|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.20
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: ASR Commercial |
$9.89
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$8.35
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Narrow Network |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Medicare |
$8.64
|
| Rate for Payer: ASR ASR |
$16.76
|
| Rate for Payer: ASR Commercial |
$16.76
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$17.28
|
| Rate for Payer: Healthscope Whirlpool |
$16.76
|
| Rate for Payer: Mclaren Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: Nomi Health Commercial |
$14.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.14
|
| Rate for Payer: Priority Health Narrow Network |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.21
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.28
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: ASR ASR |
$16.76
|
| Rate for Payer: ASR Commercial |
$16.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.08
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$17.28
|
| Rate for Payer: Healthscope Whirlpool |
$16.76
|
| Rate for Payer: Mclaren Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.69
|
| Rate for Payer: Nomi Health Commercial |
$14.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.21
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$112.87 |
| Rate for Payer: Aetna Commercial |
$101.58
|
| Rate for Payer: Aetna Medicare |
$56.44
|
| Rate for Payer: ASR ASR |
$109.48
|
| Rate for Payer: ASR Commercial |
$109.48
|
| Rate for Payer: BCBS Complete |
$45.15
|
| Rate for Payer: BCBS Trust/PPO |
$92.43
|
| Rate for Payer: BCN Commercial |
$87.51
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$106.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$112.87
|
| Rate for Payer: Healthscope Whirlpool |
$109.48
|
| Rate for Payer: Mclaren Commercial |
$101.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: Nomi Health Commercial |
$92.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.90
|
| Rate for Payer: Priority Health Narrow Network |
$79.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.33
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$112.87
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$112.87 |
| Rate for Payer: Aetna Commercial |
$101.58
|
| Rate for Payer: ASR ASR |
$109.48
|
| Rate for Payer: ASR Commercial |
$109.48
|
| Rate for Payer: BCBS Trust/PPO |
$91.98
|
| Rate for Payer: BCN Commercial |
$87.51
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$106.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$112.87
|
| Rate for Payer: Healthscope Whirlpool |
$109.48
|
| Rate for Payer: Mclaren Commercial |
$101.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.94
|
| Rate for Payer: Nomi Health Commercial |
$92.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.33
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$30.45 |
| Rate for Payer: Aetna Commercial |
$27.40
|
| Rate for Payer: ASR ASR |
$29.54
|
| Rate for Payer: ASR Commercial |
$29.54
|
| Rate for Payer: BCBS Trust/PPO |
$24.81
|
| Rate for Payer: BCN Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$28.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$30.45
|
| Rate for Payer: Healthscope Whirlpool |
$29.54
|
| Rate for Payer: Mclaren Commercial |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: Nomi Health Commercial |
$24.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.80
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$30.45 |
| Rate for Payer: Aetna Commercial |
$27.40
|
| Rate for Payer: Aetna Medicare |
$15.22
|
| Rate for Payer: ASR ASR |
$29.54
|
| Rate for Payer: ASR Commercial |
$29.54
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$28.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$30.45
|
| Rate for Payer: Healthscope Whirlpool |
$29.54
|
| Rate for Payer: Mclaren Commercial |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: Nomi Health Commercial |
$24.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.68
|
| Rate for Payer: Priority Health Narrow Network |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.80
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: Aetna Medicare |
$19.90
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: ASR Commercial |
$38.61
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$32.59
|
| Rate for Payer: BCN Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$39.80
|
| Rate for Payer: Healthscope Whirlpool |
$38.61
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.87
|
| Rate for Payer: Priority Health Narrow Network |
$27.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: ASR Commercial |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$32.43
|
| Rate for Payer: BCN Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$39.80
|
| Rate for Payer: Healthscope Whirlpool |
$38.61
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$56.73 |
| Rate for Payer: Aetna Commercial |
$51.06
|
| Rate for Payer: ASR ASR |
$55.03
|
| Rate for Payer: ASR Commercial |
$55.03
|
| Rate for Payer: BCBS Trust/PPO |
$46.23
|
| Rate for Payer: BCN Commercial |
$43.98
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$53.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$56.73
|
| Rate for Payer: Healthscope Whirlpool |
$55.03
|
| Rate for Payer: Mclaren Commercial |
