|
HC Z ARTHROCENTESIS SMALL JOINT BIL
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
36100023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC ZB002 CX ID GI PANEL 12-25 TARGETS
|
Facility
|
IP
|
$692.70
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
30600280
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$450.25 |
| Max. Negotiated Rate |
$692.70 |
| Rate for Payer: Aetna Commercial |
$623.43
|
| Rate for Payer: ASR ASR |
$671.92
|
| Rate for Payer: ASR Commercial |
$671.92
|
| Rate for Payer: BCBS Trust/PPO |
$564.48
|
| Rate for Payer: BCN Commercial |
$537.05
|
| Rate for Payer: Cash Price |
$554.16
|
| Rate for Payer: Cofinity Commercial |
$651.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.16
|
| Rate for Payer: Healthscope Commercial |
$692.70
|
| Rate for Payer: Healthscope Whirlpool |
$671.92
|
| Rate for Payer: Mclaren Commercial |
$623.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.79
|
| Rate for Payer: Nomi Health Commercial |
$568.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$609.58
|
|
|
HC ZB002 CX ID GI PANEL 12-25 TARGETS
|
Facility
|
OP
|
$692.70
|
|
|
Service Code
|
CPT 87507
|
| Hospital Charge Code |
30600280
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$692.70 |
| Rate for Payer: Aetna Commercial |
$623.43
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$671.92
|
| Rate for Payer: ASR Commercial |
$671.92
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$567.25
|
| Rate for Payer: BCN Commercial |
$537.05
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$554.16
|
| Rate for Payer: Cash Price |
$554.16
|
| Rate for Payer: Cofinity Commercial |
$651.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$692.70
|
| Rate for Payer: Healthscope Whirlpool |
$671.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$623.43
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.79
|
| Rate for Payer: Nomi Health Commercial |
$568.01
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$223.39
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.94
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$485.58
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$609.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$646.01
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP DNSP |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$223.39
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC ZB5CG RESPIRATORY VIRAL PANEL 12-25 TARGETS
|
Facility
|
OP
|
$622.69
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
30600205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$646.01 |
| Rate for Payer: Aetna Commercial |
$560.42
|
| Rate for Payer: Aetna Medicare |
$416.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: ASR ASR |
$604.01
|
| Rate for Payer: ASR Commercial |
$604.01
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$509.92
|
| Rate for Payer: BCN Commercial |
$482.77
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cofinity Commercial |
$585.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$622.69
|
| Rate for Payer: Healthscope Whirlpool |
$604.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$416.78
|
| Rate for Payer: Mclaren Commercial |
$560.42
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.29
|
| Rate for Payer: Nomi Health Commercial |
$510.61
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$458.46
|
| Rate for Payer: PHP Medicaid |
$223.39
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.60
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health Narrow Network |
$436.51
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Exchange |
$646.01
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP DNSP |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$223.39
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC ZB5CG RESPIRATORY VIRAL PANEL 12-25 TARGETS
|
Facility
|
IP
|
$622.69
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
30600205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$404.75 |
| Max. Negotiated Rate |
$622.69 |
| Rate for Payer: Aetna Commercial |
$560.42
|
| Rate for Payer: ASR ASR |
$604.01
|
| Rate for Payer: ASR Commercial |
