|
HC NEG PRES CANIST 1000CC
|
Facility
|
IP
|
$233.19
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.57 |
| Max. Negotiated Rate |
$233.19 |
| Rate for Payer: Aetna Commercial |
$209.87
|
| Rate for Payer: ASR ASR |
$226.19
|
| Rate for Payer: ASR Commercial |
$226.19
|
| Rate for Payer: BCBS Trust/PPO |
$190.03
|
| Rate for Payer: BCN Commercial |
$180.79
|
| Rate for Payer: Cash Price |
$186.55
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.55
|
| Rate for Payer: Healthscope Commercial |
$233.19
|
| Rate for Payer: Healthscope Whirlpool |
$226.19
|
| Rate for Payer: Mclaren Commercial |
$209.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.21
|
| Rate for Payer: Nomi Health Commercial |
$191.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.21
|
|
|
HC NEG PRES CANIST 1000CC
|
Facility
|
OP
|
$233.19
|
|
| Hospital Charge Code |
27200232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$233.19 |
| Rate for Payer: Aetna Commercial |
$209.87
|
| Rate for Payer: Aetna Medicare |
$116.60
|
| Rate for Payer: ASR ASR |
$226.19
|
| Rate for Payer: ASR Commercial |
$226.19
|
| Rate for Payer: BCBS Complete |
$93.28
|
| Rate for Payer: BCBS Trust/PPO |
$190.96
|
| Rate for Payer: BCN Commercial |
$180.79
|
| Rate for Payer: Cash Price |
$186.55
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.55
|
| Rate for Payer: Healthscope Commercial |
$233.19
|
| Rate for Payer: Healthscope Whirlpool |
$226.19
|
| Rate for Payer: Mclaren Commercial |
$209.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.21
|
| Rate for Payer: Nomi Health Commercial |
$191.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.32
|
| Rate for Payer: Priority Health Narrow Network |
$163.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.21
|
|
|
HC NEG PRES CANIST 500CC
|
Facility
|
IP
|
$151.46
|
|
| Hospital Charge Code |
27200136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.45 |
| Max. Negotiated Rate |
$151.46 |
| Rate for Payer: Aetna Commercial |
$136.31
|
| Rate for Payer: ASR ASR |
$146.92
|
| Rate for Payer: ASR Commercial |
$146.92
|
| Rate for Payer: BCBS Trust/PPO |
$123.42
|
| Rate for Payer: BCN Commercial |
$117.43
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cofinity Commercial |
$142.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.17
|
| Rate for Payer: Healthscope Commercial |
$151.46
|
| Rate for Payer: Healthscope Whirlpool |
$146.92
|
| Rate for Payer: Mclaren Commercial |
$136.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$124.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.28
|
|
|
HC NEG PRES CANIST 500CC
|
Facility
|
OP
|
$151.46
|
|
| Hospital Charge Code |
27200136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.58 |
| Max. Negotiated Rate |
$151.46 |
| Rate for Payer: Aetna Commercial |
$136.31
|
| Rate for Payer: Aetna Medicare |
$75.73
|
| Rate for Payer: ASR ASR |
$146.92
|
| Rate for Payer: ASR Commercial |
$146.92
|
| Rate for Payer: BCBS Complete |
$60.58
|
| Rate for Payer: BCBS Trust/PPO |
$124.03
|
| Rate for Payer: BCN Commercial |
$117.43
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cofinity Commercial |
$142.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.17
|
| Rate for Payer: Healthscope Commercial |
$151.46
|
| Rate for Payer: Healthscope Whirlpool |
$146.92
|
| Rate for Payer: Mclaren Commercial |
$136.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.74
|
| Rate for Payer: Nomi Health Commercial |
$124.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.71
|
| Rate for Payer: Priority Health Narrow Network |
$106.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.28
|
|
|
HC NEG PRES CLEANSE DRSG MED
|
Facility
|
OP
|
$510.90
|
|
| Hospital Charge Code |
27200229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$510.90 |
| Rate for Payer: Aetna Commercial |
$459.81
|
| Rate for Payer: Aetna Medicare |
$255.45
|
| Rate for Payer: ASR ASR |
$495.57
|
| Rate for Payer: ASR Commercial |
$495.57
|
| Rate for Payer: BCBS Complete |
$204.36
|
| Rate for Payer: BCBS Trust/PPO |
$418.38
|
| Rate for Payer: BCN Commercial |
$396.10
|
| Rate for Payer: Cash Price |
$408.72
|
| Rate for Payer: Cofinity Commercial |
$480.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.72
|
| Rate for Payer: Healthscope Commercial |
$510.90
|
| Rate for Payer: Healthscope Whirlpool |
$495.57
|