$51.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: Nomi Health Commercial |
$46.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.92
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$56.73 |
| Rate for Payer: Aetna Commercial |
$51.06
|
| Rate for Payer: Aetna Medicare |
$28.36
|
| Rate for Payer: ASR ASR |
$55.03
|
| Rate for Payer: ASR Commercial |
$55.03
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS Trust/PPO |
$46.46
|
| Rate for Payer: BCN Commercial |
$43.98
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$53.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$56.73
|
| Rate for Payer: Healthscope Whirlpool |
$55.03
|
| Rate for Payer: Mclaren Commercial |
$51.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: Nomi Health Commercial |
$46.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.71
|
| Rate for Payer: Priority Health Narrow Network |
$39.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.92
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$92.34
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: ASR ASR |
$99.52
|
| Rate for Payer: ASR Commercial |
$99.52
|
| Rate for Payer: BCBS Complete |
$41.04
|
| Rate for Payer: BCBS Trust/PPO |
$84.02
|
| Rate for Payer: BCN Commercial |
$79.55
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Healthscope Whirlpool |
$99.52
|
| Rate for Payer: Mclaren Commercial |
$92.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: Nomi Health Commercial |
$84.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.90
|
| Rate for Payer: Priority Health Narrow Network |
$71.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.29
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$92.34
|
| Rate for Payer: ASR ASR |
$99.52
|
| Rate for Payer: ASR Commercial |
$99.52
|
| Rate for Payer: BCBS Trust/PPO |
$83.61
|
| Rate for Payer: BCN Commercial |
$79.55
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Healthscope Whirlpool |
$99.52
|
| Rate for Payer: Mclaren Commercial |
$92.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: Nomi Health Commercial |
$84.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.29
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$19.39
|
| Rate for Payer: ASR Commercial |
$19.39
|
| Rate for Payer: BCBS Trust/PPO |
$16.29
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: Nomi Health Commercial |
$16.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.59
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: ASR ASR |
$19.39
|
| Rate for Payer: ASR Commercial |
$19.39
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.37
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: Nomi Health Commercial |
$16.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow Network |
$14.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.59
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$25.68 |
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Medicare |
$12.84
|
| Rate for Payer: ASR ASR |
$24.91
|
| Rate for Payer: ASR Commercial |
$24.91
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Healthscope Whirlpool |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.50
|
| Rate for Payer: Priority Health Narrow Network |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.60
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$25.68 |
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: ASR ASR |
$24.91
|
| Rate for Payer: ASR Commercial |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$20.93
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Healthscope Whirlpool |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.60
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.08 |
| Max. Negotiated Rate |
$552.70 |
| Rate for Payer: Aetna Commercial |
$497.43
|
| Rate for Payer: Aetna Medicare |
$276.35
|
| Rate for Payer: ASR ASR |
$536.12
|
| Rate for Payer: ASR Commercial |
$536.12
|
| Rate for Payer: BCBS Complete |
$221.08
|
| Rate for Payer: BCBS Trust/PPO |
$452.61
|
| Rate for Payer: BCN Commercial |
$428.51
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$519.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$552.70
|
| Rate for Payer: Healthscope Whirlpool |
$536.12
|
| Rate for Payer: Mclaren Commercial |
$497.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: Nomi Health Commercial |
$453.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$484.28
|
| Rate for Payer: Priority Health Narrow Network |
$387.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.38
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.26 |
| Max. Negotiated Rate |
$552.70 |
| Rate for Payer: Aetna Commercial |
$497.43
|
| Rate for Payer: ASR ASR |
$536.12
|
| Rate for Payer: ASR Commercial |
$536.12
|
| Rate for Payer: BCBS Trust/PPO |
$450.40
|
| Rate for Payer: BCN Commercial |
$428.51
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$519.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$552.70
|
| Rate for Payer: Healthscope Whirlpool |
$536.12
|
| Rate for Payer: Mclaren Commercial |
$497.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: Nomi Health Commercial |
$453.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.38
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$38.71 |
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: ASR ASR |
$37.55
|
| Rate for Payer: ASR Commercial |
$37.55
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: BCBS Trust/PPO |
$31.70
|
