|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
IP
|
$187.68
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: ASR ASR |
$182.05
|
| Rate for Payer: ASR Commercial |
$182.05
|
| Rate for Payer: BCBS Trust/PPO |
$152.94
|
| Rate for Payer: BCN Commercial |
$145.51
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cofinity Commercial |
$176.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.14
|
| Rate for Payer: Healthscope Commercial |
$187.68
|
| Rate for Payer: Healthscope Whirlpool |
$182.05
|
| Rate for Payer: Mclaren Commercial |
$168.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.53
|
| Rate for Payer: Nomi Health Commercial |
$153.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.16
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
OP
|
$187.68
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$168.91
|
| 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 |
$182.05
|
| Rate for Payer: ASR Commercial |
$182.05
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$153.69
|
| Rate for Payer: BCN Commercial |
$145.51
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cofinity Commercial |
$176.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$187.68
|
| Rate for Payer: Healthscope Whirlpool |
$182.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.85
|
| Rate for Payer: Mclaren Commercial |
$168.91
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.53
|
| Rate for Payer: Nomi Health Commercial |
$153.90
|
| 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 |
$9.03
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.45
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow Network |
$131.56
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Exchange |
$26.12
|
| Rate for Payer: UHC Medicare Advantage |
$16.85
|
| Rate for Payer: UHCCP DNSP |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: ASR Commercial |
$252.30
|
| Rate for Payer: BCBS Trust/PPO |
$211.96
|
| Rate for Payer: BCN Commercial |
$201.66
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Healthscope Whirlpool |
$252.30
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| 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 |
$252.30
|
| Rate for Payer: ASR Commercial |
$252.30
|
| Rate for Payer: BCBS Complete |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$213.00
|
| Rate for Payer: BCN Commercial |
$201.66
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Healthscope Whirlpool |
$252.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| 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 |
$27.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.90
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$182.33
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$79.53
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP DNSP |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$27.50
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| 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 |
$252.30
|
| Rate for Payer: ASR Commercial |
$252.30
|
| Rate for Payer: BCBS Complete |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$213.00
|
| Rate for Payer: BCN Commercial |
$201.66
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Healthscope Whirlpool |
$252.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.31
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| 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 |
$27.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.90
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow Network |
$182.33
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$79.53
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP DNSP |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$27.50
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: ASR Commercial |
$252.30
|
| Rate for Payer: BCBS Trust/PPO |
$211.96
|
| Rate for Payer: BCN Commercial |
$201.66
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Healthscope Whirlpool |
$252.30
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
OP
|
$3,098.41
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.36 |
| Max. Negotiated Rate |
$3,098.41 |
| Rate for Payer: Aetna Commercial |
$2,788.57
|
| Rate for Payer: Aetna Medicare |
$1,549.20
|
| Rate for Payer: ASR ASR |
$3,005.46
|
| Rate for Payer: ASR Commercial |
$3,005.46
|
| Rate for Payer: BCBS Complete |
$1,239.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,537.29
|
| Rate for Payer: BCN Commercial |
$2,402.20
|
| Rate for Payer: Cash Price |
$2,478.73
|
| Rate for Payer: Cofinity Commercial |
$2,912.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,478.73
|
| Rate for Payer: Healthscope Commercial |
$3,098.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,005.46
|
| Rate for Payer: Mclaren Commercial |
$2,788.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,633.65
|
| Rate for Payer: Nomi Health Commercial |
$2,540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,714.83