$604.01
|
| Rate for Payer: BCBS Trust/PPO |
$507.43
|
| Rate for Payer: BCN Commercial |
$482.77
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cofinity Commercial |
$585.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.15
|
| Rate for Payer: Healthscope Commercial |
$622.69
|
| Rate for Payer: Healthscope Whirlpool |
$604.01
|
| Rate for Payer: Mclaren Commercial |
$560.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.29
|
| Rate for Payer: Nomi Health Commercial |
$510.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$547.97
|
|
|
HC ZB774 FACTOR II (2) & FACTOR V LEIDEN MUTATION
|
Facility
|
OP
|
$110.28
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
30100514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna Commercial |
$99.25
|
| Rate for Payer: Aetna Medicare |
$65.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.11
|
| Rate for Payer: ASR ASR |
$106.97
|
| Rate for Payer: ASR Commercial |
$106.97
|
| Rate for Payer: BCBS Complete |
$36.97
|
| Rate for Payer: BCBS MAPPO |
$65.69
|
| Rate for Payer: BCBS Trust/PPO |
$90.31
|
| Rate for Payer: BCN Commercial |
$85.50
|
| Rate for Payer: BCN Medicare Advantage |
$65.69
|
| Rate for Payer: Cash Price |
$88.22
|
| Rate for Payer: Cash Price |
$88.22
|
| Rate for Payer: Cofinity Commercial |
$103.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.69
|
| Rate for Payer: Healthscope Commercial |
$110.28
|
| Rate for Payer: Healthscope Whirlpool |
$106.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$65.69
|
| Rate for Payer: Mclaren Commercial |
$99.25
|
| Rate for Payer: Mclaren Medicaid |
$35.21
|
| Rate for Payer: Mclaren Medicare |
$65.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.97
|
| Rate for Payer: Meridian Medicaid |
$36.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.74
|
| Rate for Payer: Nomi Health Commercial |
$90.43
|
| Rate for Payer: PACE Medicare |
$62.41
|
| Rate for Payer: PACE SWMI |
$65.69
|
| Rate for Payer: PHP Commercial |
$72.26
|
| Rate for Payer: PHP Medicaid |
$35.21
|
| Rate for Payer: PHP Medicare Advantage |
$65.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.63
|
| Rate for Payer: Priority Health Medicare |
$65.69
|
| Rate for Payer: Priority Health Narrow Network |
$77.31
|
| Rate for Payer: Railroad Medicare Medicare |
$65.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.69
|
| Rate for Payer: UHC Exchange |
$101.82
|
| Rate for Payer: UHC Medicare Advantage |
$65.69
|
| Rate for Payer: UHCCP DNSP |
$65.69
|
| Rate for Payer: UHCCP Medicaid |
$35.21
|
| Rate for Payer: VA VA |
$65.69
|
|
|
HC ZB774 FACTOR II (2) & FACTOR V LEIDEN MUTATION
|
Facility
|
IP
|
$110.28
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
30100514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna Commercial |
$99.25
|
| Rate for Payer: ASR ASR |
$106.97
|
| Rate for Payer: ASR Commercial |
$106.97
|
| Rate for Payer: BCBS Trust/PPO |
$89.87
|
| Rate for Payer: BCN Commercial |
$85.50
|
| Rate for Payer: Cash Price |
$88.22
|
| Rate for Payer: Cofinity Commercial |
$103.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.22
|
| Rate for Payer: Healthscope Commercial |
$110.28
|
| Rate for Payer: Healthscope Whirlpool |
$106.97
|
| Rate for Payer: Mclaren Commercial |
$99.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.74
|
| Rate for Payer: Nomi Health Commercial |
$90.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.05
|
|
|
HC ZB774 FACTOR II (2) & FACTOR V LEIDEN MUTATION CMPT
|
Facility
|
IP
|
$120.02
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
30100515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.01 |
| Max. Negotiated Rate |
$120.02 |
| Rate for Payer: Aetna Commercial |
$108.02
|
| Rate for Payer: ASR ASR |
$116.42
|
| Rate for Payer: ASR Commercial |
$116.42
|
| Rate for Payer: BCBS Trust/PPO |
$97.80
|
| Rate for Payer: BCN Commercial |
$93.05
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$112.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Healthscope Commercial |
$120.02
|
| Rate for Payer: Healthscope Whirlpool |
$116.42
|
| Rate for Payer: Mclaren Commercial |
$108.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.02
