|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$760.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.22 |
| Max. Negotiated Rate |
$760.56 |
| Rate for Payer: Aetna Commercial |
$684.50
|
| Rate for Payer: ASR ASR |
$737.74
|
| Rate for Payer: BCBS Complete |
$304.22
|
| Rate for Payer: BCBS Trust/PPO |
$589.66
|
| Rate for Payer: BCN Commercial |
$589.66
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cofinity Commercial |
$714.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.45
|
| Rate for Payer: Healthscope Commercial |
$760.56
|
| Rate for Payer: Healthscope Whirlpool |
$737.74
|
| Rate for Payer: Mclaren Commercial |
$684.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$692.11
|
| Rate for Payer: Priority Health Narrow Network |
$540.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$669.29
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$760.56
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.39 |
| Max. Negotiated Rate |
$760.56 |
| Rate for Payer: Aetna Commercial |
$684.50
|
| Rate for Payer: ASR ASR |
$737.74
|
| Rate for Payer: BCBS Trust/PPO |
$589.66
|
| Rate for Payer: BCN Commercial |
$589.66
|
| Rate for Payer: Cash Price |
$608.45
|
| Rate for Payer: Cofinity Commercial |
$714.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.45
|
| Rate for Payer: Healthscope Commercial |
$760.56
|
| Rate for Payer: Healthscope Whirlpool |
$737.74
|
| Rate for Payer: Mclaren Commercial |
$684.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$669.29
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC ZONISAMIDE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.58
|
| Rate for Payer: PHP Medicaid |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.36
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$15.49
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.95 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: ASR ASR |
$166.22
|
| Rate for Payer: BCBS Trust/PPO |
$132.86
|
| Rate for Payer: BCN Commercial |
$132.86
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$171.36
|
| Rate for Payer: Healthscope Whirlpool |
$166.22
|
| Rate for Payer: Mclaren Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.80
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.54 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: ASR ASR |
$166.22
|
| Rate for Payer: BCBS Complete |
$68.54
|
| Rate for Payer: BCBS Trust/PPO |
$132.86
|
| Rate for Payer: BCN Commercial |
$132.86
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$161.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$171.36
|
| Rate for Payer: Healthscope Whirlpool |
$166.22
|
| Rate for Payer: Mclaren Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.94
|
| Rate for Payer: Priority Health Narrow Network |
$121.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.80
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,306.70
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.69 |
| Max. Negotiated Rate |
$1,306.70 |
| Rate for Payer: Aetna Commercial |
$1,176.03
|
| Rate for Payer: ASR ASR |
$1,267.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.08
|
| Rate for Payer: BCN Commercial |
$1,013.08
|
| Rate for Payer: Cash Price |
$1,045.36
|
| Rate for Payer: Cofinity Commercial |
$1,228.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.36
|
| Rate for Payer: Healthscope Commercial |
$1,306.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,267.50
|
| Rate for Payer: Mclaren Commercial |
$1,176.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,110.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.90
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,306.70
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.68 |
| Max. Negotiated Rate |
$1,306.70 |
| Rate for Payer: Aetna Commercial |
$1,176.03
|
| Rate for Payer: ASR ASR |
$1,267.50
|
| Rate for Payer: BCBS Complete |
$522.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.08
|
| Rate for Payer: BCN Commercial |
$1,013.08
|
| Rate for Payer: Cash Price |
$1,045.36
|
| Rate for Payer: Cofinity Commercial |
$1,228.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,045.36
|
| Rate for Payer: Healthscope Commercial |
$1,306.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,267.50
|
| Rate for Payer: Mclaren Commercial |
$1,176.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,110.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.10
|
| Rate for Payer: Priority Health Narrow Network |
$927.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,149.90
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,189.08
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$832.36 |
| Max. Negotiated Rate |
$1,189.08 |
| Rate for Payer: Aetna Commercial |
$1,070.17
|
| Rate for Payer: ASR ASR |
$1,153.41
|
| Rate for Payer: BCBS Trust/PPO |
$921.89
|
| Rate for Payer: BCN Commercial |
$921.89
|
| Rate for Payer: Cash Price |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$1,117.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.26
|
| Rate for Payer: Healthscope Commercial |