|
| Rate for Payer: Priority Health Narrow Network |
$2,171.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,726.60
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
IP
|
$3,098.41
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,013.97 |
| Max. Negotiated Rate |
$3,098.41 |
| Rate for Payer: Aetna Commercial |
$2,788.57
|
| Rate for Payer: ASR ASR |
$3,005.46
|
| Rate for Payer: ASR Commercial |
$3,005.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,524.89
|
| Rate for Payer: BCN Commercial |
$2,402.20
|
| Rate for Payer: Cash Price |
$2,478.73
|
| Rate for Payer: Cofinity Commercial |
$2,912.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,478.73
|
| Rate for Payer: Healthscope Commercial |
$3,098.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,005.46
|
| Rate for Payer: Mclaren Commercial |
$2,788.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,633.65
|
| Rate for Payer: Nomi Health Commercial |
$2,540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,726.60
|
|
|
HC ZINC LEVEL
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| 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 |
$48.48
|
| Rate for Payer: ASR Commercial |
$48.48
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$40.93
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$46.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$49.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.39
|
| Rate for Payer: Mclaren Commercial |
$44.98
|
| Rate for Payer: Mclaren Medicaid |
$6.11
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$6.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$40.98
|
| 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 |
$6.11
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.79
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$35.04
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.39
|
| Rate for Payer: UHC Exchange |
$17.65
|
| Rate for Payer: UHC Medicare Advantage |
$11.39
|
| Rate for Payer: UHCCP DNSP |
$11.39
|
| Rate for Payer: UHCCP Medicaid |
$6.11
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC ZINC LEVEL
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$44.98
|
| Rate for Payer: ASR ASR |
$48.48
|
| Rate for Payer: ASR Commercial |
$48.48
|
| Rate for Payer: BCBS Trust/PPO |
$40.73
|
| Rate for Payer: BCN Commercial |
$38.75
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$46.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$49.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.48
|
| Rate for Payer: Mclaren Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$40.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.98
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR Commercial |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$366.70
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR Commercial |
$436.50
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$368.50
|
| Rate for Payer: BCN Commercial |
$348.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.57
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicaid |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.29
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$315.45
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$36.53
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP DNSP |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$12.63
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ZINC URINE
|
Facility
|
IP
|
$69.97
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$69.97 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| Rate for Payer: ASR ASR |
$67.87
|
| Rate for Payer: ASR Commercial |
$67.87
|
| Rate for Payer: BCBS Trust/PPO |
$57.02
|
| Rate for Payer: BCN Commercial |
$54.25
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cofinity Commercial |
$65.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.98
|
| Rate for Payer: Healthscope Commercial |
$69.97
|
| Rate for Payer: Healthscope Whirlpool |
$67.87
|
| Rate for Payer: Mclaren Commercial |
$62.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$57.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.57
|
|
|
HC ZINC URINE
|
Facility
|
OP
|
$69.97
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$69.97 |
| Rate for Payer: Aetna Commercial |
$62.97
|
| 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 |
$67.87
|
| Rate for Payer: ASR Commercial |
$67.87
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$57.30
|
| Rate for Payer: BCN Commercial |
$54.25
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cofinity Commercial |
$65.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$69.97
|
| Rate for Payer: Healthscope Whirlpool |
$67.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.39
|
| Rate for Payer: Mclaren Commercial |
$62.97
|
| Rate for Payer: Mclaren Medicaid |
$6.11
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$6.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$57.38
