|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: ASR Commercial |
$65.96
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$55.69
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.80
|
| Rate for Payer: Nomi Health Commercial |
$55.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.87
|
| Rate for Payer: Priority Health Narrow Network |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: ASR ASR |
$65.96
|
| Rate for Payer: ASR Commercial |
$65.96
|
| Rate for Payer: BCBS Trust/PPO |
$55.41
|
| Rate for Payer: BCN Commercial |
$52.72
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$68.00
|
| Rate for Payer: Healthscope Whirlpool |
$65.96
|
| Rate for Payer: Mclaren Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.80
|
| Rate for Payer: Nomi Health Commercial |
$55.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.84
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: ASR ASR |
$105.73
|
| Rate for Payer: ASR Commercial |
$105.73
|
| Rate for Payer: BCBS Trust/PPO |
$88.82
|
| Rate for Payer: BCN Commercial |
$84.51
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$105.73
|
| Rate for Payer: Mclaren Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Nomi Health Commercial |
$89.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: ASR ASR |
$105.73
|
| Rate for Payer: ASR Commercial |
$105.73
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$89.26
|
| Rate for Payer: BCN Commercial |
$84.51
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$102.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$109.00
|
| Rate for Payer: Healthscope Whirlpool |
$105.73
|
| Rate for Payer: Mclaren Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Nomi Health Commercial |
$89.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.50
|
| Rate for Payer: Priority Health Narrow Network |
$66.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.92
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$621.00
|
| Rate for Payer: ASR ASR |
$669.30
|
| Rate for Payer: ASR Commercial |
$669.30
|
| Rate for Payer: BCBS Trust/PPO |
$562.28
|
| Rate for Payer: BCN Commercial |
$534.96
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$648.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$690.00
|
| Rate for Payer: Healthscope Whirlpool |
$669.30
|
| Rate for Payer: Mclaren Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Nomi Health Commercial |
$565.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.20
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$621.00
|
| Rate for Payer: Aetna Medicare |
$345.00
|
| Rate for Payer: ASR ASR |
$669.30
|
| Rate for Payer: ASR Commercial |
$669.30
|
| Rate for Payer: BCBS Complete |
$276.00
|
| Rate for Payer: BCBS Trust/PPO |
$565.04
|
| Rate for Payer: BCN Commercial |
$534.96
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$648.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$690.00
|
| Rate for Payer: Healthscope Whirlpool |
$669.30
|
| Rate for Payer: Mclaren Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Nomi Health Commercial |
$565.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$604.58
|
| Rate for Payer: Priority Health Narrow Network |
$483.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.20
|
|
|
HC INFRARED THERAPY
|
Facility
|
IP
|
$58.63
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$58.63 |
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: ASR ASR |
$56.87
|
| Rate for Payer: ASR Commercial |
$56.87
|
| Rate for Payer: BCBS Trust/PPO |
$47.78
|
| Rate for Payer: BCN Commercial |
$45.46
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Healthscope Commercial |
$58.63
|
| Rate for Payer: Healthscope Whirlpool |
$56.87
|
| Rate for Payer: Mclaren Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.84
|
| Rate for Payer: Nomi Health Commercial |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.59
|
|
|
HC INFRARED THERAPY
|
Facility
|
OP
|
$58.63
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$58.63 |
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$29.32
|
| Rate for Payer: ASR ASR |
$56.87
|
| Rate for Payer: ASR Commercial |
$56.87
|
| Rate for Payer: BCBS Complete |
$23.45
|
| Rate for Payer: BCBS Trust/PPO |
$48.01
|
| Rate for Payer: BCN Commercial |
$45.46
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Healthscope Commercial |
$58.63
|
| Rate for Payer: Healthscope Whirlpool |
$56.87
|
| Rate for Payer: Mclaren Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.84
|
| Rate for Payer: Nomi Health Commercial |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.37
|
| Rate for Payer: Priority Health Narrow Network |
$41.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.59
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$144.58
|
| Rate for Payer: Aetna Medicare |
$80.32
|
| Rate for Payer: ASR ASR |
$155.83
|
| Rate for Payer: ASR Commercial |
$155.83
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: BCBS Trust/PPO |
