|
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 |
$157.59
|
| 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
|
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 |
$211.13
|
| 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 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 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 |
$264.69
|
| 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 |
$371.79
|
| 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
|
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 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 |
$396.65
|
| 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 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 |
$425.33
|
| 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
|
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 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 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: 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 |
$347.47
|
| Rate for Payer: Priority Health Narrow Network |
$277.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.97
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$396.56 |
| Rate for Payer: Aetna Commercial |
$356.90
|
| Rate for Payer: ASR ASR |
$384.66
|
| Rate for Payer: ASR Commercial |
$384.66
|
| Rate for Payer: BCBS Trust/PPO |
$323.16
|
| Rate for Payer: BCN Commercial |
$307.45
|
| 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: UHC All Payor (Choice/PPO) + Core |
$348.97
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$169.32 |
| Rate for Payer: Aetna Commercial |
$152.39
|
| Rate for Payer: Aetna Medicare |
$34.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: ASR ASR |
$164.24
|
| Rate for Payer: ASR Commercial |
$164.24
|
| Rate for Payer: BCBS Complete |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$138.66
|
| Rate for Payer: BCN Commercial |
$131.27
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$159.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$169.32
|
| Rate for Payer: Healthscope Whirlpool |
$164.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$34.81
|
| Rate for Payer: Mclaren Commercial |
$152.39
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: Meridian Medicaid |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$138.84
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$38.29
|
| Rate for Payer: PHP Medicaid |
$18.66
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.36
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$118.69
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.81
|
| Rate for Payer: UHC Exchange |
$53.96
|
| Rate for Payer: UHC Medicare Advantage |
$34.81
|
| Rate for Payer: UHCCP DNSP |
$34.81
|
| Rate for Payer: UHCCP Medicaid |
$18.66
|
| Rate for Payer: VA VA |
$34.81
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$169.32 |
| Rate for Payer: Aetna Commercial |
$152.39
|
| Rate for Payer: ASR ASR |
$164.24
|
| Rate for Payer: ASR Commercial |
$164.24
|
| Rate for Payer: BCBS Trust/PPO |
$137.98
|
| Rate for Payer: BCN Commercial |
$131.27
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$159.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$169.32
|
| Rate for Payer: Healthscope Whirlpool |
$164.24
|
| Rate for Payer: Mclaren Commercial |
$152.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$138.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.00
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Aetna Commercial |
$82.68
|
| Rate for Payer: ASR ASR |
$89.11
|
| Rate for Payer: ASR Commercial |
$89.11
|
| Rate for Payer: BCBS Trust/PPO |
$74.86
|
| Rate for Payer: BCN Commercial |
$71.23
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$86.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Healthscope Whirlpool |
$89.11
|
| Rate for Payer: Mclaren Commercial |
$82.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.85
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Aetna Commercial |
$82.68
|
| Rate for Payer: Aetna Medicare |
$13.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: ASR ASR |
$89.11
|
| Rate for Payer: ASR Commercial |
$89.11
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$75.23
|
| Rate for Payer: BCN Commercial |
$71.23
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$86.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$91.87
|
| Rate for Payer: Healthscope Whirlpool |
$89.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.28
|
| Rate for Payer: Mclaren Commercial |
$82.68
|
| Rate for Payer: Mclaren Medicaid |
$7.12
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$75.33
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$14.61
|
| Rate for Payer: PHP Medicaid |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.50
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow Network |
$64.40
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.28
|
| Rate for Payer: UHC Exchange |
$20.58
|
| Rate for Payer: UHC Medicare Advantage |
$13.28
|
| Rate for Payer: UHCCP DNSP |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$7.12
|
| Rate for Payer: VA VA |
$13.28
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.90
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$25.52
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: ASR Commercial |
$102.50
|
| Rate for Payer: BCBS Complete |
$7.74
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$86.53
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$105.67
|
| Rate for Payer: Healthscope Whirlpool |
$102.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.76
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Mclaren Medicaid |
$7.38
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: Meridian Medicaid |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$15.14
|
| Rate for Payer: PHP Medicaid |
$7.38
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.59
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow Network |
$74.07
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.76
|
| Rate for Payer: UHC Exchange |
$21.33
|
| Rate for Payer: UHC Medicare Advantage |
$13.76
|
| Rate for Payer: UHCCP DNSP |
$13.76
|
| Rate for Payer: UHCCP Medicaid |
$7.38
|
| Rate for Payer: VA VA |
$13.76
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$95.10
|
| Rate for Payer: ASR ASR |
$102.50
|
| Rate for Payer: ASR Commercial |
$102.50
|
| Rate for Payer: BCBS Trust/PPO |
$86.11
|
| Rate for Payer: BCN Commercial |
$81.93
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$105.67
|
| Rate for Payer: Healthscope Whirlpool |
$102.50
|
| Rate for Payer: Mclaren Commercial |
$95.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.99
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$170.11 |
| Rate for Payer: Aetna Commercial |
$153.10
|
| Rate for Payer: ASR ASR |
$165.01
|
| Rate for Payer: ASR Commercial |
$165.01
|
| Rate for Payer: BCBS Trust/PPO |
$138.62
|
| Rate for Payer: BCN Commercial |
$131.89
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$159.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Healthscope Commercial |
$170.11
|
| Rate for Payer: Healthscope Whirlpool |
$165.01
|
| Rate for Payer: Mclaren Commercial |
$153.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: Nomi Health Commercial |
$139.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.70
|
|
