|
HC OCT CATHETER
|
Facility
|
IP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,677.19 |
| Max. Negotiated Rate |
$2,580.29 |
| Rate for Payer: Aetna Commercial |
$2,322.26
|
| Rate for Payer: ASR ASR |
$2,502.88
|
| Rate for Payer: ASR Commercial |
$2,502.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.68
|
| Rate for Payer: BCN Commercial |
$2,000.50
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$2,425.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,580.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.88
|
| Rate for Payer: Mclaren Commercial |
$2,322.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: Nomi Health Commercial |
$2,115.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,270.66
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.12 |
| Max. Negotiated Rate |
$2,580.29 |
| Rate for Payer: Aetna Commercial |
$2,322.26
|
| Rate for Payer: Aetna Medicare |
$1,290.14
|
| Rate for Payer: ASR ASR |
$2,502.88
|
| Rate for Payer: ASR Commercial |
$2,502.88
|
| Rate for Payer: BCBS Complete |
$1,032.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.00
|
| Rate for Payer: BCN Commercial |
$2,000.50
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$2,425.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,580.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.88
|
| Rate for Payer: Mclaren Commercial |
$2,322.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: Nomi Health Commercial |
$2,115.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,260.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,808.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,270.66
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: ASR Commercial |
$44.52
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.22
|
| Rate for Payer: Priority Health Narrow Network |
$32.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: ASR Commercial |
$44.52
|
| Rate for Payer: BCBS Trust/PPO |
$37.40
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| 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 OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| 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: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Trust/PPO |
$36.51
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Complete |
$15.42
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.69
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Mclaren Medicaid |
$14.68
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.25
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$31.40
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicare Advantage |
$27.39
|
| Rate for Payer: UHCCP DNSP |
$27.39
|
| Rate for Payer: UHCCP Medicaid |
$14.68
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Complete |
$15.42
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.69
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.39
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Mclaren Medicaid |
$14.68
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: Meridian Medicaid |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$30.13
|
| Rate for Payer: PHP Medicaid |
$14.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.25
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health Narrow Network |
$31.40
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicare Advantage |
$27.39
|
| Rate for Payer: UHCCP DNSP |
$27.39
|
| Rate for Payer: UHCCP Medicaid |
$14.68
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: ASR ASR |
$43.46
|
| Rate for Payer: ASR Commercial |
$43.46
|
| Rate for Payer: BCBS Trust/PPO |
$36.51
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$43.46
|
| Rate for Payer: Mclaren Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$384.73
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$503.72 |
| Rate for Payer: Aetna Commercial |
$346.26
|
| Rate for Payer: Aetna Medicare |
$324.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: ASR ASR |
$373.19
|
| Rate for Payer: ASR Commercial |
$373.19
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$315.06
|
| Rate for Payer: BCN Commercial |
$298.28
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$361.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$384.73
|
| Rate for Payer: Healthscope Whirlpool |
$373.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$324.98
|
| Rate for Payer: Mclaren Commercial |
$346.26
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.02
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$357.48
|
| Rate for Payer: PHP Medicaid |
$174.19
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.10
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$269.70
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$503.72
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP DNSP |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: VA VA |
$324.98
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$384.73
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$250.07 |
| Max. Negotiated Rate |
$384.73 |
| Rate for Payer: Aetna Commercial |
$346.26
|
| Rate for Payer: ASR ASR |
$373.19
|