| Rate for Payer: Mclaren Commercial |
$459.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.26
|
| Rate for Payer: Nomi Health Commercial |
$418.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.65
|
| Rate for Payer: Priority Health Narrow Network |
$358.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.59
|
|
|
HC NEG PRES CLEANSE DRSG MED
|
Facility
|
IP
|
$510.90
|
|
| Hospital Charge Code |
27200229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.08 |
| Max. Negotiated Rate |
$510.90 |
| Rate for Payer: Aetna Commercial |
$459.81
|
| Rate for Payer: ASR ASR |
$495.57
|
| Rate for Payer: ASR Commercial |
$495.57
|
| Rate for Payer: BCBS Trust/PPO |
$416.33
|
| Rate for Payer: BCN Commercial |
$396.10
|
| Rate for Payer: Cash Price |
$408.72
|
| Rate for Payer: Cofinity Commercial |
$480.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.72
|
| Rate for Payer: Healthscope Commercial |
$510.90
|
| Rate for Payer: Healthscope Whirlpool |
$495.57
|
| Rate for Payer: Mclaren Commercial |
$459.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.26
|
| Rate for Payer: Nomi Health Commercial |
$418.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.59
|
|
|
HC NEG PRESSURE DERMATAC DRAPE
|
Facility
|
IP
|
$64.50
|
|
| Hospital Charge Code |
27200374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: ASR Commercial |
$62.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.56
|
| Rate for Payer: BCN Commercial |
$50.01
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$64.50
|
| Rate for Payer: Healthscope Whirlpool |
$62.56
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.82
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC NEG PRESSURE DERMATAC DRAPE
|
Facility
|
OP
|
$64.50
|
|
| Hospital Charge Code |
27200374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: ASR Commercial |
$62.56
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$52.82
|
| Rate for Payer: BCN Commercial |
$50.01
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$64.50
|
| Rate for Payer: Healthscope Whirlpool |
$62.56
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.82
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.51
|
| Rate for Payer: Priority Health Narrow Network |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
IP
|
$540.83
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.54 |
| Max. Negotiated Rate |
$540.83 |
| Rate for Payer: Aetna Commercial |
$486.75
|
| Rate for Payer: ASR ASR |
$524.61
|
| Rate for Payer: ASR Commercial |
$524.61
|
| Rate for Payer: BCBS Trust/PPO |
$440.72
|
| Rate for Payer: BCN Commercial |
$419.31
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cofinity Commercial |
$508.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.66
|
| Rate for Payer: Healthscope Commercial |
$540.83
|
| Rate for Payer: Healthscope Whirlpool |
$524.61
|
| Rate for Payer: Mclaren Commercial |
$486.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.71
|
| Rate for Payer: Nomi Health Commercial |
$443.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.93
|
|
|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
OP
|
$540.83
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.95 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$486.75
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$524.61
|
| Rate for Payer: ASR Commercial |
$524.61
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$442.89
|
| Rate for Payer: BCN Commercial |
$419.31
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cash Price |
$432.66
|
| Rate for Payer: Cofinity Commercial |
$508.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$540.83
|
| Rate for Payer: Healthscope Whirlpool |
$524.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$486.75
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.71
|
| Rate for Payer: Nomi Health Commercial |
$443.48
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.19
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$180.95
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC NEG PRESSURE WND TX DME UP TO 50 SQ CM
|
Facility
|
OP
|
$428.32
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$428.32 |
| Rate for Payer: Aetna Commercial |
$385.49
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$415.47
|
| Rate for Payer: ASR Commercial |
$415.47
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$350.75
