|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
IP
|
$2,263.31
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.89 |
| Max. Negotiated Rate |
$2,036.98 |
| Rate for Payer: Aetna Commercial |
$1,923.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,471.15
|
| Rate for Payer: Cash Price |
$1,810.65
|
| Rate for Payer: Cofinity Advantage |
$1,584.32
|
| Rate for Payer: Cofinity Commercial |
$1,946.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.65
|
| Rate for Payer: Healthscope Commercial |
$2,036.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,923.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,697.48
|
| Rate for Payer: PHP Commercial |
$1,923.81
|
| Rate for Payer: Priority Health SBD |
$1,425.89
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
OP
|
$2,263.31
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$889.48 |
| Max. Negotiated Rate |
$2,036.98 |
| Rate for Payer: Aetna Commercial |
$1,923.81
|
| Rate for Payer: Aetna Medicare |
$1,131.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,471.15
|
| Rate for Payer: BCBS Complete |
$905.32
|
| Rate for Payer: Cash Price |
$1,810.65
|
| Rate for Payer: Cofinity Advantage |
$1,584.32
|
| Rate for Payer: Cofinity Commercial |
$1,946.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.65
|
| Rate for Payer: Healthscope Commercial |
$2,036.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,810.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,923.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,697.48
|
| Rate for Payer: PHP Commercial |
$1,923.81
|
| Rate for Payer: Priority Health SBD |
$1,425.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,471.15
|
| Rate for Payer: UHC Core |
$1,179.18
|
| Rate for Payer: UHC Exchange |
$889.48
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
OP
|
$191.43
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$172.29 |
| Rate for Payer: Aetna Commercial |
$162.72
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Commercial |
$17.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$153.14
|
| Rate for Payer: Cash Price |
$153.14
|
| Rate for Payer: Cofinity Advantage |
$134.00
|
| Rate for Payer: Cofinity Commercial |
$164.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$172.29
|
| Rate for Payer: Mclaren Medicaid |
$8.81
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.72
|
| Rate for Payer: Nomi Health Commercial |
$25.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.57
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$162.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.85
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$120.60
|
| Rate for Payer: Priority Health Tiered Network |
$13.48
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.28
|
| Rate for Payer: UHC Core |
$25.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.85
|
| Rate for Payer: UHC Exchange |
$25.28
|
| Rate for Payer: UHC Medicaid |
$8.81
|
| Rate for Payer: UHCCP Medicaid |
$8.81
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
IP
|
$191.43
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$172.29 |
| Rate for Payer: Aetna Commercial |
$162.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.43
|
| Rate for Payer: Cash Price |
$153.14
|
| Rate for Payer: Cofinity Advantage |
$134.00
|
| Rate for Payer: Cofinity Commercial |
$164.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.14
|
| Rate for Payer: Healthscope Commercial |
$172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.57
|
| Rate for Payer: PHP Commercial |
$162.72
|
| Rate for Payer: Priority Health SBD |
$120.60
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$54.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$26.84
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$76.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.31
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: Priority Health Tiered Network |
$41.05
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.97
|
| Rate for Payer: UHC Core |
$76.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$76.97
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health SBD |
$167.14
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$54.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$26.84
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$76.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.31
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: Priority Health Tiered Network |
$41.05
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.97
|
| Rate for Payer: UHC Core |
$76.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$76.97
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health SBD |
$167.14
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
IP
|
$3,160.38
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.04 |
| Max. Negotiated Rate |
$2,844.34 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,054.25
|
| Rate for Payer: Cash Price |
$2,528.30
|
| Rate for Payer: Cofinity Advantage |
$2,212.27
|
| Rate for Payer: Cofinity Commercial |
$2,717.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,528.30
|
| Rate for Payer: Healthscope Commercial |
$2,844.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,686.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,370.28
|
| Rate for Payer: PHP Commercial |
$2,686.32
|
| Rate for Payer: Priority Health SBD |
$1,991.04
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
OP
|
$3,160.38
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.03 |
| Max. Negotiated Rate |
$2,844.34 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,054.25
|
| Rate for Payer: BCBS Complete |
$1,264.15
|
| Rate for Payer: Cash Price |
$2,528.30
|
| Rate for Payer: Cofinity Advantage |
$2,212.27
|
| Rate for Payer: Cofinity Commercial |
