|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$16.94
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$16.94 |
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: ASR ASR |
$16.43
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$15.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$16.94
|
| Rate for Payer: Healthscope Whirlpool |
$16.43
|
| Rate for Payer: Mclaren Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow Network |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.91
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$16.94
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$16.94 |
| Rate for Payer: Aetna Commercial |
$15.25
|
| Rate for Payer: ASR ASR |
$16.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$15.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$16.94
|
| Rate for Payer: Healthscope Whirlpool |
$16.43
|
| Rate for Payer: Mclaren Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.91
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$110.66
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$110.66 |
| Rate for Payer: Aetna Commercial |
$99.59
|
| Rate for Payer: ASR ASR |
$107.34
|
| Rate for Payer: BCBS Trust/PPO |
$85.79
|
| Rate for Payer: BCN Commercial |
$85.79
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cofinity Commercial |
$104.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.53
|
| Rate for Payer: Healthscope Commercial |
$110.66
|
| Rate for Payer: Healthscope Whirlpool |
$107.34
|
| Rate for Payer: Mclaren Commercial |
$99.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.38
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$110.66
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$110.66 |
| Rate for Payer: Aetna Commercial |
$99.59
|
| Rate for Payer: ASR ASR |
$107.34
|
| Rate for Payer: BCBS Complete |
$44.26
|
| Rate for Payer: BCBS Trust/PPO |
$85.79
|
| Rate for Payer: BCN Commercial |
$85.79
|
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Cofinity Commercial |
$104.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.53
|
| Rate for Payer: Healthscope Commercial |
$110.66
|
| Rate for Payer: Healthscope Whirlpool |
$107.34
|
| Rate for Payer: Mclaren Commercial |
$99.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Narrow Network |
$78.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.38
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$29.85
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: ASR ASR |
$28.95
|
| Rate for Payer: BCBS Trust/PPO |
$23.14
|
| Rate for Payer: BCN Commercial |
$23.14
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$28.95
|
| Rate for Payer: Mclaren Commercial |
$26.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.27
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$29.85
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: ASR ASR |
$28.95
|
| Rate for Payer: BCBS Complete |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$23.14
|
| Rate for Payer: BCN Commercial |
$23.14
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Healthscope Whirlpool |
$28.95
|
| Rate for Payer: Mclaren Commercial |
$26.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.16
|
| Rate for Payer: Priority Health Narrow Network |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.27
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.02
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$39.02 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: ASR ASR |
$37.85
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$30.25
|
| Rate for Payer: BCN Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$36.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$39.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.85
|
| Rate for Payer: Mclaren Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.51
|
| Rate for Payer: Priority Health Narrow Network |
$27.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.34
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.02
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.31 |
| Max. Negotiated Rate |
$39.02 |
| Rate for Payer: Aetna Commercial |
$35.12
|
| Rate for Payer: ASR ASR |
$37.85
|
| Rate for Payer: BCBS Trust/PPO |
$30.25
|
| Rate for Payer: BCN Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$36.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$39.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.85
|
| Rate for Payer: Mclaren Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.34
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$55.62
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Aetna Commercial |
$50.06
|
| Rate for Payer: ASR ASR |
$53.95
|
| Rate for Payer: BCBS Complete |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$43.12
|
| Rate for Payer: BCN Commercial |
$43.12
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$52.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$55.62
|
| Rate for Payer: Healthscope Whirlpool |
$53.95
|
| Rate for Payer: Mclaren Commercial |
$50.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.61
|
| Rate for Payer: Priority Health Narrow Network |
$39.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.95
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$55.62
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Aetna Commercial |
$50.06
|
| Rate for Payer: ASR ASR |
$53.95
|
| Rate for Payer: BCBS Trust/PPO |
$43.12
|
| Rate for Payer: BCN Commercial |
$43.12
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$52.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$55.62