$1,189.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,153.41
|
| Rate for Payer: Mclaren Commercial |
$1,070.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.39
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,189.08
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.63 |
| Max. Negotiated Rate |
$1,189.08 |
| Rate for Payer: Aetna Commercial |
$1,070.17
|
| Rate for Payer: ASR ASR |
$1,153.41
|
| Rate for Payer: BCBS Complete |
$475.63
|
| Rate for Payer: BCBS Trust/PPO |
$921.89
|
| Rate for Payer: BCN Commercial |
$921.89
|
| Rate for Payer: Cash Price |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$1,117.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$951.26
|
| Rate for Payer: Healthscope Commercial |
$1,189.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,153.41
|
| Rate for Payer: Mclaren Commercial |
$1,070.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,082.06
|
| Rate for Payer: Priority Health Narrow Network |
$844.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,046.39
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$1,722.49
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.00 |
| Max. Negotiated Rate |
$1,722.49 |
| Rate for Payer: Aetna Commercial |
$1,550.24
|
| Rate for Payer: ASR ASR |
$1,670.82
|
| Rate for Payer: BCBS Complete |
$689.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.45
|
| Rate for Payer: BCN Commercial |
$1,335.45
|
| Rate for Payer: Cash Price |
$1,377.99
|
| Rate for Payer: Cofinity Commercial |
$1,619.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.99
|
| Rate for Payer: Healthscope Commercial |
$1,722.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,670.82
|
| Rate for Payer: Mclaren Commercial |
$1,550.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,567.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,222.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,515.79
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$1,722.49
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,205.74 |
| Max. Negotiated Rate |
$1,722.49 |
| Rate for Payer: Aetna Commercial |
$1,550.24
|
| Rate for Payer: ASR ASR |
$1,670.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.45
|
| Rate for Payer: BCN Commercial |
$1,335.45
|
| Rate for Payer: Cash Price |
$1,377.99
|
| Rate for Payer: Cofinity Commercial |
$1,619.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.99
|
| Rate for Payer: Healthscope Commercial |
$1,722.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,670.82
|
| Rate for Payer: Mclaren Commercial |
$1,550.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,515.79
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
OP
|
$633.62
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.45 |
| Max. Negotiated Rate |
$633.62 |
| Rate for Payer: Aetna Commercial |
$570.26
|
| Rate for Payer: ASR ASR |
$614.61
|
| Rate for Payer: BCBS Complete |
$253.45
|
| Rate for Payer: BCBS Trust/PPO |
$491.25
|
| Rate for Payer: BCN Commercial |
$491.25
|
| Rate for Payer: Cash Price |
$506.90
|
| Rate for Payer: Cofinity Commercial |
$595.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.90
|
| Rate for Payer: Healthscope Commercial |
$633.62
|
| Rate for Payer: Healthscope Whirlpool |
$614.61
|
| Rate for Payer: Mclaren Commercial |
$570.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.59
|
| Rate for Payer: Priority Health Narrow Network |
$449.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$557.59
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
IP
|
$633.62
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.53 |
| Max. Negotiated Rate |
$633.62 |
| Rate for Payer: Aetna Commercial |
$570.26
|
| Rate for Payer: ASR ASR |
$614.61
|
| Rate for Payer: BCBS Trust/PPO |
$491.25
|
| Rate for Payer: BCN Commercial |
$491.25
|
| Rate for Payer: Cash Price |
$506.90
|
| Rate for Payer: Cofinity Commercial |
$595.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.90
|
| Rate for Payer: Healthscope Commercial |
$633.62
|
| Rate for Payer: Healthscope Whirlpool |
$614.61
|
| Rate for Payer: Mclaren Commercial |
$570.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$557.59
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
OP
|
$1,000.88
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.35 |
| Max. Negotiated Rate |
$1,000.88 |
| Rate for Payer: Aetna Commercial |
$900.79
|
| Rate for Payer: ASR ASR |
$970.85
|
| Rate for Payer: BCBS Complete |
$400.35
|
| Rate for Payer: BCBS Trust/PPO |
$775.98
|
| Rate for Payer: BCN Commercial |
$775.98
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cofinity Commercial |
$940.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.70
|
| Rate for Payer: Healthscope Commercial |
$1,000.88
|
| Rate for Payer: Healthscope Whirlpool |
$970.85
|
| Rate for Payer: Mclaren Commercial |
$900.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$910.80
|
| Rate for Payer: Priority Health Narrow Network |
$710.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.77
