|
HC GUIDING CATHETER LVL19
|
Facility
|
OP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$1,978.37 |
| Rate for Payer: Aetna Commercial |
$1,780.53
|
| Rate for Payer: Aetna Medicare |
$989.18
|
| Rate for Payer: ASR ASR |
$1,919.02
|
| Rate for Payer: ASR Commercial |
$1,919.02
|
| Rate for Payer: BCBS Complete |
$791.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.09
|
| Rate for Payer: BCN Commercial |
$1,533.83
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,859.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Healthscope Commercial |
$1,978.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,919.02
|
| Rate for Payer: Mclaren Commercial |
$1,780.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.61
|
| Rate for Payer: Nomi Health Commercial |
$1,622.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,386.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.97
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
IP
|
$285.99
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.89 |
| Max. Negotiated Rate |
$285.99 |
| Rate for Payer: Aetna Commercial |
$257.39
|
| Rate for Payer: ASR ASR |
$277.41
|
| Rate for Payer: ASR Commercial |
$277.41
|
| Rate for Payer: BCBS Trust/PPO |
$233.05
|
| Rate for Payer: BCN Commercial |
$221.73
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$268.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.79
|
| Rate for Payer: Healthscope Commercial |
$285.99
|
| Rate for Payer: Healthscope Whirlpool |
$277.41
|
| Rate for Payer: Mclaren Commercial |
$257.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.09
|
| Rate for Payer: Nomi Health Commercial |
$234.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.67
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
OP
|
$285.99
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$285.99 |
| Rate for Payer: Aetna Commercial |
$257.39
|
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: ASR ASR |
$277.41
|
| Rate for Payer: ASR Commercial |
$277.41
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: BCBS Trust/PPO |
$234.20
|
| Rate for Payer: BCN Commercial |
$221.73
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$268.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.79
|
| Rate for Payer: Healthscope Commercial |
$285.99
|
| Rate for Payer: Healthscope Whirlpool |
$277.41
|
| Rate for Payer: Mclaren Commercial |
$257.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.09
|
| Rate for Payer: Nomi Health Commercial |
$234.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.67
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
OP
|
$2,477.72
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.09 |
| Max. Negotiated Rate |
$2,477.72 |
| Rate for Payer: Aetna Commercial |
$2,229.95
|
| Rate for Payer: Aetna Medicare |
$1,238.86
|
| Rate for Payer: ASR ASR |
$2,403.39
|
| Rate for Payer: ASR Commercial |
$2,403.39
|
| Rate for Payer: BCBS Complete |
$991.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,029.00
|
| Rate for Payer: BCN Commercial |
$1,920.98
|
| Rate for Payer: Cash Price |
$1,982.18
|
| Rate for Payer: Cofinity Commercial |
$2,329.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.18
|
| Rate for Payer: Healthscope Commercial |
$2,477.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,403.39
|
| Rate for Payer: Mclaren Commercial |
$2,229.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.06
|
| Rate for Payer: Nomi Health Commercial |
$2,031.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,170.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,736.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,180.39
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
IP
|
$2,477.72
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,610.52 |
| Max. Negotiated Rate |
$2,477.72 |
| Rate for Payer: Aetna Commercial |
$2,229.95
|
| Rate for Payer: ASR ASR |
$2,403.39
|
| Rate for Payer: ASR Commercial |
$2,403.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,019.09
|
| Rate for Payer: BCN Commercial |
$1,920.98
|
| Rate for Payer: Cash Price |
$1,982.18
|
| Rate for Payer: Cofinity Commercial |
$2,329.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.18
|
| Rate for Payer: Healthscope Commercial |
$2,477.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,403.39
|
| Rate for Payer: Mclaren Commercial |
$2,229.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.06
|
| Rate for Payer: Nomi Health Commercial |
$2,031.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,180.39
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$303.75
|
| Rate for Payer: Aetna Medicare |
$168.75
|
| Rate for Payer: ASR ASR |
$327.38
|
| Rate for Payer: ASR Commercial |
$327.38
|
| Rate for Payer: BCBS Complete |
$135.00
|
| Rate for Payer: BCBS Trust/PPO |
$276.38
|
| Rate for Payer: BCN Commercial |
$261.66
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$317.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Whirlpool |
$327.38
|
| Rate for Payer: Mclaren Commercial |