|
| Rate for Payer: Nomi Health Commercial |
$98.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.62
|
|
|
HC ZB774 FACTOR II (2) & FACTOR V LEIDEN MUTATION CMPT
|
Facility
|
OP
|
$120.02
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
30100515
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$120.02 |
| Rate for Payer: Aetna Commercial |
$108.02
|
| Rate for Payer: Aetna Medicare |
$73.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.71
|
| Rate for Payer: ASR ASR |
$116.42
|
| Rate for Payer: ASR Commercial |
$116.42
|
| Rate for Payer: BCBS Complete |
$41.29
|
| Rate for Payer: BCBS MAPPO |
$73.37
|
| Rate for Payer: BCBS Trust/PPO |
$98.28
|
| Rate for Payer: BCN Commercial |
$93.05
|
| Rate for Payer: BCN Medicare Advantage |
$73.37
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cash Price |
$96.02
|
| Rate for Payer: Cofinity Commercial |
$112.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.37
|
| Rate for Payer: Healthscope Commercial |
$120.02
|
| Rate for Payer: Healthscope Whirlpool |
$116.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$73.37
|
| Rate for Payer: Mclaren Commercial |
$108.02
|
| Rate for Payer: Mclaren Medicaid |
$39.33
|
| Rate for Payer: Mclaren Medicare |
$73.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.04
|
| Rate for Payer: Meridian Medicaid |
$41.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.02
|
| Rate for Payer: Nomi Health Commercial |
$98.42
|
| Rate for Payer: PACE Medicare |
$69.70
|
| Rate for Payer: PACE SWMI |
$73.37
|
| Rate for Payer: PHP Commercial |
$80.71
|
| Rate for Payer: PHP Medicaid |
$39.33
|
| Rate for Payer: PHP Medicare Advantage |
$73.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.16
|
| Rate for Payer: Priority Health Medicare |
$73.37
|
| Rate for Payer: Priority Health Narrow Network |
$84.13
|
| Rate for Payer: Railroad Medicare Medicare |
$73.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.37
|
| Rate for Payer: UHC Exchange |
$113.72
|
| Rate for Payer: UHC Medicare Advantage |
$73.37
|
| Rate for Payer: UHCCP DNSP |
$73.37
|
| Rate for Payer: UHCCP Medicaid |
$39.33
|
| Rate for Payer: VA VA |
$73.37
|
|
|
HC Z EMBOLIZATION COILS
|
Facility
|
OP
|
$4,097.89
|
|
| Hospital Charge Code |
27800045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,639.16 |
| Max. Negotiated Rate |
$4,097.89 |
| Rate for Payer: Aetna Commercial |
$3,688.10
|
| Rate for Payer: Aetna Medicare |
$2,048.95
|
| Rate for Payer: ASR ASR |
$3,974.95
|
| Rate for Payer: ASR Commercial |
$3,974.95
|
| Rate for Payer: BCBS Complete |
$1,639.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,355.76
|
| Rate for Payer: BCN Commercial |
$3,177.09
|
| Rate for Payer: Cash Price |
$3,278.31
|
| Rate for Payer: Cofinity Commercial |
$3,852.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,278.31
|
| Rate for Payer: Healthscope Commercial |
$4,097.89
|
| Rate for Payer: Healthscope Whirlpool |
$3,974.95
|
| Rate for Payer: Mclaren Commercial |
$3,688.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,483.21
|
| Rate for Payer: Nomi Health Commercial |
$3,360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,590.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,872.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,606.14
|
|
|
HC Z EMBOLIZATION COILS
|
Facility
|
IP
|
$4,097.89
|
|
| Hospital Charge Code |
27800045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.63 |
| Max. Negotiated Rate |
$4,097.89 |
| Rate for Payer: Aetna Commercial |
$3,688.10
|
| Rate for Payer: ASR ASR |
$3,974.95
|
| Rate for Payer: ASR Commercial |
$3,974.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,339.37
|
| Rate for Payer: BCN Commercial |
$3,177.09
|
| Rate for Payer: Cash Price |
$3,278.31
|
| Rate for Payer: Cofinity Commercial |
$3,852.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,278.31
|
| Rate for Payer: Healthscope Commercial |
$4,097.89
|
| Rate for Payer: Healthscope Whirlpool |
$3,974.95
|
| Rate for Payer: Mclaren Commercial |
$3,688.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,483.21
|
| Rate for Payer: Nomi Health Commercial |
$3,360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,606.14