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
IP
|
$1,000.88
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.62 |
| Max. Negotiated Rate |
$1,000.88 |
| Rate for Payer: Aetna Commercial |
$900.79
|
| Rate for Payer: ASR ASR |
$970.85
|
| Rate for Payer: BCBS Trust/PPO |
$775.98
|
| Rate for Payer: BCN Commercial |
$775.98
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cofinity Commercial |
$940.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.70
|
| Rate for Payer: Healthscope Commercial |
$1,000.88
|
| Rate for Payer: Healthscope Whirlpool |
$970.85
|
| Rate for Payer: Mclaren Commercial |
$900.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.77
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
IP
|
$5,756.21
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.35 |
| Max. Negotiated Rate |
$5,756.21 |
| Rate for Payer: Aetna Commercial |
$5,180.59
|
| Rate for Payer: ASR ASR |
$5,583.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,462.79
|
| Rate for Payer: BCN Commercial |
$4,462.79
|
| Rate for Payer: Cash Price |
$4,604.97
|
| Rate for Payer: Cofinity Commercial |
$5,410.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,604.97
|
| Rate for Payer: Healthscope Commercial |
$5,756.21
|
| Rate for Payer: Healthscope Whirlpool |
$5,583.52
|
| Rate for Payer: Mclaren Commercial |
$5,180.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,892.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,029.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,065.46
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
OP
|
$5,756.21
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.48 |
| Max. Negotiated Rate |
$5,756.21 |
| Rate for Payer: Aetna Commercial |
$5,180.59
|
| Rate for Payer: ASR ASR |
$5,583.52
|
| Rate for Payer: BCBS Complete |
$2,302.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,462.79
|
| Rate for Payer: BCN Commercial |
$4,462.79
|
| Rate for Payer: Cash Price |
$4,604.97
|
| Rate for Payer: Cofinity Commercial |
$5,410.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,604.97
|
| Rate for Payer: Healthscope Commercial |
$5,756.21
|
| Rate for Payer: Healthscope Whirlpool |
$5,583.52
|
| Rate for Payer: Mclaren Commercial |
$5,180.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,892.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,029.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,238.15
|
| Rate for Payer: Priority Health Narrow Network |
$4,086.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,065.46
|
|
|
HC Z ZILVER STENT
|
Facility
|
IP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,048.03 |
| Max. Negotiated Rate |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,483.48
|
| Rate for Payer: BCN Commercial |
$4,483.48
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$5,435.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,782.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,609.41
|
| Rate for Payer: Mclaren Commercial |
$5,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
|
HC Z ZILVER STENT
|
Facility
|
OP
|
$5,782.90
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,313.16 |
| Max. Negotiated Rate |
$5,782.90 |
| Rate for Payer: Aetna Commercial |
$5,204.61
|
| Rate for Payer: ASR ASR |
$5,609.41
|
| Rate for Payer: BCBS Complete |
$2,313.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,483.48
|
| Rate for Payer: BCN Commercial |
$4,483.48
|
| Rate for Payer: Cash Price |
$4,626.32
|
| Rate for Payer: Cofinity Commercial |
$5,435.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,626.32
|
| Rate for Payer: Healthscope Commercial |
$5,782.90
|
| Rate for Payer: Healthscope Whirlpool |
$5,609.41
|
| Rate for Payer: Mclaren Commercial |
$5,204.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,262.44
|
| Rate for Payer: Priority Health Narrow Network |
$4,105.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,088.95
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$15,492.74
|
|
|
Service Code
|
MS-DRG 102
|
| Min. Negotiated Rate |
$11,301.67 |
| Max. Negotiated Rate |
$15,492.74 |
| Rate for Payer: Aetna Medicare |
$11,896.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,870.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,870.61
|
| Rate for Payer: BCBS MAPPO |
$11,896.49
|
| Rate for Payer: BCN Medicare Advantage |
$11,896.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,896.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,896.49
|
| Rate for Payer: Mclaren Medicare |
$11,896.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,491.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,680.96
|
| Rate for Payer: PACE Medicare |
$11,301.67
|
| Rate for Payer: PACE SWMI |
$11,896.49
|
| Rate for Payer: PHP Commercial |
$13,086.14
|
| Rate for Payer: PHP Medicare Advantage |
$11,896.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,492.74
|
| Rate for Payer: Priority Health Medicare |
$11,896.49
|
| Rate for Payer: Priority Health Narrow Network |
$12,394.19
|
| Rate for Payer: Railroad Medicare Medicare |
$11,896.49
