|
HC ZONISAMIDE
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| 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 |
$74.20
|
| Rate for Payer: ASR Commercial |
$74.20
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$62.65
|
| Rate for Payer: BCN Commercial |
$59.31
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$61.20
|
| 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: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Healthscope Whirlpool |
$74.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.25
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$14.57
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.03
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$53.63
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP DNSP |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$174.79
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.92 |
| Max. Negotiated Rate |
$174.79 |
| Rate for Payer: Aetna Commercial |
$157.31
|
| Rate for Payer: Aetna Medicare |
$87.39
|
| Rate for Payer: ASR ASR |
$169.55
|
| Rate for Payer: ASR Commercial |
$169.55
|
| Rate for Payer: BCBS Complete |
$69.92
|
| Rate for Payer: BCBS Trust/PPO |
$143.14
|
| Rate for Payer: BCN Commercial |
$135.51
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$164.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Healthscope Commercial |
$174.79
|
| Rate for Payer: Healthscope Whirlpool |
$169.55
|
| Rate for Payer: Mclaren Commercial |
$157.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: Nomi Health Commercial |
$143.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.15
|
| Rate for Payer: Priority Health Narrow Network |
$122.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.82
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$174.79
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.61 |
| Max. Negotiated Rate |
$174.79 |
| Rate for Payer: Aetna Commercial |
$157.31
|
| Rate for Payer: ASR ASR |
$169.55
|
| Rate for Payer: ASR Commercial |
$169.55
|
| Rate for Payer: BCBS Trust/PPO |
$142.44
|
| Rate for Payer: BCN Commercial |
$135.51
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$164.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Healthscope Commercial |
$174.79
|
| Rate for Payer: Healthscope Whirlpool |
$169.55
|
| Rate for Payer: Mclaren Commercial |
$157.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: Nomi Health Commercial |
$143.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.82
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,332.83
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$866.34 |
| Max. Negotiated Rate |
$1,332.83 |
| Rate for Payer: Aetna Commercial |
$1,199.55
|
| Rate for Payer: ASR ASR |
$1,292.85
|
| Rate for Payer: ASR Commercial |
$1,292.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.12
|
| Rate for Payer: BCN Commercial |
$1,033.34
|
| Rate for Payer: Cash Price |
$1,066.26
|
| Rate for Payer: Cofinity Commercial |
$1,252.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.26
|
| Rate for Payer: Healthscope Commercial |
$1,332.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,292.85
|
| Rate for Payer: Mclaren Commercial |
$1,199.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.91
|
| Rate for Payer: Nomi Health Commercial |
$1,092.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,172.89
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,332.83
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.13 |
| Max. Negotiated Rate |
$1,332.83 |
| Rate for Payer: Aetna Commercial |
$1,199.55
|
| Rate for Payer: Aetna Medicare |
$666.41
|
| Rate for Payer: ASR ASR |
$1,292.85
|
| Rate for Payer: ASR Commercial |
$1,292.85
|
| Rate for Payer: BCBS Complete |
$533.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.45
|
| Rate for Payer: BCN Commercial |
$1,033.34
|
| Rate for Payer: Cash Price |
$1,066.26
|
| Rate for Payer: Cofinity Commercial |
$1,252.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.26
|
| Rate for Payer: Healthscope Commercial |
$1,332.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,292.85
|
| Rate for Payer: Mclaren Commercial |
$1,199.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,132.91
|
| Rate for Payer: Nomi Health Commercial |
$1,092.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.83
|
| Rate for Payer: Priority Health Narrow Network |
$934.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,172.89
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,212.86
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$1,212.86 |
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: Aetna Medicare |
$606.43
|
| Rate for Payer: ASR ASR |
$1,176.47
|
| Rate for Payer: ASR Commercial |
$1,176.47
|
| Rate for Payer: BCBS Complete |
$485.14
|
| Rate for Payer: BCBS Trust/PPO |
$993.21
|
| Rate for Payer: BCN Commercial |
$940.33
|
| Rate for Payer: Cash Price |
$970.29
|
| Rate for Payer: Cofinity Commercial |
$1,140.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.29
|
| Rate for Payer: Healthscope Commercial |
$1,212.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.47
|
| Rate for Payer: Mclaren Commercial |
$1,091.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.93