| Rate for Payer: BCN Commercial |
$30.01
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$36.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$38.71
|
| Rate for Payer: Healthscope Whirlpool |
$37.55
|
| Rate for Payer: Mclaren Commercial |
$34.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.92
|
| Rate for Payer: Priority Health Narrow Network |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.06
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$38.71 |
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: ASR ASR |
$37.55
|
| Rate for Payer: ASR Commercial |
$37.55
|
| Rate for Payer: BCBS Trust/PPO |
$31.54
|
| Rate for Payer: BCN Commercial |
$30.01
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$36.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$38.71
|
| Rate for Payer: Healthscope Whirlpool |
$37.55
|
| Rate for Payer: Mclaren Commercial |
$34.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.06
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$537.98 |
| Rate for Payer: Aetna Commercial |
$484.18
|
| Rate for Payer: Aetna Medicare |
$268.99
|
| Rate for Payer: ASR ASR |
$521.84
|
| Rate for Payer: ASR Commercial |
$521.84
|
| Rate for Payer: BCBS Complete |
$215.19
|
| Rate for Payer: BCBS Trust/PPO |
$440.55
|
| Rate for Payer: BCN Commercial |
$417.10
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$505.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$537.98
|
| Rate for Payer: Healthscope Whirlpool |
$521.84
|
| Rate for Payer: Mclaren Commercial |
$484.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: Nomi Health Commercial |
$441.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.38
|
| Rate for Payer: Priority Health Narrow Network |
$377.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.42
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.69 |
| Max. Negotiated Rate |
$537.98 |
| Rate for Payer: Aetna Commercial |
$484.18
|
| Rate for Payer: ASR ASR |
$521.84
|
| Rate for Payer: ASR Commercial |
$521.84
|
| Rate for Payer: BCBS Trust/PPO |
$438.40
|
| Rate for Payer: BCN Commercial |
$417.10
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$505.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$537.98
|
| Rate for Payer: Healthscope Whirlpool |
$521.84
|
| Rate for Payer: Mclaren Commercial |
$484.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: Nomi Health Commercial |
$441.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.42
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,717.51 |
| Max. Negotiated Rate |
$11,873.09 |
| Rate for Payer: Aetna Commercial |
$10,685.78
|
| Rate for Payer: ASR ASR |
$11,516.90
|
| Rate for Payer: ASR Commercial |
$11,516.90
|
| Rate for Payer: BCBS Trust/PPO |
$9,675.38
|
| Rate for Payer: BCN Commercial |
$9,205.21
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$11,160.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Healthscope Commercial |
$11,873.09
|
| Rate for Payer: Healthscope Whirlpool |
$11,516.90
|
| Rate for Payer: Mclaren Commercial |
$10,685.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: Nomi Health Commercial |
$9,735.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,448.32
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,495.99 |
| Max. Negotiated Rate |
$15,893.27 |
| Rate for Payer: Aetna Commercial |
$10,685.78
|
| Rate for Payer: Aetna Medicare |
$10,253.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,817.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,817.15
|
| Rate for Payer: ASR ASR |
$11,516.90
|
| Rate for Payer: ASR Commercial |
$11,516.90
|
| Rate for Payer: BCBS Complete |
$5,770.79
|
| Rate for Payer: BCBS MAPPO |
$10,253.72
|
| Rate for Payer: BCBS Trust/PPO |
$9,722.87
|
| Rate for Payer: BCN Commercial |
$9,205.21
|
| Rate for Payer: BCN Medicare Advantage |
$10,253.72
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$11,160.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,253.72
|
| Rate for Payer: Healthscope Commercial |
$11,873.09
|
| Rate for Payer: Healthscope Whirlpool |
$11,516.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,253.72
|
| Rate for Payer: Mclaren Commercial |
$10,685.78
|
| Rate for Payer: Mclaren Medicaid |
$5,495.99
|
| Rate for Payer: Mclaren Medicare |
$10,253.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,766.41
|
| Rate for Payer: Meridian Medicaid |
$5,770.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,791.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: Nomi Health Commercial |
$9,735.93
|
| Rate for Payer: PACE Medicare |
$9,741.03
|
| Rate for Payer: PACE SWMI |
$10,253.72
|
| Rate for Payer: PHP Commercial |
$11,279.09
|
| Rate for Payer: PHP Medicaid |
$5,495.99
|
| Rate for Payer: PHP Medicare Advantage |
$10,253.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,495.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,403.20
|
| Rate for Payer: Priority Health Medicare |
$10,253.72
|
| Rate for Payer: Priority Health Narrow Network |
$8,323.04
|
| Rate for Payer: Railroad Medicare Medicare |
$10,253.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,448.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,253.72
|
| Rate for Payer: UHC Exchange |
$15,893.27
|
| Rate for Payer: UHC Medicare Advantage |
$10,253.72
|
| Rate for Payer: UHCCP DNSP |
$10,253.72
|
| Rate for Payer: UHCCP Medicaid |
$5,495.99
|
| Rate for Payer: VA VA |
$10,253.72
|
|