|
| Rate for Payer: UHC Medicare Advantage |
$12,253.38
|
| Rate for Payer: VA VA |
$11,896.49
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$11,016.29
|
|
|
Service Code
|
MS-DRG 103
|
| Min. Negotiated Rate |
$8,372.38 |
| Max. Negotiated Rate |
$11,016.29 |
| Rate for Payer: Aetna Medicare |
$8,813.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,016.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,016.29
|
| Rate for Payer: BCBS MAPPO |
$8,813.03
|
| Rate for Payer: BCN Medicare Advantage |
$8,813.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,813.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,813.03
|
| Rate for Payer: Mclaren Medicare |
$8,813.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,253.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,134.98
|
| Rate for Payer: PACE Medicare |
$8,372.38
|
| Rate for Payer: PACE SWMI |
$8,813.03
|
| Rate for Payer: PHP Commercial |
$9,694.33
|
| Rate for Payer: PHP Medicare Advantage |
$8,813.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,816.42
|
| Rate for Payer: Priority Health Medicare |
$8,813.03
|
| Rate for Payer: Priority Health Narrow Network |
$8,653.14
|
| Rate for Payer: Railroad Medicare Medicare |
$8,813.03
|
| Rate for Payer: UHC Medicare Advantage |
$9,077.42
|
| Rate for Payer: VA VA |
$8,813.03
|
|
|
HEART FAILURE AND SHOCK WITH CC
|
Facility
|
IP
|
$11,165.51
|
|
|
Service Code
|
MS-DRG 292
|
| Min. Negotiated Rate |
$8,485.79 |
| Max. Negotiated Rate |
$11,165.51 |
| Rate for Payer: Aetna Medicare |
$8,932.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,165.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,165.51
|
| Rate for Payer: BCBS MAPPO |
$8,932.41
|
| Rate for Payer: BCN Medicare Advantage |
$8,932.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,932.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,932.41
|
| Rate for Payer: Mclaren Medicare |
$8,932.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,379.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,272.27
|
| Rate for Payer: PACE Medicare |
$8,485.79
|
| Rate for Payer: PACE SWMI |
$8,932.41
|
| Rate for Payer: PHP Commercial |
$9,825.65
|
| Rate for Payer: PHP Medicare Advantage |
$8,932.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,997.46
|
| Rate for Payer: Priority Health Medicare |
$8,932.41
|
| Rate for Payer: Priority Health Narrow Network |
$8,797.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8,932.41
|
| Rate for Payer: UHC Medicare Advantage |
$9,200.38
|
| Rate for Payer: VA VA |
$8,932.41
|
|
|
HEART FAILURE AND SHOCK WITH MCC
|
Facility
|
IP
|
$16,485.28
|
|
|
Service Code
|
MS-DRG 291
|
| Min. Negotiated Rate |
$11,923.39 |
| Max. Negotiated Rate |
$16,485.28 |
| Rate for Payer: Aetna Medicare |
$12,550.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,688.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,688.68
|
| Rate for Payer: BCBS MAPPO |
$12,550.94
|
| Rate for Payer: BCN Medicare Advantage |
$12,550.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,550.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,550.94
|
| Rate for Payer: Mclaren Medicare |
$12,550.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,178.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,433.58
|
| Rate for Payer: PACE Medicare |
$11,923.39
|
| Rate for Payer: PACE SWMI |
$12,550.94
|
| Rate for Payer: PHP Commercial |
$13,806.03
|
| Rate for Payer: PHP Medicare Advantage |
$12,550.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,485.28
|
| Rate for Payer: Priority Health Medicare |
$12,550.94
|
| Rate for Payer: Priority Health Narrow Network |
$13,188.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12,550.94
|
| Rate for Payer: UHC Medicare Advantage |
$12,927.47
|
| Rate for Payer: VA VA |
$12,550.94
|
|
|
HEART FAILURE AND SHOCK WITHOUT CC/MCC
|
Facility
|
IP
|
$8,043.54
|
|
|
Service Code
|
MS-DRG 293
|
| Min. Negotiated Rate |
$5,767.73 |
| Max. Negotiated Rate |
$8,043.54 |
| Rate for Payer: Aetna Medicare |
$6,434.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,043.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,043.54
|
| Rate for Payer: BCBS MAPPO |
$6,434.83
|
| Rate for Payer: BCN Medicare Advantage |
$6,434.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,434.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,434.83
|
| Rate for Payer: Mclaren Medicare |
$6,434.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,756.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,400.05
|
| Rate for Payer: PACE Medicare |
$6,113.09
|
| Rate for Payer: PACE SWMI |
$6,434.83
|
| Rate for Payer: PHP Commercial |
$7,078.31
|
| Rate for Payer: PHP Medicare Advantage |
$6,434.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,209.66
|
| Rate for Payer: Priority Health Medicare |
$6,434.83
|
| Rate for Payer: Priority Health Narrow Network |
$5,767.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6,434.83
|
| Rate for Payer: UHC Medicare Advantage |
$6,627.87
|
| Rate for Payer: VA VA |
$6,434.83
|
|
