aetna Commercial |
$861.99
|
| Rate for Payer: Aetna Medicare |
$478.88
|
| Rate for Payer: ASR ASR |
$929.04
|
| Rate for Payer: ASR Commercial |
$929.04
|
| Rate for Payer: BCBS Complete |
$383.11
|
| Rate for Payer: BCBS Trust/PPO |
$784.32
|
| Rate for Payer: BCN Commercial |
$742.56
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$900.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$957.77
|
| Rate for Payer: Healthscope Whirlpool |
$929.04
|
| Rate for Payer: Mclaren Commercial |
$861.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: Nomi Health Commercial |
$785.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.20
|
| Rate for Payer: Priority Health Narrow Network |
$671.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$842.84
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$396.56 |
| Rate for Payer: Aetna Commercial |
$356.90
|
| Rate for Payer: Aetna Medicare |
$198.28
|
| Rate for Payer: ASR ASR |
$384.66
|
| Rate for Payer: ASR Commercial |
$384.66
|
| Rate for Payer: BCBS Complete |
$158.62
|
| Rate for Payer: BCBS Trust/PPO |
$324.74
|
| Rate for Payer: BCN Commercial |
$307.45
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$372.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$396.56
|
| Rate for Payer: Healthscope Whirlpool |
$384.66
|
| Rate for Payer: Mclaren Commercial |
$356.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: Nomi Health Commercial |
$325.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.21
|
| Rate for Payer: Priority Health Narrow Network |
$172.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.97
|
|