|
| Rate for Payer: BCN Commercial |
$332.08
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$342.66
|
| Rate for Payer: Cash Price |
$342.66
|
| Rate for Payer: Cofinity Commercial |
$402.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$428.32
|
| Rate for Payer: Healthscope Whirlpool |
$415.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$385.49
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.07
|
| Rate for Payer: Nomi Health Commercial |
$351.22
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.25
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$109.80
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC NEG PRESSURE WND TX DME UP TO 50 SQ CM
|
Facility
|
IP
|
$428.32
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$428.32 |
| Rate for Payer: Aetna Commercial |
$385.49
|
| Rate for Payer: ASR ASR |
$415.47
|
| Rate for Payer: ASR Commercial |
$415.47
|
| Rate for Payer: BCBS Trust/PPO |
$349.04
|
| Rate for Payer: BCN Commercial |
$332.08
|
| Rate for Payer: Cash Price |
$342.66
|
| Rate for Payer: Cofinity Commercial |
$402.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.66
|
| Rate for Payer: Healthscope Commercial |
$428.32
|
| Rate for Payer: Healthscope Whirlpool |
$415.47
|
| Rate for Payer: Mclaren Commercial |
$385.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.07
|
| Rate for Payer: Nomi Health Commercial |
$351.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.92
|
|
|
HC NEG PRES TRAC PAD
|
Facility
|
IP
|
$73.81
|
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$73.81 |
| Rate for Payer: Aetna Commercial |
$66.43
|
| Rate for Payer: ASR ASR |
$71.60
|
| Rate for Payer: ASR Commercial |
$71.60
|
| Rate for Payer: BCBS Trust/PPO |
$60.15
|
| Rate for Payer: BCN Commercial |
$57.22
|
| Rate for Payer: Cash Price |
$59.05
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.05
|
| Rate for Payer: Healthscope Commercial |
$73.81
|
| Rate for Payer: Healthscope Whirlpool |
$71.60
|
| Rate for Payer: Mclaren Commercial |
$66.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.74
|
| Rate for Payer: Nomi Health Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.95
|
|
|
HC NEG PRES TRAC PAD
|
Facility
|
OP
|
$73.81
|
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$73.81 |
| Rate for Payer: Aetna Commercial |
$66.43
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: ASR ASR |
$71.60
|
| Rate for Payer: ASR Commercial |
$71.60
|
| Rate for Payer: BCBS Complete |
$29.52
|
| Rate for Payer: BCBS Trust/PPO |
$60.44
|
| Rate for Payer: BCN Commercial |
$57.22
|
| Rate for Payer: Cash Price |
$59.05
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.05
|
| Rate for Payer: Healthscope Commercial |
$73.81
|
| Rate for Payer: Healthscope Whirlpool |
$71.60
|
| Rate for Payer: Mclaren Commercial |
$66.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.74
|
| Rate for Payer: Nomi Health Commercial |
$60.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.67
|
| Rate for Payer: Priority Health Narrow Network |
$51.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.95
|
|
|
HC NEG PRES VF CASSETTE
|
Facility
|
IP
|
$212.87
|
|
| Hospital Charge Code |
27200230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.37 |
| Max. Negotiated Rate |
$212.87 |
| Rate for Payer: Aetna Commercial |
$191.58
|
| Rate for Payer: ASR ASR |
$206.48
|
| Rate for Payer: ASR Commercial |
$206.48
|
| Rate for Payer: BCBS Trust/PPO |
$173.47
|
| Rate for Payer: BCN Commercial |
$165.04
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$200.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$212.87
|
| Rate for Payer: Healthscope Whirlpool |
$206.48
|
| Rate for Payer: Mclaren Commercial |
$191.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.33
|
|
|
HC NEG PRES VF CASSETTE
|
Facility
|
OP
|
$212.87
|
|
| Hospital Charge Code |
27200230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$212.87 |
| Rate for Payer: Aetna Commercial |
$191.58
|
| Rate for Payer: Aetna Medicare |
$106.44
|
| Rate for Payer: ASR ASR |
$206.48
|
| Rate for Payer: ASR Commercial |
$206.48
|
| Rate for Payer: BCBS Complete |
$85.15
|
| Rate for Payer: BCBS Trust/PPO |
$174.32
|
| Rate for Payer: BCN Commercial |
$165.04
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$200.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$212.87