$2,717.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,528.30
|
| Rate for Payer: Healthscope Commercial |
$2,844.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,528.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,686.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,370.28
|
| Rate for Payer: PHP Commercial |
$2,686.32
|
| Rate for Payer: Priority Health SBD |
$1,991.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,054.25
|
| Rate for Payer: UHC Core |
$1,646.56
|
| Rate for Payer: UHC Exchange |
$1,242.03
|
|
|
HC ZINC LEVEL
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.14
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Advantage |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$5.96
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$11.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$17.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.23
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.39
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Priority Health Tiered Network |
$9.11
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.09
|
| Rate for Payer: UHC Core |
$17.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.39
|
| Rate for Payer: UHC Exchange |
$17.09
|
| Rate for Payer: UHC Medicaid |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC ZINC LEVEL
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Advantage |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.23
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health SBD |
$32.12
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.13
|
| Rate for Payer: BCN Commercial |
$25.13
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Advantage |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$35.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.25
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.57
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: Priority Health Tiered Network |
$18.86
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.36
|
| Rate for Payer: UHC Core |
$35.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.57
|
| Rate for Payer: UHC Exchange |
$35.36
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$289.17 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Advantage |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.25
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC ZINC URINE
|
Facility
|
IP
|
$71.37
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.96 |
| Max. Negotiated Rate |
$64.23 |
| Rate for Payer: Aetna Commercial |
$60.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.39
|
| Rate for Payer: Cash Price |
$57.10
|
| Rate for Payer: Cofinity Advantage |
$49.96
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.10
|
| Rate for Payer: Healthscope Commercial |
$64.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.53
|
| Rate for Payer: PHP Commercial |
$60.66
|
| Rate for Payer: Priority Health SBD |
$44.96
|
|
|
HC ZINC URINE
|
Facility
|
OP
|
$71.37
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$64.23 |
| Rate for Payer: Aetna Commercial |
$60.66
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.14
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$57.10
|
| Rate for Payer: Cash Price |
$57.10
|
| Rate for Payer: Cofinity Advantage |
$49.96
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$64.23
|
| Rate for Payer: Mclaren Medicaid |
$5.96
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$11.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.66
|
| Rate for Payer: Nomi Health Commercial |
$17.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.53
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$60.66
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.39
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health SBD |
$44.96
|
| Rate for Payer: Priority Health Tiered Network |
$9.11
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.09
|
| Rate for Payer: UHC Core |
$17.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.39
|
| Rate for Payer: UHC Exchange |
$17.09
|
| Rate for Payer: UHC Medicaid |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC Z INFUSION WIRE
|
Facility
|
OP
|
$892.35
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$350.69 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna Commercial |
$758.50
|
| Rate for Payer: Aetna Medicare |
$446.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.03
|
| Rate for Payer: BCBS Complete |
$356.94
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Advantage |
$624.64
|
| Rate for Payer: Cofinity Commercial |
$767.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Healthscope Commercial |
$803.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$713.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PHP Commercial |
$758.50
|
| Rate for Payer: Priority Health SBD |
$562.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.03
|
| Rate for Payer: UHC Core |
$464.91
|
| Rate for Payer: UHC Exchange |
$350.69
|
|
|
HC Z INFUSION WIRE
|
Facility
|
IP
|
$892.35
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$562.18 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna Commercial |
$758.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.03
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Advantage |
$624.64
|
| Rate for Payer: Cofinity Commercial |
$767.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Healthscope Commercial |
$803.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PHP Commercial |
$758.50
|
| Rate for Payer: Priority Health SBD |
$562.18
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
OP
|
$13,401.24
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,266.69 |
| Max. Negotiated Rate |
$12,061.12 |
| Rate for Payer: Aetna Commercial |