|
| Rate for Payer: Healthscope Whirlpool |
$53.95
|
| Rate for Payer: Mclaren Commercial |
$50.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.95
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$100.59
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$100.59 |
| Rate for Payer: Aetna Commercial |
$90.53
|
| Rate for Payer: ASR ASR |
$97.57
|
| Rate for Payer: BCBS Complete |
$40.24
|
| Rate for Payer: BCBS Trust/PPO |
$77.99
|
| Rate for Payer: BCN Commercial |
$77.99
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cofinity Commercial |
$94.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.47
|
| Rate for Payer: Healthscope Commercial |
$100.59
|
| Rate for Payer: Healthscope Whirlpool |
$97.57
|
| Rate for Payer: Mclaren Commercial |
$90.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.54
|
| Rate for Payer: Priority Health Narrow Network |
$71.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.52
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$100.59
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.41 |
| Max. Negotiated Rate |
$100.59 |
| Rate for Payer: Aetna Commercial |
$90.53
|
| Rate for Payer: ASR ASR |
$97.57
|
| Rate for Payer: BCBS Trust/PPO |
$77.99
|
| Rate for Payer: BCN Commercial |
$77.99
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cofinity Commercial |
$94.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.47
|
| Rate for Payer: Healthscope Commercial |
$100.59
|
| Rate for Payer: Healthscope Whirlpool |
$97.57
|
| Rate for Payer: Mclaren Commercial |
$90.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.52
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.60
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna Commercial |
$17.64
|
| Rate for Payer: ASR ASR |
$19.01
|
| Rate for Payer: BCBS Complete |
$7.84
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$19.60
|
| Rate for Payer: Healthscope Whirlpool |
$19.01
|
| Rate for Payer: Mclaren Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.84
|
| Rate for Payer: Priority Health Narrow Network |
$13.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.25
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.60
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna Commercial |
$17.64
|
| Rate for Payer: ASR ASR |
$19.01
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.68
|
| Rate for Payer: Healthscope Commercial |
$19.60
|
| Rate for Payer: Healthscope Whirlpool |
$19.01
|
| Rate for Payer: Mclaren Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.25
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.18
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$25.18 |
| Rate for Payer: Aetna Commercial |
$22.66
|
| Rate for Payer: ASR ASR |
$24.42
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$25.18
|
| Rate for Payer: Healthscope Whirlpool |
$24.42
|
| Rate for Payer: Mclaren Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.91
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.16
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.18
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$25.18 |
| Rate for Payer: Aetna Commercial |
$22.66
|
| Rate for Payer: ASR ASR |
$24.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$25.18
|
| Rate for Payer: Healthscope Whirlpool |
$24.42
|
| Rate for Payer: Mclaren Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.16
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$541.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.30 |
| Max. Negotiated Rate |
$541.86 |
| Rate for Payer: Aetna Commercial |
$487.67
|
| Rate for Payer: ASR ASR |
$525.60
|
| Rate for Payer: BCBS Trust/PPO |
$420.10
|
| Rate for Payer: BCN Commercial |
$420.10
|
| Rate for Payer: Cash Price |
$433.49
|
| Rate for Payer: Cofinity Commercial |
$509.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.49
|
| Rate for Payer: Healthscope Commercial |
$541.86
|
| Rate for Payer: Healthscope Whirlpool |
$525.60
|
| Rate for Payer: Mclaren Commercial |
$487.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.84
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$541.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.74 |
| Max. Negotiated Rate |
$541.86 |
| Rate for Payer: Aetna Commercial |
$487.67
|
| Rate for Payer: ASR ASR |
$525.60
|
| Rate for Payer: BCBS Complete |
$216.74
|
| Rate for Payer: BCBS Trust/PPO |
$420.10
|
| Rate for Payer: BCN Commercial |
$420.10
|
| Rate for Payer: Cash Price |
$433.49
|
| Rate for Payer: Cofinity Commercial |
$509.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.49
|
| Rate for Payer: Healthscope Commercial |
$541.86
|
| Rate for Payer: Healthscope Whirlpool |
$525.60
|
| Rate for Payer: Mclaren Commercial |
$487.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$493.09
|
| Rate for Payer: Priority Health Narrow Network |
$384.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.84
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$37.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: ASR ASR |
$36.81
|
| Rate for Payer: BCBS Complete |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.36
|
| Rate for Payer: Healthscope Commercial |
$37.95
|
| Rate for Payer: Healthscope Whirlpool |
$36.81
|
| Rate for Payer: Mclaren Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.53
|
| Rate for Payer: Priority Health Narrow Network |
$26.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.40
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$37.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: Aetna Commercial |