|
| Rate for Payer: Healthscope Whirlpool |
$206.48
|
| Rate for Payer: Mclaren Commercial |
$191.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.52
|
| Rate for Payer: Priority Health Narrow Network |
$149.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.33
|
|
|
HC NEG PRES VF DRSG MED
|
Facility
|
IP
|
$445.10
|
|
| Hospital Charge Code |
27200228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.32 |
| Max. Negotiated Rate |
$445.10 |
| Rate for Payer: Aetna Commercial |
$400.59
|
| Rate for Payer: ASR ASR |
$431.75
|
| Rate for Payer: ASR Commercial |
$431.75
|
| Rate for Payer: BCBS Trust/PPO |
$362.71
|
| Rate for Payer: BCN Commercial |
$345.09
|
| Rate for Payer: Cash Price |
$356.08
|
| Rate for Payer: Cofinity Commercial |
$418.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.08
|
| Rate for Payer: Healthscope Commercial |
$445.10
|
| Rate for Payer: Healthscope Whirlpool |
$431.75
|
| Rate for Payer: Mclaren Commercial |
$400.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.34
|
| Rate for Payer: Nomi Health Commercial |
$364.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.69
|
|
|
HC NEG PRES VF DRSG MED
|
Facility
|
OP
|
$445.10
|
|
| Hospital Charge Code |
27200228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.04 |
| Max. Negotiated Rate |
$445.10 |
| Rate for Payer: Aetna Commercial |
$400.59
|
| Rate for Payer: Aetna Medicare |
$222.55
|
| Rate for Payer: ASR ASR |
$431.75
|
| Rate for Payer: ASR Commercial |
$431.75
|
| Rate for Payer: BCBS Complete |
$178.04
|
| Rate for Payer: BCBS Trust/PPO |
$364.49
|
| Rate for Payer: BCN Commercial |
$345.09
|
| Rate for Payer: Cash Price |
$356.08
|
| Rate for Payer: Cofinity Commercial |
$418.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.08
|
| Rate for Payer: Healthscope Commercial |
$445.10
|
| Rate for Payer: Healthscope Whirlpool |
$431.75
|
| Rate for Payer: Mclaren Commercial |
$400.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.34
|
| Rate for Payer: Nomi Health Commercial |
$364.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.00
|
| Rate for Payer: Priority Health Narrow Network |
$312.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.69
|
|
|
HC NEG PRES VF DRSG SMA
|
Facility
|
IP
|
$379.30
|
|
| Hospital Charge Code |
27200227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.54 |
| Max. Negotiated Rate |
$379.30 |
| Rate for Payer: Aetna Commercial |
$341.37
|
| Rate for Payer: ASR ASR |
$367.92
|
| Rate for Payer: ASR Commercial |
$367.92
|
| Rate for Payer: BCBS Trust/PPO |
$309.09
|
| Rate for Payer: BCN Commercial |
$294.07
|
| Rate for Payer: Cash Price |
$303.44
|
| Rate for Payer: Cofinity Commercial |
$356.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.44
|
| Rate for Payer: Healthscope Commercial |
$379.30
|
| Rate for Payer: Healthscope Whirlpool |
$367.92
|
| Rate for Payer: Mclaren Commercial |
$341.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.40
|
| Rate for Payer: Nomi Health Commercial |
$311.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.78
|
|
|
HC NEG PRES VF DRSG SMA
|
Facility
|
OP
|
$379.30
|
|
| Hospital Charge Code |
27200227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$379.30 |
| Rate for Payer: Aetna Commercial |
$341.37
|
| Rate for Payer: Aetna Medicare |
$189.65
|
| Rate for Payer: ASR ASR |
$367.92
|
| Rate for Payer: ASR Commercial |
$367.92
|
| Rate for Payer: BCBS Complete |
$151.72
|
| Rate for Payer: BCBS Trust/PPO |
$310.61
|
| Rate for Payer: BCN Commercial |
$294.07
|
| Rate for Payer: Cash Price |
$303.44
|
| Rate for Payer: Cofinity Commercial |
$356.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.44
|
| Rate for Payer: Healthscope Commercial |
$379.30
|
| Rate for Payer: Healthscope Whirlpool |
$367.92
|
| Rate for Payer: Mclaren Commercial |
$341.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.40
|
| Rate for Payer: Nomi Health Commercial |
$311.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.34
|
| Rate for Payer: Priority Health Narrow Network |
$265.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.78
|
|
|
HC NEG PRES VF DUO TRAC PAD
|
Facility
|
IP
|
$290.28
|
|
| Hospital Charge Code |
27200231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.68 |
| Max. Negotiated Rate |
$290.28 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: ASR ASR |
