|
HC Z HEMODIALYSIS ANGIODYNAMIC
|
Facility
|
OP
|
$1,199.35
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.74 |
| Max. Negotiated Rate |
$1,199.35 |
| Rate for Payer: Aetna Commercial |
$1,079.42
|
| Rate for Payer: ASR ASR |
$1,163.37
|
| Rate for Payer: BCBS Complete |
$479.74
|
| Rate for Payer: BCBS Trust/PPO |
$929.86
|
| Rate for Payer: BCN Commercial |
$929.86
|
| Rate for Payer: Cash Price |
$959.48
|
| Rate for Payer: Cofinity Commercial |
$1,127.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$959.48
|
| Rate for Payer: Healthscope Commercial |
$1,199.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,163.37
|
| Rate for Payer: Mclaren Commercial |
$1,079.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,019.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$839.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,091.41
|
| Rate for Payer: Priority Health Narrow Network |
$851.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,055.43
|
|
|
HC Z HEMODIALYSIS BARD
|
Facility
|
OP
|
$1,552.09
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.84 |
| Max. Negotiated Rate |
$1,552.09 |
| Rate for Payer: Aetna Commercial |
$1,396.88
|
| Rate for Payer: ASR ASR |
$1,505.53
|
| Rate for Payer: BCBS Complete |
$620.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.34
|
| Rate for Payer: BCN Commercial |
$1,203.34
|
| Rate for Payer: Cash Price |
$1,241.67
|
| Rate for Payer: Cofinity Commercial |
$1,458.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.67
|
| Rate for Payer: Healthscope Commercial |
$1,552.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,505.53
|
| Rate for Payer: Mclaren Commercial |
$1,396.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,319.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,412.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,101.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,365.84
|
|
|
HC Z HEMODIALYSIS BARD
|
Facility
|
IP
|
$1,552.09
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,086.46 |
| Max. Negotiated Rate |
$1,552.09 |
| Rate for Payer: Aetna Commercial |
$1,396.88
|
| Rate for Payer: ASR ASR |
$1,505.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.34
|
| Rate for Payer: BCN Commercial |
$1,203.34
|
| Rate for Payer: Cash Price |
$1,241.67
|
| Rate for Payer: Cofinity Commercial |
$1,458.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.67
|
| Rate for Payer: Healthscope Commercial |
$1,552.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,505.53
|
| Rate for Payer: Mclaren Commercial |
$1,396.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,319.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,365.84
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
OP
|
$2,175.42
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.17 |
| Max. Negotiated Rate |
$2,175.42 |
| Rate for Payer: Aetna Commercial |
$1,957.88
|
| Rate for Payer: ASR ASR |
$2,110.16
|
| Rate for Payer: BCBS Complete |
$870.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,686.60
|
| Rate for Payer: BCN Commercial |
$1,686.60
|
| Rate for Payer: Cash Price |
$1,740.34
|
| Rate for Payer: Cofinity Commercial |
$2,044.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.34
|
| Rate for Payer: Healthscope Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,110.16
|
| Rate for Payer: Mclaren Commercial |
$1,957.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,849.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,979.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,914.37
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
IP
|
$2,175.42
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,522.79 |
| Max. Negotiated Rate |
$2,175.42 |
| Rate for Payer: Aetna Commercial |
$1,957.88
|
| Rate for Payer: ASR ASR |
$2,110.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,686.60
|
| Rate for Payer: BCN Commercial |
$1,686.60
|
| Rate for Payer: Cash Price |
$1,740.34
|
| Rate for Payer: Cofinity Commercial |
$2,044.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.34
|
| Rate for Payer: Healthscope Commercial |
$2,175.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,110.16
|
| Rate for Payer: Mclaren Commercial |
$1,957.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,849.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,914.37
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: ASR ASR |
$178.48
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCN Commercial |
$142.66
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Healthscope Whirlpool |
$178.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$165.60
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Medicaid |
$9.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: PHP Medicaid |
$9.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$15.61
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.92
|
| Rate for Payer: UHC Medicare Advantage |
$17.36
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: ASR ASR |
$178.48
|
| Rate for Payer: BCBS Trust/PPO |
$142.66
|
| Rate for Payer: BCN Commercial |
$142.66
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$172.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Healthscope Whirlpool |
$178.48
|
| Rate for Payer: Mclaren Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.92
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$28.07
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Medicaid |
$29.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: PHP Medicaid |
$28.07
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.32
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$60.26
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$28.07