|
|
|
HC Z ENTERPRISE DEVICE
|
Facility
|
OP
|
$7,692.24
|
|
| Hospital Charge Code |
27800047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.90 |
| Max. Negotiated Rate |
$7,692.24 |
| Rate for Payer: Aetna Commercial |
$6,923.02
|
| Rate for Payer: Aetna Medicare |
$3,846.12
|
| Rate for Payer: ASR ASR |
$7,461.47
|
| Rate for Payer: ASR Commercial |
$7,461.47
|
| Rate for Payer: BCBS Complete |
$3,076.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,299.18
|
| Rate for Payer: BCN Commercial |
$5,963.79
|
| Rate for Payer: Cash Price |
$6,153.79
|
| Rate for Payer: Cofinity Commercial |
$7,230.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,153.79
|
| Rate for Payer: Healthscope Commercial |
$7,692.24
|
| Rate for Payer: Healthscope Whirlpool |
$7,461.47
|
| Rate for Payer: Mclaren Commercial |
$6,923.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,538.40
|
| Rate for Payer: Nomi Health Commercial |
$6,307.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,999.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,739.94
|
| Rate for Payer: Priority Health Narrow Network |
$5,392.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,769.17
|
|
|
HC Z ENTERPRISE DEVICE
|
Facility
|
IP
|
$7,692.24
|
|
| Hospital Charge Code |
27800047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,999.96 |
| Max. Negotiated Rate |
$7,692.24 |
| Rate for Payer: Aetna Commercial |
$6,923.02
|
| Rate for Payer: ASR ASR |
$7,461.47
|
| Rate for Payer: ASR Commercial |
$7,461.47
|
| Rate for Payer: BCBS Trust/PPO |
$6,268.41
|
| Rate for Payer: BCN Commercial |
$5,963.79
|
| Rate for Payer: Cash Price |
$6,153.79
|
| Rate for Payer: Cofinity Commercial |
$7,230.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,153.79
|
| Rate for Payer: Healthscope Commercial |
$7,692.24
|
| Rate for Payer: Healthscope Whirlpool |
$7,461.47
|
| Rate for Payer: Mclaren Commercial |
$6,923.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,538.40
|
| Rate for Payer: Nomi Health Commercial |
$6,307.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,999.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,769.17
|
|
|
HC ZEVALIN IN-III PER STUDY
|
Facility
|
OP
|
$2,229.12
|
|
|
Service Code
|
HCPCS A9542
|
| Hospital Charge Code |
34300025
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$427.74 |
| Max. Negotiated Rate |
$2,229.12 |
| Rate for Payer: Aetna Commercial |
$2,006.21
|
| Rate for Payer: Aetna Medicare |
$798.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$997.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$997.52
|
| Rate for Payer: ASR ASR |
$2,162.25
|
| Rate for Payer: ASR Commercial |
$2,162.25
|
| Rate for Payer: BCBS Complete |
$449.13
|
| Rate for Payer: BCBS MAPPO |
$798.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,825.43
|
| Rate for Payer: BCN Commercial |
$1,728.24
|
| Rate for Payer: BCN Medicare Advantage |
$798.02
|
| Rate for Payer: Cash Price |
$1,783.30
|
| Rate for Payer: Cash Price |
$1,783.30
|
| Rate for Payer: Cofinity Commercial |
$2,095.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.02
|
| Rate for Payer: Healthscope Commercial |
$2,229.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,162.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$798.02
|
| Rate for Payer: Mclaren Commercial |
$2,006.21
|
| Rate for Payer: Mclaren Medicaid |
$427.74
|
| Rate for Payer: Mclaren Medicare |
$798.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$837.92
|
| Rate for Payer: Meridian Medicaid |
$449.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$917.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,894.75
|
| Rate for Payer: Nomi Health Commercial |
$1,827.88
|
| Rate for Payer: PACE Medicare |
$758.12
|
| Rate for Payer: PACE SWMI |
$798.02
|
| Rate for Payer: PHP Commercial |
$877.82
|
| Rate for Payer: PHP Medicaid |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$798.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,953.15
|
| Rate for Payer: Priority Health Medicare |
$798.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,562.61
|
| Rate for Payer: Railroad Medicare Medicare |