$281.57
|
| Rate for Payer: ASR Commercial |
$281.57
|
| Rate for Payer: BCBS Trust/PPO |
$236.55
|
| Rate for Payer: BCN Commercial |
$225.05
|
| Rate for Payer: Cash Price |
$232.22
|
| Rate for Payer: Cofinity Commercial |
$272.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.22
|
| Rate for Payer: Healthscope Commercial |
$290.28
|
| Rate for Payer: Healthscope Whirlpool |
$281.57
|
| Rate for Payer: Mclaren Commercial |
$261.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.74
|
| Rate for Payer: Nomi Health Commercial |
$238.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.45
|
|
|
HC NEG PRES VF DUO TRAC PAD
|
Facility
|
OP
|
$290.28
|
|
| Hospital Charge Code |
27200231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.11 |
| Max. Negotiated Rate |
$290.28 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: Aetna Medicare |
$145.14
|
| Rate for Payer: ASR ASR |
$281.57
|
| Rate for Payer: ASR Commercial |
$281.57
|
| Rate for Payer: BCBS Complete |
$116.11
|
| Rate for Payer: BCBS Trust/PPO |
$237.71
|
| Rate for Payer: BCN Commercial |
$225.05
|
| Rate for Payer: Cash Price |
$232.22
|
| Rate for Payer: Cofinity Commercial |
$272.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.22
|
| Rate for Payer: Healthscope Commercial |
$290.28
|
| Rate for Payer: Healthscope Whirlpool |
$281.57
|
| Rate for Payer: Mclaren Commercial |
$261.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.74
|
| Rate for Payer: Nomi Health Commercial |
$238.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.34
|
| Rate for Payer: Priority Health Narrow Network |
$203.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.45
|
|
|
HC NEG PRES WHT FOAM DRSG
|
Facility
|
IP
|
$180.10
|
|
| Hospital Charge Code |
27200158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.06 |
| Max. Negotiated Rate |
$180.10 |
| Rate for Payer: Aetna Commercial |
$162.09
|
| Rate for Payer: ASR ASR |
$174.70
|
| Rate for Payer: ASR Commercial |
$174.70
|
| Rate for Payer: BCBS Trust/PPO |
$146.76
|
| Rate for Payer: BCN Commercial |
$139.63
|
| Rate for Payer: Cash Price |
$144.08
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.08
|
| Rate for Payer: Healthscope Commercial |
$180.10
|
| Rate for Payer: Healthscope Whirlpool |
$174.70
|
| Rate for Payer: Mclaren Commercial |
$162.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.08
|
| Rate for Payer: Nomi Health Commercial |
$147.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.49
|
|
|
HC NEG PRES WHT FOAM DRSG
|
Facility
|
OP
|
$180.10
|
|
| Hospital Charge Code |
27200158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$180.10 |
| Rate for Payer: Aetna Commercial |
$162.09
|
| Rate for Payer: Aetna Medicare |
$90.05
|
| Rate for Payer: ASR ASR |
$174.70
|
| Rate for Payer: ASR Commercial |
$174.70
|
| Rate for Payer: BCBS Complete |
$72.04
|
| Rate for Payer: BCBS Trust/PPO |
$147.48
|
| Rate for Payer: BCN Commercial |
$139.63
|
| Rate for Payer: Cash Price |
$144.08
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.08
|
| Rate for Payer: Healthscope Commercial |
$180.10
|
| Rate for Payer: Healthscope Whirlpool |
$174.70
|
| Rate for Payer: Mclaren Commercial |
$162.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.08
|
| Rate for Payer: Nomi Health Commercial |
$147.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.80
|
| Rate for Payer: Priority Health Narrow Network |
$126.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.49
|
|
|
HC NEG PRES WND THRPY DSG EXLGE
|
Facility
|
IP
|
$381.25
|
|
| Hospital Charge Code |
27200137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.81 |
| Max. Negotiated Rate |
$381.25 |
| Rate for Payer: Aetna Commercial |
$343.12
|
| Rate for Payer: ASR ASR |
$369.81
|
| Rate for Payer: ASR Commercial |
$369.81
|
| Rate for Payer: BCBS Trust/PPO |
$310.68
|
| Rate for Payer: BCN Commercial |
$295.58
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cofinity Commercial |
$358.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.00
|
| Rate for Payer: Healthscope Commercial |
$381.25
|
| Rate for Payer: Healthscope Whirlpool |
$369.81
|
| Rate for Payer: Mclaren Commercial |
$343.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.06
|
| Rate for Payer: Nomi Health Commercial |
$312.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.50
|
|