| Rate for Payer: ASR Commercial |
$373.19
|
| Rate for Payer: BCBS Trust/PPO |
$313.52
|
| Rate for Payer: BCN Commercial |
$298.28
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$361.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.78
|
| Rate for Payer: Healthscope Commercial |
$384.73
|
| Rate for Payer: Healthscope Whirlpool |
$373.19
|
| Rate for Payer: Mclaren Commercial |
$346.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.02
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.56
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna Commercial |
$1.63
|
| Rate for Payer: ASR ASR |
$1.76
|
| Rate for Payer: ASR Commercial |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.47
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$1.81
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.54
|
| Rate for Payer: Nomi Health Commercial |
$1.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.59
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$1.63
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: ASR ASR |
$1.76
|
| Rate for Payer: ASR Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$1.81
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.54
|
| Rate for Payer: Nomi Health Commercial |
$1.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.19
|
| Rate for Payer: Priority Health Narrow Network |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.59
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
IP
|
$5,803.80
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,772.47 |
| Max. Negotiated Rate |
$5,803.80 |
| Rate for Payer: Aetna Commercial |
$5,223.42
|
| Rate for Payer: ASR ASR |
$5,629.69
|
| Rate for Payer: ASR Commercial |
$5,629.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,729.52
|
| Rate for Payer: BCN Commercial |
$4,499.69
|
| Rate for Payer: Cash Price |
$4,643.04
|
| Rate for Payer: Cofinity Commercial |
$5,455.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,643.04
|
| Rate for Payer: Healthscope Commercial |
$5,803.80
|
| Rate for Payer: Healthscope Whirlpool |
$5,629.69
|
| Rate for Payer: Mclaren Commercial |
$5,223.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,933.23
|
| Rate for Payer: Nomi Health Commercial |
$4,759.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,772.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,107.34
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
OP
|
$5,803.80
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,321.52 |
| Max. Negotiated Rate |
$5,803.80 |
| Rate for Payer: Aetna Commercial |
$5,223.42
|
| Rate for Payer: Aetna Medicare |
$2,901.90
|
| Rate for Payer: ASR ASR |
$5,629.69
|
| Rate for Payer: ASR Commercial |
$5,629.69
|
| Rate for Payer: BCBS Complete |
$2,321.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,752.73
|
| Rate for Payer: BCN Commercial |
$4,499.69
|
| Rate for Payer: Cash Price |
$4,643.04
|
| Rate for Payer: Cofinity Commercial |
$5,455.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,643.04
|
| Rate for Payer: Healthscope Commercial |
$5,803.80
|
| Rate for Payer: Healthscope Whirlpool |
$5,629.69
|
| Rate for Payer: Mclaren Commercial |
$5,223.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,933.23
|
| Rate for Payer: Nomi Health Commercial |
$4,759.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,772.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,085.29
|
| Rate for Payer: Priority Health Narrow Network |
$4,068.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,107.34
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$944.00
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna Commercial |
$849.60
|
| Rate for Payer: ASR ASR |
$915.68
|
| Rate for Payer: ASR Commercial |
$915.68
|
| Rate for Payer: BCBS Trust/PPO |
$769.27
|
| Rate for Payer: BCN Commercial |
$731.88
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$887.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.20
|
| Rate for Payer: Healthscope Commercial |
$944.00
|
| Rate for Payer: Healthscope Whirlpool |
$915.68
|
| Rate for Payer: Mclaren Commercial |
$849.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.40
|
| Rate for Payer: Nomi Health Commercial |
$774.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.72
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$944.00
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna Commercial |
$849.60
|
| Rate for Payer: Aetna Medicare |
$472.00
|
| Rate for Payer: ASR ASR |
$915.68
|
| Rate for Payer: ASR Commercial |
$915.68
|
| Rate for Payer: BCBS Complete |
$377.60
|
| Rate for Payer: BCBS Trust/PPO |
$773.04
|
| Rate for Payer: BCN Commercial |
$731.88
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$887.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.20
|
| Rate for Payer: Healthscope Commercial |
$944.00
|
| Rate for Payer: Healthscope Whirlpool |
$915.68
|
| Rate for Payer: Mclaren Commercial |
$849.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.40
|
| Rate for Payer: Nomi Health Commercial |
$774.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.13
|
| Rate for Payer: Priority Health Narrow Network |