|
| 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 |
$6.11
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.31
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$49.05
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.39
|
| Rate for Payer: UHC Exchange |
$17.65
|
| Rate for Payer: UHC Medicare Advantage |
$11.39
|
| Rate for Payer: UHCCP DNSP |
$11.39
|
| Rate for Payer: UHCCP Medicaid |
$6.11
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC Z INFUSION WIRE
|
Facility
|
OP
|
$874.85
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$349.94 |
| Max. Negotiated Rate |
$874.85 |
| Rate for Payer: Aetna Commercial |
$787.37
|
| Rate for Payer: Aetna Medicare |
$437.43
|
| Rate for Payer: ASR ASR |
$848.60
|
| Rate for Payer: ASR Commercial |
$848.60
|
| Rate for Payer: BCBS Complete |
$349.94
|
| Rate for Payer: BCBS Trust/PPO |
$716.41
|
| Rate for Payer: BCN Commercial |
$678.27
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$822.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Healthscope Commercial |
$874.85
|
| Rate for Payer: Healthscope Whirlpool |
$848.60
|
| Rate for Payer: Mclaren Commercial |
$787.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$766.54
|
| Rate for Payer: Priority Health Narrow Network |
$613.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.87
|
|
|
HC Z INFUSION WIRE
|
Facility
|
IP
|
$874.85
|
|
| Hospital Charge Code |
62100001
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$568.65 |
| Max. Negotiated Rate |
$874.85 |
| Rate for Payer: Aetna Commercial |
$787.37
|
| Rate for Payer: ASR ASR |
$848.60
|
| Rate for Payer: ASR Commercial |
$848.60
|
| Rate for Payer: BCBS Trust/PPO |
$712.92
|
| Rate for Payer: BCN Commercial |
$678.27
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$822.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Healthscope Commercial |
$874.85
|
| Rate for Payer: Healthscope Whirlpool |
$848.60
|
| Rate for Payer: Mclaren Commercial |
$787.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.87
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
IP
|
$13,138.47
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,540.01 |
| Max. Negotiated Rate |
$13,138.47 |
| Rate for Payer: Aetna Commercial |
$11,824.62
|
| Rate for Payer: ASR ASR |
$12,744.32
|
| Rate for Payer: ASR Commercial |
$12,744.32
|
| Rate for Payer: BCBS Trust/PPO |
$10,706.54
|
| Rate for Payer: BCN Commercial |
$10,186.26
|
| Rate for Payer: Cash Price |
$10,510.78
|
| Rate for Payer: Cofinity Commercial |
$12,350.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,510.78
|
| Rate for Payer: Healthscope Commercial |
$13,138.47
|
| Rate for Payer: Healthscope Whirlpool |
$12,744.32
|
| Rate for Payer: Mclaren Commercial |
$11,824.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,167.70
|
| Rate for Payer: Nomi Health Commercial |
$10,773.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,540.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,561.85
|
|
|
HC Z INTRACRANIAL STENT
|
Facility
|
OP
|
$13,138.47
|
|
| Hospital Charge Code |
27800049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,255.39 |
| Max. Negotiated Rate |
$13,138.47 |
| Rate for Payer: Aetna Commercial |
$11,824.62
|
| Rate for Payer: Aetna Medicare |
$6,569.23
|
| Rate for Payer: ASR ASR |
$12,744.32
|
| Rate for Payer: ASR Commercial |
$12,744.32
|
| Rate for Payer: BCBS Complete |
$5,255.39
|
| Rate for Payer: BCBS Trust/PPO |
$10,759.09
|
| Rate for Payer: BCN Commercial |
$10,186.26
|
| Rate for Payer: Cash Price |
$10,510.78
|
| Rate for Payer: Cofinity Commercial |
$12,350.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,510.78
|
| Rate for Payer: Healthscope Commercial |
$13,138.47
|
| Rate for Payer: Healthscope Whirlpool |
$12,744.32
|
| Rate for Payer: Mclaren Commercial |
$11,824.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,167.70
|
| Rate for Payer: Nomi Health Commercial |
$10,773.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,540.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,511.93
|
| Rate for Payer: Priority Health Narrow Network |
$9,210.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11,561.85
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
OP
|
$329.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.70 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Aetna Commercial |
$296.32
|
| Rate for Payer: Aetna Medicare |
$164.62
|
| Rate for Payer: ASR ASR |
$319.37
|
| Rate for Payer: ASR Commercial |
$319.37
|
| Rate for Payer: BCBS Complete |
$131.70
|
| Rate for Payer: BCBS Trust/PPO |
$269.62
|
| Rate for Payer: BCN Commercial |
$255.27
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cofinity Commercial |
$309.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.40
|
| Rate for Payer: Healthscope Commercial |
$329.25
|
| Rate for Payer: Healthscope Whirlpool |
$319.37
|
| Rate for Payer: Mclaren Commercial |