$131.56
|
| Rate for Payer: BCN Commercial |
$124.55
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Healthscope Whirlpool |
$155.83
|
| Rate for Payer: Mclaren Commercial |
$144.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Nomi Health Commercial |
$131.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.76
|
| Rate for Payer: Priority Health Narrow Network |
$112.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.37
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.42 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna Commercial |
$144.58
|
| Rate for Payer: ASR ASR |
$155.83
|
| Rate for Payer: ASR Commercial |
$155.83
|
| Rate for Payer: BCBS Trust/PPO |
$130.91
|
| Rate for Payer: BCN Commercial |
$124.55
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$151.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$160.65
|
| Rate for Payer: Healthscope Whirlpool |
$155.83
|
| Rate for Payer: Mclaren Commercial |
$144.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Nomi Health Commercial |
$131.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.37
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$241.86 |
| Rate for Payer: Aetna Commercial |
$217.67
|
| Rate for Payer: Aetna Medicare |
$120.93
|
| Rate for Payer: ASR ASR |
$234.60
|
| Rate for Payer: ASR Commercial |
$234.60
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: BCBS Trust/PPO |
$198.06
|
| Rate for Payer: BCN Commercial |
$187.51
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Commercial |
$227.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Healthscope Commercial |
$241.86
|
| Rate for Payer: Healthscope Whirlpool |
$234.60
|
| Rate for Payer: Mclaren Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Nomi Health Commercial |
$198.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.92
|
| Rate for Payer: Priority Health Narrow Network |
$169.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.84
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
IP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.21 |
| Max. Negotiated Rate |
$241.86 |
| Rate for Payer: Aetna Commercial |
$217.67
|
| Rate for Payer: ASR ASR |
$234.60
|
| Rate for Payer: ASR Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$197.09
|
| Rate for Payer: BCN Commercial |
$187.51
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Commercial |
$227.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Healthscope Commercial |
$241.86
|
| Rate for Payer: Healthscope Whirlpool |
$234.60
|
| Rate for Payer: Mclaren Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Nomi Health Commercial |
$198.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.84
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
OP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$357.21
|
| Rate for Payer: Aetna Medicare |
$198.45
|
| Rate for Payer: ASR ASR |
$384.99
|
| Rate for Payer: ASR Commercial |
$384.99
|
| Rate for Payer: BCBS Complete |
$158.76
|
| Rate for Payer: BCBS Trust/PPO |
$325.02
|
| Rate for Payer: BCN Commercial |
$307.72
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$373.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Healthscope Whirlpool |
$384.99
|
| Rate for Payer: Mclaren Commercial |
$357.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.36
|
| Rate for Payer: Nomi Health Commercial |
$325.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.76
|
| Rate for Payer: Priority Health Narrow Network |
$278.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.27
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
IP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.98 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$357.21
|
| Rate for Payer: ASR ASR |
$384.99
|
| Rate for Payer: ASR Commercial |
$384.99
|
| Rate for Payer: BCBS Trust/PPO |
$323.43
|
| Rate for Payer: BCN Commercial |
$307.72
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$373.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Healthscope Whirlpool |
$384.99
|
| Rate for Payer: Mclaren Commercial |
$357.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.36
|
| Rate for Payer: Nomi Health Commercial |
$325.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.27
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
IP
|
$676.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$676.12 |
| Rate for Payer: Aetna Commercial |
$608.51
|
| Rate for Payer: ASR ASR |
$655.84
|
| Rate for Payer: ASR Commercial |
$655.84
|
| Rate for Payer: BCBS Trust/PPO |
$550.97
|
| Rate for Payer: BCN Commercial |
$524.20
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cofinity Commercial |
$635.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.90
|
| Rate for Payer: Healthscope Commercial |
$676.12
|
| Rate for Payer: Healthscope Whirlpool |
$655.84
|
| Rate for Payer: Mclaren Commercial |
$608.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.70