$303.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$236.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.00
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.38 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$303.75
|
| Rate for Payer: ASR ASR |
$327.38
|
| Rate for Payer: ASR Commercial |
$327.38
|
| Rate for Payer: BCBS Trust/PPO |
$275.03
|
| Rate for Payer: BCN Commercial |
$261.66
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$317.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Healthscope Whirlpool |
$327.38
|
| Rate for Payer: Mclaren Commercial |
$303.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: Nomi Health Commercial |
$276.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.00
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,335.16 |
| Max. Negotiated Rate |
$3,592.55 |
| Rate for Payer: Aetna Commercial |
$3,233.30
|
| Rate for Payer: ASR ASR |
$3,484.77
|
| Rate for Payer: ASR Commercial |
$3,484.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,927.57
|
| Rate for Payer: BCN Commercial |
$2,785.30
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$3,377.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,592.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,484.77
|
| Rate for Payer: Mclaren Commercial |
$3,233.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,945.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,161.44
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
OP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,437.02 |
| Max. Negotiated Rate |
$3,592.55 |
| Rate for Payer: Aetna Commercial |
$3,233.30
|
| Rate for Payer: Aetna Medicare |
$1,796.28
|
| Rate for Payer: ASR ASR |
$3,484.77
|
| Rate for Payer: ASR Commercial |
$3,484.77
|
| Rate for Payer: BCBS Complete |
$1,437.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,941.94
|
| Rate for Payer: BCN Commercial |
$2,785.30
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$3,377.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,592.55
|
| Rate for Payer: Healthscope Whirlpool |
$3,484.77
|
| Rate for Payer: Mclaren Commercial |
$3,233.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,945.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,147.79
|
| Rate for Payer: Priority Health Narrow Network |
$2,518.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,161.44
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
OP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.21 |
| Max. Negotiated Rate |
$490.52 |
| Rate for Payer: Aetna Commercial |
$441.47
|
| Rate for Payer: Aetna Medicare |
$245.26
|
| Rate for Payer: ASR ASR |
$475.80
|
| Rate for Payer: ASR Commercial |
$475.80
|
| Rate for Payer: BCBS Complete |
$196.21
|
| Rate for Payer: BCBS Trust/PPO |
$401.69
|
| Rate for Payer: BCN Commercial |
$380.30
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$490.52
|
| Rate for Payer: Healthscope Whirlpool |
$475.80
|
| Rate for Payer: Mclaren Commercial |
$441.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.79
|
| Rate for Payer: Priority Health Narrow Network |
$343.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.66
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.84 |
| Max. Negotiated Rate |
$490.52 |
| Rate for Payer: Aetna Commercial |
$441.47
|
| Rate for Payer: ASR ASR |
$475.80
|
| Rate for Payer: ASR Commercial |
$475.80
|
| Rate for Payer: BCBS Trust/PPO |
$399.72
|
| Rate for Payer: BCN Commercial |
$380.30
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$490.52
|
| Rate for Payer: Healthscope Whirlpool |
$475.80
|
| Rate for Payer: Mclaren Commercial |
$441.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.66
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
OP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,718.21 |
| Max. Negotiated Rate |
$4,295.53 |
| Rate for Payer: Aetna Commercial |
$3,865.98
|
| Rate for Payer: Aetna Medicare |
$2,147.76
|
| Rate for Payer: ASR ASR |
$4,166.66
|
| Rate for Payer: ASR Commercial |
$4,166.66
|
| Rate for Payer: BCBS Complete |
$1,718.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,517.61
|
| Rate for Payer: BCN Commercial |
$3,330.32
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$4,037.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$4,295.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,166.66
|
| Rate for Payer: Mclaren Commercial |
$3,865.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,763.74
|
| Rate for Payer: Priority Health Narrow Network |
$3,011.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,780.07
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,792.09 |
| Max. Negotiated Rate |
$4,295.53 |
| Rate for Payer: Aetna Commercial |
$3,865.98
|
| Rate for Payer: ASR ASR |
$4,166.66
|
| Rate for Payer: ASR Commercial |
$4,166.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,500.43
|
| Rate for Payer: BCN Commercial |
$3,330.32