$661.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.72
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$552.37
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.95 |
| Max. Negotiated Rate |
$552.37 |
| Rate for Payer: Aetna Commercial |
$497.13
|
| Rate for Payer: Aetna Medicare |
$276.18
|
| Rate for Payer: ASR ASR |
$535.80
|
| Rate for Payer: ASR Commercial |
$535.80
|
| Rate for Payer: BCBS Complete |
$220.95
|
| Rate for Payer: BCBS Trust/PPO |
$452.34
|
| Rate for Payer: BCN Commercial |
$428.25
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cofinity Commercial |
$519.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.90
|
| Rate for Payer: Healthscope Commercial |
$552.37
|
| Rate for Payer: Healthscope Whirlpool |
$535.80
|
| Rate for Payer: Mclaren Commercial |
$497.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.51
|
| Rate for Payer: Nomi Health Commercial |
$452.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.99
|
| Rate for Payer: Priority Health Narrow Network |
$387.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.09
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$552.37
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$359.04 |
| Max. Negotiated Rate |
$552.37 |
| Rate for Payer: Aetna Commercial |
$497.13
|
| Rate for Payer: ASR ASR |
$535.80
|
| Rate for Payer: ASR Commercial |
$535.80
|
| Rate for Payer: BCBS Trust/PPO |
$450.13
|
| Rate for Payer: BCN Commercial |
$428.25
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cofinity Commercial |
$519.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.90
|
| Rate for Payer: Healthscope Commercial |
$552.37
|
| Rate for Payer: Healthscope Whirlpool |
$535.80
|
| Rate for Payer: Mclaren Commercial |
$497.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.51
|
| Rate for Payer: Nomi Health Commercial |
$452.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.09
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$349.23
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$139.69 |
| Max. Negotiated Rate |
$349.23 |
| Rate for Payer: Aetna Commercial |
$314.31
|
| Rate for Payer: Aetna Medicare |
$174.62
|
| Rate for Payer: ASR ASR |
$338.75
|
| Rate for Payer: ASR Commercial |
$338.75
|
| Rate for Payer: BCBS Complete |
$139.69
|
| Rate for Payer: BCBS Trust/PPO |
$285.98
|
| Rate for Payer: BCN Commercial |
$270.76
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Cofinity Commercial |
$328.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.38
|
| Rate for Payer: Healthscope Commercial |
$349.23
|
| Rate for Payer: Healthscope Whirlpool |
$338.75
|
| Rate for Payer: Mclaren Commercial |
$314.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.85
|
| Rate for Payer: Nomi Health Commercial |
$286.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.00
|
| Rate for Payer: Priority Health Narrow Network |
$244.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.32
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$349.23
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$349.23 |
| Rate for Payer: Aetna Commercial |
$314.31
|
| Rate for Payer: ASR ASR |
$338.75
|
| Rate for Payer: ASR Commercial |
$338.75
|
| Rate for Payer: BCBS Trust/PPO |
$284.59
|
| Rate for Payer: BCN Commercial |
$270.76
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Cofinity Commercial |
$328.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.38
|
| Rate for Payer: Healthscope Commercial |
$349.23
|
| Rate for Payer: Healthscope Whirlpool |
$338.75
|
| Rate for Payer: Mclaren Commercial |
$314.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.85
|
| Rate for Payer: Nomi Health Commercial |
$286.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.32
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$193.26
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$193.26 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: ASR ASR |
$187.46
|
| Rate for Payer: ASR Commercial |
$187.46
|
| Rate for Payer: BCBS Trust/PPO |
$157.49
|
| Rate for Payer: BCN Commercial |
$149.83
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$193.26
|
| Rate for Payer: Healthscope Whirlpool |
$187.46
|
| Rate for Payer: Mclaren Commercial |
$173.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.07
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$193.26
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$77.30 |
| Max. Negotiated Rate |
$193.26 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$96.63
|
| Rate for Payer: ASR ASR |
$187.46
|
| Rate for Payer: ASR Commercial |
$187.46
|
| Rate for Payer: BCBS Complete |
$77.30
|
| Rate for Payer: BCBS Trust/PPO |
$158.26
|
| Rate for Payer: BCN Commercial |
$149.83
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$193.26
|
| Rate for Payer: Healthscope Whirlpool |
$187.46
|
| Rate for Payer: Mclaren Commercial |
$173.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.33
|
| Rate for Payer: Priority Health Narrow Network |
$135.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.07
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$789.64
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