$798.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,961.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.02
|
| Rate for Payer: UHC Exchange |
$1,236.93
|
| Rate for Payer: UHC Medicare Advantage |
$798.02
|
| Rate for Payer: UHCCP DNSP |
$798.02
|
| Rate for Payer: UHCCP Medicaid |
$427.74
|
| Rate for Payer: VA VA |
$798.02
|
|
|
HC ZEVALIN IN-III PER STUDY
|
Facility
|
IP
|
$2,229.12
|
|
|
Service Code
|
HCPCS A9542
|
| Hospital Charge Code |
34300025
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,448.93 |
| Max. Negotiated Rate |
$2,229.12 |
| Rate for Payer: Aetna Commercial |
$2,006.21
|
| Rate for Payer: ASR ASR |
$2,162.25
|
| Rate for Payer: ASR Commercial |
$2,162.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.51
|
| Rate for Payer: BCN Commercial |
$1,728.24
|
| Rate for Payer: Cash Price |
$1,783.30
|
| Rate for Payer: Cofinity Commercial |
$2,095.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.30
|
| Rate for Payer: Healthscope Commercial |
$2,229.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,162.25
|
| Rate for Payer: Mclaren Commercial |
$2,006.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,894.75
|
| Rate for Payer: Nomi Health Commercial |
$1,827.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,961.63
|
|
|
HC ZEVALIN Y-90 PER STUDY
|
Facility
|
OP
|
$61,963.39
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34400006
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$30,457.96 |
| Max. Negotiated Rate |
$88,078.05 |
| Rate for Payer: Aetna Commercial |
$55,767.05
|
| Rate for Payer: Aetna Medicare |
$56,824.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71,030.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71,030.69
|
| Rate for Payer: ASR ASR |
$60,104.49
|
| Rate for Payer: ASR Commercial |
$60,104.49
|
| Rate for Payer: BCBS Complete |
$31,980.86
|
| Rate for Payer: BCBS MAPPO |
$56,824.55
|
| Rate for Payer: BCBS Trust/PPO |
$50,741.82
|
| Rate for Payer: BCN Commercial |
$48,040.22
|
| Rate for Payer: BCN Medicare Advantage |
$56,824.55
|
| Rate for Payer: Cash Price |
$49,570.71
|
| Rate for Payer: Cash Price |
$49,570.71
|
| Rate for Payer: Cofinity Commercial |
$58,245.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,570.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,824.55
|
| Rate for Payer: Healthscope Commercial |
$61,963.39
|
| Rate for Payer: Healthscope Whirlpool |
$60,104.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$56,824.55
|
| Rate for Payer: Mclaren Commercial |
$55,767.05
|
| Rate for Payer: Mclaren Medicaid |
$30,457.96
|
| Rate for Payer: Mclaren Medicare |
$56,824.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,665.78
|
| Rate for Payer: Meridian Medicaid |
$31,980.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65,348.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,668.88
|
| Rate for Payer: Nomi Health Commercial |
$50,809.98
|
| Rate for Payer: PACE Medicare |
$53,983.32
|
| Rate for Payer: PACE SWMI |
$56,824.55
|
| Rate for Payer: PHP Commercial |
$62,507.00
|
| Rate for Payer: PHP Medicaid |
$30,457.96
|
| Rate for Payer: PHP Medicare Advantage |
$56,824.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,457.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,276.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54,292.32
|
| Rate for Payer: Priority Health Medicare |
$56,824.55
|
| Rate for Payer: Priority Health Narrow Network |
$43,436.34
|
| Rate for Payer: Railroad Medicare Medicare |
$56,824.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54,527.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$56,824.55
|
| Rate for Payer: UHC Exchange |
$88,078.05
|
| Rate for Payer: UHC Medicare Advantage |
$56,824.55
|
| Rate for Payer: UHCCP DNSP |
$56,824.55
|
| Rate for Payer: UHCCP Medicaid |
$30,457.96
|
| Rate for Payer: VA VA |
$56,824.55
|
|
|
HC ZEVALIN Y-90 PER STUDY
|
Facility
|
IP
|
$61,963.39
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34400006
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$40,276.20 |
| Max. Negotiated Rate |
$61,963.39 |
| Rate for Payer: Aetna Commercial |
$55,767.05
|
| Rate for Payer: ASR ASR |