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$4,037.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$4,295.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,166.66
|
| Rate for Payer: Mclaren Commercial |
$3,865.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,780.07
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
OP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,284.86 |
| Max. Negotiated Rate |
$5,712.15 |
| Rate for Payer: Aetna Commercial |
$5,140.94
|
| Rate for Payer: Aetna Medicare |
$2,856.08
|
| Rate for Payer: ASR ASR |
$5,540.79
|
| Rate for Payer: ASR Commercial |
$5,540.79
|
| Rate for Payer: BCBS Complete |
$2,284.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,677.68
|
| Rate for Payer: BCN Commercial |
$4,428.63
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$5,369.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,712.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,540.79
|
| Rate for Payer: Mclaren Commercial |
$5,140.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,004.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,004.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,026.69
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
IP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,712.90 |
| Max. Negotiated Rate |
$5,712.15 |
| Rate for Payer: Aetna Commercial |
$5,140.94
|
| Rate for Payer: ASR ASR |
$5,540.79
|
| Rate for Payer: ASR Commercial |
$5,540.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,654.83
|
| Rate for Payer: BCN Commercial |
$4,428.63
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$5,369.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,712.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,540.79
|
| Rate for Payer: Mclaren Commercial |
$5,140.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,026.69
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
IP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.82 |
| Max. Negotiated Rate |
$662.80 |
| Rate for Payer: Aetna Commercial |
$596.52
|
| Rate for Payer: ASR ASR |
$642.92
|
| Rate for Payer: ASR Commercial |
$642.92
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$513.87
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$623.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$662.80
|
| Rate for Payer: Healthscope Whirlpool |
$642.92
|
| Rate for Payer: Mclaren Commercial |
$596.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.26
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
OP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.12 |
| Max. Negotiated Rate |
$662.80 |
| Rate for Payer: Aetna Commercial |
$596.52
|
| Rate for Payer: Aetna Medicare |
$331.40
|
| Rate for Payer: ASR ASR |
$642.92
|
| Rate for Payer: ASR Commercial |
$642.92
|
| Rate for Payer: BCBS Complete |
$265.12
|
| Rate for Payer: BCBS Trust/PPO |
$542.77
|
| Rate for Payer: BCN Commercial |
$513.87
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$623.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$662.80
|
| Rate for Payer: Healthscope Whirlpool |
$642.92
|
| Rate for Payer: Mclaren Commercial |
$596.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.75
|
| Rate for Payer: Priority Health Narrow Network |
$464.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.26
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$33.29 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: ASR ASR |
$32.29
|
| Rate for Payer: ASR Commercial |
$32.29
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$25.81
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$33.29
|
| Rate for Payer: Healthscope Whirlpool |
$32.29
|
| Rate for Payer: Mclaren Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.30
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$33.29 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: ASR ASR |
$32.29
|
| Rate for Payer: ASR Commercial |
$32.29
|
| Rate for Payer: BCBS Complete |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$27.26
|
| Rate for Payer: BCN Commercial |
$25.81
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$33.29
|
| Rate for Payer: Healthscope Whirlpool |
$32.29
|
| Rate for Payer: Mclaren Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.87
|
| Rate for Payer: Priority Health Narrow Network |
$11.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.30
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: ASR Commercial |
$143.74
|
| Rate for Payer: BCBS Trust/PPO |
$120.76
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: Aetna Medicare |
$74.10
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: ASR Commercial |
$143.74
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$121.35
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC HAI PICC FLUSH
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.56 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$109.78
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HAI PICC FLUSH
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$110.31
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