$11,391.05
|
| Rate for Payer: Aetna Medicare |
$6,700.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,710.81
|
| Rate for Payer: BCBS Complete |
$5,360.50
|
| Rate for Payer: Cash Price |
$10,720.99
|
| Rate for Payer: Cofinity Advantage |
$9,380.87
|
| Rate for Payer: Cofinity Commercial |
$11,525.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,720.99
|
| Rate for Payer: Healthscope Commercial |
$12,061.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,720.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,391.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,050.93
|
| Rate for Payer: PHP Commercial |
$11,391.05
|
| Rate for Payer: Priority Health SBD |
$8,442.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,710.81
|
| Rate for Payer: UHC Core |
$6,982.05
|
| Rate for Payer: UHC Exchange |
$5,266.69
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
IP
|
$13,401.24
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,442.78 |
| Max. Negotiated Rate |
$12,061.12 |
| Rate for Payer: Aetna Commercial |
$11,391.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,710.81
|
| Rate for Payer: Cash Price |
$10,720.99
|
| Rate for Payer: Cofinity Advantage |
$9,380.87
|
| Rate for Payer: Cofinity Commercial |
$11,525.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,720.99
|
| Rate for Payer: Healthscope Commercial |
$12,061.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,391.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,050.93
|
| Rate for Payer: PHP Commercial |
$11,391.05
|
| Rate for Payer: Priority Health SBD |
$8,442.78
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
IP
|
$335.84
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$302.26 |
| Rate for Payer: Aetna Commercial |
$285.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.30
|
| Rate for Payer: Cash Price |
$268.67
|
| Rate for Payer: Cofinity Advantage |
$235.09
|
| Rate for Payer: Cofinity Commercial |
$288.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.67
|
| Rate for Payer: Healthscope Commercial |
$302.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.88
|
| Rate for Payer: PHP Commercial |
$285.46
|
| Rate for Payer: Priority Health SBD |
$211.58
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
OP
|
$335.84
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.99 |
| Max. Negotiated Rate |
$302.26 |
| Rate for Payer: Aetna Commercial |
$285.46
|
| Rate for Payer: Aetna Medicare |
$167.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.30
|
| Rate for Payer: BCBS Complete |
$134.34
|
| Rate for Payer: Cash Price |
$268.67
|
| Rate for Payer: Cofinity Advantage |
$235.09
|
| Rate for Payer: Cofinity Commercial |
$288.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.67
|
| Rate for Payer: Healthscope Commercial |
$302.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.88
|
| Rate for Payer: PHP Commercial |
$285.46
|
| Rate for Payer: Priority Health SBD |
$211.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.30
|
| Rate for Payer: UHC Core |
$174.97
|
| Rate for Payer: UHC Exchange |
$131.99
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
OP
|
$3,851.00
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,513.44 |
| Max. Negotiated Rate |
$3,465.90 |
| Rate for Payer: Aetna Commercial |
$3,273.35
|
| Rate for Payer: Aetna Medicare |
$1,925.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,503.15
|
| Rate for Payer: BCBS Complete |
$1,540.40
|
| Rate for Payer: Cash Price |
$3,080.80
|
| Rate for Payer: Cofinity Advantage |
$2,695.70
|
| Rate for Payer: Cofinity Commercial |
$3,311.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,080.80
|
| Rate for Payer: Healthscope Commercial |
$3,465.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,080.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,273.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,888.25
|
| Rate for Payer: PHP Commercial |
$3,273.35
|
| Rate for Payer: Priority Health SBD |
$2,426.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,503.15
|
| Rate for Payer: UHC Core |
$2,006.37
|
| Rate for Payer: UHC Exchange |
$1,513.44
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
IP
|
$3,851.00
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,426.13 |
| Max. Negotiated Rate |
$3,465.90 |
| Rate for Payer: Aetna Commercial |
$3,273.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,503.15
|
| Rate for Payer: Cash Price |
$3,080.80
|
| Rate for Payer: Cofinity Advantage |
$2,695.70
|
| Rate for Payer: Cofinity Commercial |
$3,311.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,080.80
|
| Rate for Payer: Healthscope Commercial |
$3,465.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,273.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,888.25
|
| Rate for Payer: PHP Commercial |
$3,273.35
|
| Rate for Payer: Priority Health SBD |
$2,426.13
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$791.29
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$712.16 |
| Rate for Payer: Aetna Commercial |
$672.60
|
| Rate for Payer: Aetna Medicare |
$395.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.34
|
| Rate for Payer: BCBS Complete |
$316.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$633.03
|
| Rate for Payer: Cash Price |
$633.03
|
| Rate for Payer: Cofinity Advantage |
$553.90
|
| Rate for Payer: Cofinity Commercial |
$680.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.03
|
| Rate for Payer: Healthscope Commercial |
$712.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.47
|
| Rate for Payer: PHP Commercial |
$672.60
|
| Rate for Payer: Priority Health SBD |
$498.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.34
|
| Rate for Payer: UHC Core |
$412.26
|
| Rate for Payer: UHC Exchange |
$310.98
|
|