|
| Rate for Payer: Nomi Health Commercial |
$554.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.99
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
OP
|
$676.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.45 |
| Max. Negotiated Rate |
$676.12 |
| Rate for Payer: Aetna Commercial |
$608.51
|
| Rate for Payer: Aetna Medicare |
$338.06
|
| Rate for Payer: ASR ASR |
$655.84
|
| Rate for Payer: ASR Commercial |
$655.84
|
| Rate for Payer: BCBS Complete |
$270.45
|
| Rate for Payer: BCBS Trust/PPO |
$553.67
|
| Rate for Payer: BCN Commercial |
$524.20
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cofinity Commercial |
$635.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.90
|
| Rate for Payer: Healthscope Commercial |
$676.12
|
| Rate for Payer: Healthscope Whirlpool |
$655.84
|
| Rate for Payer: Mclaren Commercial |
$608.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.70
|
| Rate for Payer: Nomi Health Commercial |
$554.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.42
|
| Rate for Payer: Priority Health Narrow Network |
$473.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.99
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
IP
|
$755.19
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.87 |
| Max. Negotiated Rate |
$755.19 |
| Rate for Payer: Aetna Commercial |
$679.67
|
| Rate for Payer: ASR ASR |
$732.53
|
| Rate for Payer: ASR Commercial |
$732.53
|
| Rate for Payer: BCBS Trust/PPO |
$615.40
|
| Rate for Payer: BCN Commercial |
$585.50
|
| Rate for Payer: Cash Price |
$604.15
|
| Rate for Payer: Cofinity Commercial |
$709.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.15
|
| Rate for Payer: Healthscope Commercial |
$755.19
|
| Rate for Payer: Healthscope Whirlpool |
$732.53
|
| Rate for Payer: Mclaren Commercial |
$679.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$641.91
|
| Rate for Payer: Nomi Health Commercial |
$619.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$664.57
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
OP
|
$755.19
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$302.08 |
| Max. Negotiated Rate |
$755.19 |
| Rate for Payer: Aetna Commercial |
$679.67
|
| Rate for Payer: Aetna Medicare |
$377.60
|
| Rate for Payer: ASR ASR |
$732.53
|
| Rate for Payer: ASR Commercial |
$732.53
|
| Rate for Payer: BCBS Complete |
$302.08
|
| Rate for Payer: BCBS Trust/PPO |
$618.43
|
| Rate for Payer: BCN Commercial |
$585.50
|
| Rate for Payer: Cash Price |
$604.15
|
| Rate for Payer: Cofinity Commercial |
$709.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.15
|
| Rate for Payer: Healthscope Commercial |
$755.19
|
| Rate for Payer: Healthscope Whirlpool |
$732.53
|
| Rate for Payer: Mclaren Commercial |
$679.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$641.91
|
| Rate for Payer: Nomi Health Commercial |
$619.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.70
|
| Rate for Payer: Priority Health Narrow Network |
$529.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$664.57
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
OP
|
$922.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.90 |
| Max. Negotiated Rate |
$922.26 |
| Rate for Payer: Aetna Commercial |
$830.03
|
| Rate for Payer: Aetna Medicare |
$461.13
|
| Rate for Payer: ASR ASR |
$894.59
|
| Rate for Payer: ASR Commercial |
$894.59
|
| Rate for Payer: BCBS Complete |
$368.90
|
| Rate for Payer: BCBS Trust/PPO |
$755.24
|
| Rate for Payer: BCN Commercial |
$715.03
|
| Rate for Payer: Cash Price |
$737.81
|
| Rate for Payer: Cofinity Commercial |
$866.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.81
|
| Rate for Payer: Healthscope Commercial |
$922.26
|
| Rate for Payer: Healthscope Whirlpool |
$894.59
|
| Rate for Payer: Mclaren Commercial |
$830.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.92
|
| Rate for Payer: Nomi Health Commercial |
$756.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$808.08
|
| Rate for Payer: Priority Health Narrow Network |
$646.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.59
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
IP
|
$922.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$599.47 |
| Max. Negotiated Rate |
$922.26 |
| Rate for Payer: Aetna Commercial |
$830.03
|
| Rate for Payer: ASR ASR |
$894.59
|
| Rate for Payer: ASR Commercial |
$894.59
|
| Rate for Payer: BCBS Trust/PPO |
$751.55
|
| Rate for Payer: BCN Commercial |
$715.03
|
| Rate for Payer: Cash Price |
$737.81
|
| Rate for Payer: Cofinity Commercial |
$866.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.81
|
| Rate for Payer: Healthscope Commercial |
$922.26
|
| Rate for Payer: Healthscope Whirlpool |
$894.59
|
| Rate for Payer: Mclaren Commercial |
$830.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.92
|
| Rate for Payer: Nomi Health Commercial |
$756.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.59