$60,104.49
|
| Rate for Payer: ASR Commercial |
$60,104.49
|
| Rate for Payer: BCBS Trust/PPO |
$50,493.97
|
| Rate for Payer: BCN Commercial |
$48,040.22
|
| Rate for Payer: Cash Price |
$49,570.71
|
| Rate for Payer: Cofinity Commercial |
$58,245.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,570.71
|
| Rate for Payer: Healthscope Commercial |
$61,963.39
|
| Rate for Payer: Healthscope Whirlpool |
$60,104.49
|
| Rate for Payer: Mclaren Commercial |
$55,767.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,668.88
|
| Rate for Payer: Nomi Health Commercial |
$50,809.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,276.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54,527.78
|
|
|
HC Z G J TUBE
|
Facility
|
IP
|
$1,530.89
|
|
| Hospital Charge Code |
27800048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$1,530.89 |
| Rate for Payer: Aetna Commercial |
$1,377.80
|
| Rate for Payer: ASR ASR |
$1,484.96
|
| Rate for Payer: ASR Commercial |
$1,484.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.52
|
| Rate for Payer: BCN Commercial |
$1,186.90
|
| Rate for Payer: Cash Price |
$1,224.71
|
| Rate for Payer: Cofinity Commercial |
$1,439.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.71
|
| Rate for Payer: Healthscope Commercial |
$1,530.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.96
|
| Rate for Payer: Mclaren Commercial |
$1,377.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.26
|
| Rate for Payer: Nomi Health Commercial |
$1,255.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.18
|
|
|
HC Z G J TUBE
|
Facility
|
OP
|
$1,530.89
|
|
| Hospital Charge Code |
27800048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.36 |
| Max. Negotiated Rate |
$1,530.89 |
| Rate for Payer: Aetna Commercial |
$1,377.80
|
| Rate for Payer: Aetna Medicare |
$765.45
|
| Rate for Payer: ASR ASR |
$1,484.96
|
| Rate for Payer: ASR Commercial |
$1,484.96
|
| Rate for Payer: BCBS Complete |
$612.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.65
|
| Rate for Payer: BCN Commercial |
$1,186.90
|
| Rate for Payer: Cash Price |
$1,224.71
|
| Rate for Payer: Cofinity Commercial |
$1,439.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.71
|
| Rate for Payer: Healthscope Commercial |
$1,530.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.96
|
| Rate for Payer: Mclaren Commercial |
$1,377.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.26
|
| Rate for Payer: Nomi Health Commercial |
$1,255.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,341.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,073.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,347.18
|
|
|
HC Z HEMODIALYSIS ANGIODYNAMIC
|
Facility
|
OP
|
$1,223.34
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$1,223.34 |
| Rate for Payer: Aetna Commercial |
$1,101.01
|
| Rate for Payer: Aetna Medicare |
$611.67
|
| Rate for Payer: ASR ASR |
$1,186.64
|
| Rate for Payer: ASR Commercial |
$1,186.64
|
| Rate for Payer: BCBS Complete |
$489.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.79
|
| Rate for Payer: BCN Commercial |
$948.46
|
| Rate for Payer: Cash Price |
$978.67
|
| Rate for Payer: Cofinity Commercial |
$1,149.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.67
|
| Rate for Payer: Healthscope Commercial |
$1,223.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,186.64
|
| Rate for Payer: Mclaren Commercial |
$1,101.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.84
|
| Rate for Payer: Nomi Health Commercial |
$1,003.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.89
|
| Rate for Payer: Priority Health Narrow Network |
$857.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,076.54
|
|
|
HC Z HEMODIALYSIS ANGIODYNAMIC
|
Facility
|
IP
|
$1,223.34
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.17 |
| Max. Negotiated Rate |
$1,223.34 |
| Rate for Payer: Aetna Commercial |
$1,101.01
|
| Rate for Payer: ASR ASR |
$1,186.64
|
| Rate for Payer: ASR Commercial |
$1,186.64
|
| Rate for Payer: BCBS Trust/PPO |
$996.90
|
| Rate for Payer: BCN Commercial |
$948.46
|
| Rate for Payer: Cash Price |
$978.67
|
| Rate for Payer: Cofinity Commercial |