$34.16
|
| Rate for Payer: ASR ASR |
$36.81
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.36
|
| Rate for Payer: Healthscope Commercial |
$37.95
|
| Rate for Payer: Healthscope Whirlpool |
$36.81
|
| Rate for Payer: Mclaren Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.40
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$527.43
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$527.43 |
| Rate for Payer: Aetna Commercial |
$474.69
|
| Rate for Payer: ASR ASR |
$511.61
|
| Rate for Payer: BCBS Trust/PPO |
$408.92
|
| Rate for Payer: BCN Commercial |
$408.92
|
| Rate for Payer: Cash Price |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$495.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.94
|
| Rate for Payer: Healthscope Commercial |
$527.43
|
| Rate for Payer: Healthscope Whirlpool |
$511.61
|
| Rate for Payer: Mclaren Commercial |
$474.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.14
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$527.43
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$527.43 |
| Rate for Payer: Aetna Commercial |
$474.69
|
| Rate for Payer: ASR ASR |
$511.61
|
| Rate for Payer: BCBS Complete |
$210.97
|
| Rate for Payer: BCBS Trust/PPO |
$408.92
|
| Rate for Payer: BCN Commercial |
$408.92
|
| Rate for Payer: Cash Price |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$495.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.94
|
| Rate for Payer: Healthscope Commercial |
$527.43
|
| Rate for Payer: Healthscope Whirlpool |
$511.61
|
| Rate for Payer: Mclaren Commercial |
$474.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.96
|
| Rate for Payer: Priority Health Narrow Network |
$374.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.14
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,640.28
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,191.95 |
| Max. Negotiated Rate |
$11,864.60 |
| Rate for Payer: Aetna Commercial |
$10,476.25
|
| Rate for Payer: Aetna Medicare |
$9,491.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,864.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,864.60
|
| Rate for Payer: ASR ASR |
$11,291.07
|
| Rate for Payer: BCBS Complete |
$5,452.02
|
| Rate for Payer: BCBS MAPPO |
$9,491.68
|
| Rate for Payer: BCBS Trust/PPO |
$9,024.71
|
| Rate for Payer: BCN Commercial |
$9,024.71
|
| Rate for Payer: BCN Medicare Advantage |
$9,491.68
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cofinity Commercial |
$10,941.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,312.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,491.68
|
| Rate for Payer: Healthscope Commercial |
$11,640.28
|
| Rate for Payer: Healthscope Whirlpool |
$11,291.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,491.68
|
| Rate for Payer: Mclaren Commercial |
$10,476.25
|
| Rate for Payer: Mclaren Medicaid |
$5,191.95
|
| Rate for Payer: Mclaren Medicare |
$9,491.68
|
| Rate for Payer: Meridian Medicaid |
$5,452.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,966.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,915.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,894.24
|
| Rate for Payer: PACE Medicare |
$9,017.10
|
| Rate for Payer: PACE SWMI |
$9,491.68
|
| Rate for Payer: PHP Commercial |
$10,440.85
|
| Rate for Payer: PHP Medicaid |
$5,191.95
|
| Rate for Payer: PHP Medicare Advantage |
$9,491.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,191.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,592.65
|
| Rate for Payer: Priority Health Medicare |
$9,491.68
|
| Rate for Payer: Priority Health Narrow Network |
$8,264.60
|
| Rate for Payer: Railroad Medicare Medicare |
$9,491.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,243.45
|
| Rate for Payer: UHC Medicare Advantage |
$9,776.43
|
| Rate for Payer: VA VA |
$9,491.68
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$11,640.28
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,148.20 |
| Max. Negotiated Rate |
$11,640.28 |
| Rate for Payer: Aetna Commercial |
$10,476.25
|
| Rate for Payer: ASR ASR |
$11,291.07
|
| Rate for Payer: BCBS Trust/PPO |
$9,024.71
|
| Rate for Payer: BCN Commercial |
$9,024.71
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cofinity Commercial |
$10,941.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,312.22
|
| Rate for Payer: Healthscope Commercial |
$11,640.28
|
| Rate for Payer: Healthscope Whirlpool |
$11,291.07
|
| Rate for Payer: Mclaren Commercial |
$10,476.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,894.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,148.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,243.45
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$12,804.30
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,963.01 |
| Max. Negotiated Rate |
$12,804.30 |
| Rate for Payer: Aetna Commercial |
$11,523.87
|
| Rate for Payer: ASR ASR |
$12,420.17
|
| Rate for Payer: BCBS Trust/PPO |
$9,927.17
|
| Rate for Payer: BCN Commercial |
$9,927.17
|
| Rate for Payer: Cash Price |
$10,243.44
|
| Rate for Payer: Cofinity Commercial |
$12,036.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,243.44
|
| Rate for Payer: Healthscope Commercial |
$12,804.30
|
| Rate for Payer: Healthscope Whirlpool |
$12,420.17
|
| Rate for Payer: Mclaren Commercial |
$11,523.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,883.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,963.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,267.78
|
|