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
IP
|
$1,026.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.45 |
| Max. Negotiated Rate |
$1,026.84 |
| Rate for Payer: Aetna Commercial |
$924.16
|
| Rate for Payer: ASR ASR |
$996.03
|
| Rate for Payer: ASR Commercial |
$996.03
|
| Rate for Payer: BCBS Trust/PPO |
$836.77
|
| Rate for Payer: BCN Commercial |
$796.11
|
| Rate for Payer: Cash Price |
$821.47
|
| Rate for Payer: Cofinity Commercial |
$965.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.47
|
| Rate for Payer: Healthscope Commercial |
$1,026.84
|
| Rate for Payer: Healthscope Whirlpool |
$996.03
|
| Rate for Payer: Mclaren Commercial |
$924.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.81
|
| Rate for Payer: Nomi Health Commercial |
$842.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$903.62
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
OP
|
$1,026.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.74 |
| Max. Negotiated Rate |
$1,026.84 |
| Rate for Payer: Aetna Commercial |
$924.16
|
| Rate for Payer: Aetna Medicare |
$513.42
|
| Rate for Payer: ASR ASR |
$996.03
|
| Rate for Payer: ASR Commercial |
$996.03
|
| Rate for Payer: BCBS Complete |
$410.74
|
| Rate for Payer: BCBS Trust/PPO |
$840.88
|
| Rate for Payer: BCN Commercial |
$796.11
|
| Rate for Payer: Cash Price |
$821.47
|
| Rate for Payer: Cofinity Commercial |
$965.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.47
|
| Rate for Payer: Healthscope Commercial |
$1,026.84
|
| Rate for Payer: Healthscope Whirlpool |
$996.03
|
| Rate for Payer: Mclaren Commercial |
$924.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.81
|
| Rate for Payer: Nomi Health Commercial |
$842.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.72
|
| Rate for Payer: Priority Health Narrow Network |
$719.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$903.62
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
IP
|
$1,143.29
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$743.14 |
| Max. Negotiated Rate |
$1,143.29 |
| Rate for Payer: Aetna Commercial |
$1,028.96
|
| Rate for Payer: ASR ASR |
$1,108.99
|
| Rate for Payer: ASR Commercial |
$1,108.99
|
| Rate for Payer: BCBS Trust/PPO |
$931.67
|
| Rate for Payer: BCN Commercial |
$886.39
|
| Rate for Payer: Cash Price |
$914.63
|
| Rate for Payer: Cofinity Commercial |
$1,074.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.63
|
| Rate for Payer: Healthscope Commercial |
$1,143.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,108.99
|
| Rate for Payer: Mclaren Commercial |
$1,028.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.80
|
| Rate for Payer: Nomi Health Commercial |
$937.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.10
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
OP
|
$1,143.29
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.32 |
| Max. Negotiated Rate |
$1,143.29 |
| Rate for Payer: Aetna Commercial |
$1,028.96
|
| Rate for Payer: Aetna Medicare |
$571.64
|
| Rate for Payer: ASR ASR |
$1,108.99
|
| Rate for Payer: ASR Commercial |
$1,108.99
|
| Rate for Payer: BCBS Complete |
$457.32
|
| Rate for Payer: BCBS Trust/PPO |
$936.24
|
| Rate for Payer: BCN Commercial |
$886.39
|
| Rate for Payer: Cash Price |
$914.63
|
| Rate for Payer: Cofinity Commercial |
$1,074.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.63
|
| Rate for Payer: Healthscope Commercial |
$1,143.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,108.99
|
| Rate for Payer: Mclaren Commercial |
$1,028.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.80
|
| Rate for Payer: Nomi Health Commercial |
$937.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$743.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,001.75
|
| Rate for Payer: Priority Health Narrow Network |
$801.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,006.10
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
OP
|
$1,272.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.17 |
| Max. Negotiated Rate |
$1,272.93 |
| Rate for Payer: Aetna Commercial |
$1,145.64
|
| Rate for Payer: Aetna Medicare |
$636.46
|
| Rate for Payer: ASR ASR |
$1,234.74
|
| Rate for Payer: ASR Commercial |
$1,234.74
|
| Rate for Payer: BCBS Complete |
$509.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.40
|
| Rate for Payer: BCN Commercial |
$986.90
|
| Rate for Payer: Cash Price |
$1,018.34
|
| Rate for Payer: Cofinity Commercial |
$1,196.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.34
|
| Rate for Payer: Healthscope Commercial |
$1,272.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,234.74
|
| Rate for Payer: Mclaren Commercial |
$1,145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.99
|
| Rate for Payer: Nomi Health Commercial |
$1,043.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.34
|
| Rate for Payer: Priority Health Narrow Network |
$892.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,120.18
|
|