$296.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.86
|
| Rate for Payer: Nomi Health Commercial |
$269.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.49
|
| Rate for Payer: Priority Health Narrow Network |
$230.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.74
|
|
|
HC Z INTRODUCER SHEATH
|
Facility
|
IP
|
$329.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.01 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Aetna Commercial |
$296.32
|
| Rate for Payer: ASR ASR |
$319.37
|
| Rate for Payer: ASR Commercial |
$319.37
|
| Rate for Payer: BCBS Trust/PPO |
$268.31
|
| Rate for Payer: BCN Commercial |
$255.27
|
| Rate for Payer: Cash Price |
$263.40
|
| Rate for Payer: Cofinity Commercial |
$309.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.40
|
| Rate for Payer: Healthscope Commercial |
$329.25
|
| Rate for Payer: Healthscope Whirlpool |
$319.37
|
| Rate for Payer: Mclaren Commercial |
$296.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.86
|
| Rate for Payer: Nomi Health Commercial |
$269.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.74
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
OP
|
$3,775.49
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,510.20 |
| Max. Negotiated Rate |
$3,775.49 |
| Rate for Payer: Aetna Commercial |
$3,397.94
|
| Rate for Payer: Aetna Medicare |
$1,887.74
|
| Rate for Payer: ASR ASR |
$3,662.23
|
| Rate for Payer: ASR Commercial |
$3,662.23
|
| Rate for Payer: BCBS Complete |
$1,510.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,091.75
|
| Rate for Payer: BCN Commercial |
$2,927.14
|
| Rate for Payer: Cash Price |
$3,020.39
|
| Rate for Payer: Cofinity Commercial |
$3,548.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.39
|
| Rate for Payer: Healthscope Commercial |
$3,775.49
|
| Rate for Payer: Healthscope Whirlpool |
$3,662.23
|
| Rate for Payer: Mclaren Commercial |
$3,397.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.17
|
| Rate for Payer: Nomi Health Commercial |
$3,095.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,308.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,646.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,322.43
|
|
|
HC Z ITERPRET VISCERAL PTRA
|
Facility
|
IP
|
$3,775.49
|
|
| Hospital Charge Code |
32000272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,454.07 |
| Max. Negotiated Rate |
$3,775.49 |
| Rate for Payer: Aetna Commercial |
$3,397.94
|
| Rate for Payer: ASR ASR |
$3,662.23
|
| Rate for Payer: ASR Commercial |
$3,662.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,076.65
|
| Rate for Payer: BCN Commercial |
$2,927.14
|
| Rate for Payer: Cash Price |
$3,020.39
|
| Rate for Payer: Cofinity Commercial |
$3,548.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.39
|
| Rate for Payer: Healthscope Commercial |
$3,775.49
|
| Rate for Payer: Healthscope Whirlpool |
$3,662.23
|
| Rate for Payer: Mclaren Commercial |
$3,397.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.17
|
| Rate for Payer: Nomi Health Commercial |
$3,095.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,322.43
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$775.77
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.25 |
| Max. Negotiated Rate |
$775.77 |
| Rate for Payer: Aetna Commercial |
$698.19
|
| Rate for Payer: ASR ASR |
$752.50
|
| Rate for Payer: ASR Commercial |
$752.50
|
| Rate for Payer: BCBS Trust/PPO |
$632.17
|
| Rate for Payer: BCN Commercial |
$601.45
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$729.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.62
|
| Rate for Payer: Healthscope Commercial |
$775.77
|
| Rate for Payer: Healthscope Whirlpool |
$752.50
|
| Rate for Payer: Mclaren Commercial |
$698.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.40
|
| Rate for Payer: Nomi Health Commercial |
$636.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.68
|
|
|
HC Z NEPHROSTOMY CATH
|
Facility
|
OP
|
$775.77
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$775.77 |
| Rate for Payer: Aetna Commercial |
$698.19
|
| Rate for Payer: Aetna Medicare |
$387.88
|
| Rate for Payer: ASR ASR |
$752.50
|
| Rate for Payer: ASR Commercial |
$752.50
|
| Rate for Payer: BCBS Complete |
$310.31
|
| Rate for Payer: BCBS Trust/PPO |
$635.28
|
| Rate for Payer: BCN Commercial |
$601.45
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$729.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.62
|
| Rate for Payer: Healthscope Commercial |
$775.77
|
| Rate for Payer: Healthscope Whirlpool |
$752.50
|
| Rate for Payer: Mclaren Commercial |
$698.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.40
|
| Rate for Payer: Nomi Health Commercial |
$636.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.73
|
| Rate for Payer: Priority Health Narrow Network |
$543.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.68
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$62.34
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