$1,149.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.67
|
| Rate for Payer: Healthscope Commercial |
$1,223.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,186.64
|
| Rate for Payer: Mclaren Commercial |
$1,101.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.84
|
| Rate for Payer: Nomi Health Commercial |
$1,003.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,076.54
|
|
|
HC Z HEMODIALYSIS BARD
|
Facility
|
IP
|
$1,583.13
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,029.03 |
| Max. Negotiated Rate |
$1,583.13 |
| Rate for Payer: Aetna Commercial |
$1,424.82
|
| Rate for Payer: ASR ASR |
$1,535.64
|
| Rate for Payer: ASR Commercial |
$1,535.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.09
|
| Rate for Payer: BCN Commercial |
$1,227.40
|
| Rate for Payer: Cash Price |
$1,266.50
|
| Rate for Payer: Cofinity Commercial |
$1,488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.50
|
| Rate for Payer: Healthscope Commercial |
$1,583.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,535.64
|
| Rate for Payer: Mclaren Commercial |
$1,424.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.66
|
| Rate for Payer: Nomi Health Commercial |
$1,298.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.15
|
|
|
HC Z HEMODIALYSIS BARD
|
Facility
|
OP
|
$1,583.13
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.25 |
| Max. Negotiated Rate |
$1,583.13 |
| Rate for Payer: Aetna Commercial |
$1,424.82
|
| Rate for Payer: Aetna Medicare |
$791.57
|
| Rate for Payer: ASR ASR |
$1,535.64
|
| Rate for Payer: ASR Commercial |
$1,535.64
|
| Rate for Payer: BCBS Complete |
$633.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.43
|
| Rate for Payer: BCN Commercial |
$1,227.40
|
| Rate for Payer: Cash Price |
$1,266.50
|
| Rate for Payer: Cofinity Commercial |
$1,488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.50
|
| Rate for Payer: Healthscope Commercial |
$1,583.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,535.64
|
| Rate for Payer: Mclaren Commercial |
$1,424.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.66
|
| Rate for Payer: Nomi Health Commercial |
$1,298.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.15
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
IP
|
$2,218.93
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,442.30 |
| Max. Negotiated Rate |
$2,218.93 |
| Rate for Payer: Aetna Commercial |
$1,997.04
|
| Rate for Payer: ASR ASR |
$2,152.36
|
| Rate for Payer: ASR Commercial |
$2,152.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.21
|
| Rate for Payer: BCN Commercial |
$1,720.34
|
| Rate for Payer: Cash Price |
$1,775.14
|
| Rate for Payer: Cofinity Commercial |
$2,085.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.14
|
| Rate for Payer: Healthscope Commercial |
$2,218.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,152.36
|
| Rate for Payer: Mclaren Commercial |
$1,997.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.09
|
| Rate for Payer: Nomi Health Commercial |
$1,819.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,952.66
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
OP
|
$2,218.93
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.57 |
| Max. Negotiated Rate |
$2,218.93 |
| Rate for Payer: Aetna Commercial |
$1,997.04
|
| Rate for Payer: Aetna Medicare |
$1,109.46
|
| Rate for Payer: ASR ASR |
$2,152.36
|
| Rate for Payer: ASR Commercial |
$2,152.36
|
| Rate for Payer: BCBS Complete |
$887.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,817.08
|
| Rate for Payer: BCN Commercial |
$1,720.34
|
| Rate for Payer: Cash Price |
$1,775.14
|
| Rate for Payer: Cofinity Commercial |
$2,085.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.14
|
| Rate for Payer: Healthscope Commercial |
$2,218.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,152.36
|
| Rate for Payer: Mclaren Commercial |
$1,997.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.09
|
| Rate for Payer: Nomi Health Commercial |
$1,819.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,944.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,555.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,952.66
|
|