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Medicaid |
$29.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: PHP Medicaid |
$28.07
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.32
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$60.26
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
OP
|
$3,037.66
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.06 |
| Max. Negotiated Rate |
$3,037.66 |
| Rate for Payer: Aetna Commercial |
$2,733.89
|
| Rate for Payer: ASR ASR |
$2,946.53
|
| Rate for Payer: BCBS Complete |
$1,215.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,355.10
|
| Rate for Payer: BCN Commercial |
$2,355.10
|
| Rate for Payer: Cash Price |
$2,430.13
|
| Rate for Payer: Cofinity Commercial |
$2,855.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.13
|
| Rate for Payer: Healthscope Commercial |
$3,037.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,946.53
|
| Rate for Payer: Mclaren Commercial |
$2,733.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,582.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,764.27
|
| Rate for Payer: Priority Health Narrow Network |
$2,156.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,673.14
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
IP
|
$3,037.66
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.36 |
| Max. Negotiated Rate |
$3,037.66 |
| Rate for Payer: Aetna Commercial |
$2,733.89
|
| Rate for Payer: ASR ASR |
$2,946.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,355.10
|
| Rate for Payer: BCN Commercial |
$2,355.10
|
| Rate for Payer: Cash Price |
$2,430.13
|
| Rate for Payer: Cofinity Commercial |
$2,855.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,430.13
|
| Rate for Payer: Healthscope Commercial |
$3,037.66
|
| Rate for Payer: Healthscope Whirlpool |
$2,946.53
|
| Rate for Payer: Mclaren Commercial |
$2,733.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,582.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,673.14
|
|
|
HC ZINC LEVEL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: ASR ASR |
$47.53
|
| Rate for Payer: BCBS Trust/PPO |
$37.99
|
| Rate for Payer: BCN Commercial |
$37.99
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Healthscope Commercial |
$49.00
|
| Rate for Payer: Healthscope Whirlpool |
$47.53
|
| Rate for Payer: Mclaren Commercial |
$44.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.12
|
|
|
HC ZINC LEVEL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: ASR ASR |
$47.53
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$37.99
|
| Rate for Payer: BCN Commercial |
$37.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$49.00
|
| Rate for Payer: Healthscope Whirlpool |
$47.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.39
|
| Rate for Payer: Mclaren Commercial |
$44.10
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.65
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$12.53
|
| Rate for Payer: PHP Medicaid |
$6.23
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.24
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$38.59
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.73
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC ZINC URINE
|
Facility
|
OP
|
$68.60
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: Aetna Commercial |
$61.74
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: ASR ASR |
$66.54
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.19
|
| Rate for Payer: BCN Commercial |
$53.19
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cofinity Commercial |
$64.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$68.60
|
| Rate for Payer: Healthscope Whirlpool |
$66.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.39
|
| Rate for Payer: Mclaren Commercial |
$61.74
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.31
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$12.53
|
| Rate for Payer: PHP Medicaid |
$6.23
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.24
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$38.59
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.37
|
| Rate for Payer: UHC Medicare Advantage |
$11.73
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC ZINC URINE
|
Facility
|
IP
|
$68.60
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: Aetna Commercial |
$61.74
|
| Rate for Payer: ASR ASR |
$66.54
|
| Rate for Payer: BCBS Trust/PPO |
$53.19
|
| Rate for Payer: BCN Commercial |
$53.19
|
| Rate for Payer: Cash Price |
$54.88
|
| Rate for Payer: Cofinity Commercial |
$64.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.88
|
| Rate for Payer: Healthscope Commercial |
$68.60
|
| Rate for Payer: Healthscope Whirlpool |
$66.54
|
| Rate for Payer: Mclaren Commercial |
$61.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.37
|
|
|
HC Z INFUSION WIRE
|
Facility
|
OP
|
$857.70
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$343.08 |
| Max. Negotiated Rate |
$857.70 |
| Rate for Payer: Aetna Commercial |
$771.93
|
| Rate for Payer: ASR ASR |
$831.97
|
| Rate for Payer: BCBS Complete |
$343.08
|
| Rate for Payer: BCBS Trust/PPO |
$664.97
|
| Rate for Payer: BCN Commercial |
$664.97
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$806.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Healthscope Commercial |
$857.70
|
| Rate for Payer: Healthscope Whirlpool |
$831.97
|
| Rate for Payer: Mclaren Commercial |
$771.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$780.51
|
| Rate for Payer: Priority Health Narrow Network |
$608.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.78
|
|
|
HC Z INFUSION WIRE
|
Facility
|
IP
|
$857.70
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$600.39 |
| Max. Negotiated Rate |
$857.70 |
| Rate for Payer: Aetna Commercial |
$771.93
|
| Rate for Payer: ASR ASR |
$831.97
|
| Rate for Payer: BCBS Trust/PPO |
$664.97
|
| Rate for Payer: BCN Commercial |
$664.97
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$806.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Healthscope Commercial |
$857.70
|
| Rate for Payer: Healthscope Whirlpool |
$831.97
|
| Rate for Payer: Mclaren Commercial |
$771.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$754.78
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
OP
|
$12,880.85
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,152.34 |
| Max. Negotiated Rate |
$12,880.85 |
| Rate for Payer: Aetna Commercial |
$11,592.76
|
| Rate for Payer: ASR ASR |
$12,494.42
|
| Rate for Payer: BCBS Complete |
$5,152.34
|
| Rate for Payer: BCBS Trust/PPO |
$9,986.52
|
| Rate for Payer: BCN Commercial |
$9,986.52
|
| Rate for Payer: Cash Price |
$10,304.68
|
| Rate for Payer: Cofinity Commercial |
$12,108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,304.68
|
| Rate for Payer: Healthscope Commercial |
$12,880.85
|
| Rate for Payer: Healthscope Whirlpool |
$12,494.42
|
| Rate for Payer: Mclaren Commercial |
$11,592.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,721.57
|
| Rate for Payer: Priority Health Narrow Network |
$9,145.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,335.15
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
IP
|
$12,880.85
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,016.60 |
| Max. Negotiated Rate |
$12,880.85 |
| Rate for Payer: Aetna Commercial |
$11,592.76
|
| Rate for Payer: ASR ASR |
$12,494.42
|
| Rate for Payer: BCBS Trust/PPO |
$9,986.52
|
| Rate for Payer: BCN Commercial |
$9,986.52
|
| Rate for Payer: Cash Price |
$10,304.68
|
| Rate for Payer: Cofinity Commercial |
$12,108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,304.68
|
| Rate for Payer: Healthscope Commercial |
$12,880.85
|
| Rate for Payer: Healthscope Whirlpool |
$12,494.42
|
| Rate for Payer: Mclaren Commercial |
$11,592.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,948.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,016.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,335.15
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
IP
|
$322.79
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.95 |
| Max. Negotiated Rate |
$322.79 |
| Rate for Payer: Aetna Commercial |
$290.51
|
| Rate for Payer: ASR ASR |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$250.26
|
| Rate for Payer: BCN Commercial |
$250.26
|
| Rate for Payer: Cash Price |
$258.23
|
| Rate for Payer: Cofinity Commercial |
$303.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.23
|
| Rate for Payer: Healthscope Commercial |
$322.79
|
| Rate for Payer: Healthscope Whirlpool |
$313.11
|
| Rate for Payer: Mclaren Commercial |
$290.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.06
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
OP
|
$322.79
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.12 |
| Max. Negotiated Rate |
$322.79 |
| Rate for Payer: Aetna Commercial |
$290.51
|
| Rate for Payer: ASR ASR |
$313.11
|
| Rate for Payer: BCBS Complete |
$129.12
|
| Rate for Payer: BCBS Trust/PPO |
$250.26
|
| Rate for Payer: BCN Commercial |
$250.26
|
| Rate for Payer: Cash Price |
$258.23
|
| Rate for Payer: Cofinity Commercial |
$303.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.23
|
| Rate for Payer: Healthscope Commercial |
$322.79
|
| Rate for Payer: Healthscope Whirlpool |
$313.11
|
| Rate for Payer: Mclaren Commercial |
$290.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.74
|
| Rate for Payer: Priority Health Narrow Network |
$229.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.06
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
OP
|
$3,701.46
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,480.58 |
| Max. Negotiated Rate |
$3,701.46 |
| Rate for Payer: Aetna Commercial |
$3,331.31
|
| Rate for Payer: ASR ASR |
$3,590.42
|
| Rate for Payer: BCBS Complete |
$1,480.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,869.74
|
| Rate for Payer: BCN Commercial |
$2,869.74
|
| Rate for Payer: Cash Price |
$2,961.17
|
| Rate for Payer: Cofinity Commercial |
$3,479.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,961.17
|
| Rate for Payer: Healthscope Commercial |
$3,701.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,590.42
|
| Rate for Payer: Mclaren Commercial |
$3,331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,146.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,591.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,368.33
|
| Rate for Payer: Priority Health Narrow Network |
$2,628.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,257.28
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
IP
|
$3,701.46
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,591.02 |
| Max. Negotiated Rate |
$3,701.46 |
| Rate for Payer: Aetna Commercial |
$3,331.31
|
| Rate for Payer: ASR ASR |
$3,590.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,869.74
|
| Rate for Payer: BCN Commercial |
$2,869.74
|
| Rate for Payer: Cash Price |
$2,961.17
|
| Rate for Payer: Cofinity Commercial |
$3,479.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,961.17
|
| Rate for Payer: Healthscope Commercial |
$3,701.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,590.42
|
| Rate for Payer: Mclaren Commercial |
$3,331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,146.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,591.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,257.28
|
|