|
| Rate for Payer: Nomi Health Commercial |
$994.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,062.71
|
| Rate for Payer: Priority Health Narrow Network |
$850.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.32
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,212.86
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.36 |
| Max. Negotiated Rate |
$1,212.86 |
| Rate for Payer: Aetna Commercial |
$1,091.57
|
| Rate for Payer: ASR ASR |
$1,176.47
|
| Rate for Payer: ASR Commercial |
$1,176.47
|
| Rate for Payer: BCBS Trust/PPO |
$988.36
|
| Rate for Payer: BCN Commercial |
$940.33
|
| Rate for Payer: Cash Price |
$970.29
|
| Rate for Payer: Cofinity Commercial |
$1,140.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.29
|
| Rate for Payer: Healthscope Commercial |
$1,212.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.47
|
| Rate for Payer: Mclaren Commercial |
$1,091.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.93
|
| Rate for Payer: Nomi Health Commercial |
$994.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.32
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$1,756.94
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.78 |
| Max. Negotiated Rate |
$1,756.94 |
| Rate for Payer: Aetna Commercial |
$1,581.25
|
| Rate for Payer: Aetna Medicare |
$878.47
|
| Rate for Payer: ASR ASR |
$1,704.23
|
| Rate for Payer: ASR Commercial |
$1,704.23
|
| Rate for Payer: BCBS Complete |
$702.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.76
|
| Rate for Payer: BCN Commercial |
$1,362.16
|
| Rate for Payer: Cash Price |
$1,405.55
|
| Rate for Payer: Cofinity Commercial |
$1,651.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.55
|
| Rate for Payer: Healthscope Commercial |
$1,756.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.23
|
| Rate for Payer: Mclaren Commercial |
$1,581.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.40
|
| Rate for Payer: Nomi Health Commercial |
$1,440.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,546.11
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$1,756.94
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,142.01 |
| Max. Negotiated Rate |
$1,756.94 |
| Rate for Payer: Aetna Commercial |
$1,581.25
|
| Rate for Payer: ASR ASR |
$1,704.23
|
| Rate for Payer: ASR Commercial |
$1,704.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,431.73
|
| Rate for Payer: BCN Commercial |
$1,362.16
|
| Rate for Payer: Cash Price |
$1,405.55
|
| Rate for Payer: Cofinity Commercial |
$1,651.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.55
|
| Rate for Payer: Healthscope Commercial |
$1,756.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.23
|
| Rate for Payer: Mclaren Commercial |
$1,581.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.40
|
| Rate for Payer: Nomi Health Commercial |
$1,440.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,546.11
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
OP
|
$646.29
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.52 |
| Max. Negotiated Rate |
$646.29 |
| Rate for Payer: Aetna Commercial |
$581.66
|
| Rate for Payer: Aetna Medicare |
$323.14
|
| Rate for Payer: ASR ASR |
$626.90
|
| Rate for Payer: ASR Commercial |
$626.90
|
| Rate for Payer: BCBS Complete |
$258.52
|
| Rate for Payer: BCBS Trust/PPO |
$529.25
|
| Rate for Payer: BCN Commercial |
$501.07
|
| Rate for Payer: Cash Price |
$517.03
|
| Rate for Payer: Cofinity Commercial |
$607.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$517.03
|
| Rate for Payer: Healthscope Commercial |
$646.29
|
| Rate for Payer: Healthscope Whirlpool |
$626.90
|
| Rate for Payer: Mclaren Commercial |
$581.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.35
|
| Rate for Payer: Nomi Health Commercial |
$529.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$566.28
|
| Rate for Payer: Priority Health Narrow Network |
$453.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.74
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
IP
|
$646.29
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.09 |
| Max. Negotiated Rate |
$646.29 |
| Rate for Payer: Aetna Commercial |
$581.66
|
| Rate for Payer: ASR ASR |
$626.90
|
| Rate for Payer: ASR Commercial |
$626.90
|
| Rate for Payer: BCBS Trust/PPO |
$526.66
|
| Rate for Payer: BCN Commercial |
$501.07
|
| Rate for Payer: Cash Price |
$517.03
|
| Rate for Payer: Cofinity Commercial |
$607.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$517.03
|
| Rate for Payer: Healthscope Commercial |
$646.29
|
| Rate for Payer: Healthscope Whirlpool |
$626.90
|
| Rate for Payer: Mclaren Commercial |
$581.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$549.35
|
| Rate for Payer: Nomi Health Commercial |
$529.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.74
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
IP
|
$1,020.90
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.59 |
| Max. Negotiated Rate |
$1,020.90 |
| Rate for Payer: Aetna Commercial |
$918.81
|
| Rate for Payer: ASR ASR |
$990.27
|
| Rate for Payer: ASR Commercial |
$990.27
|
| Rate for Payer: BCBS Trust/PPO |
$831.93
|
| Rate for Payer: BCN Commercial |
$791.50
|
| Rate for Payer: Cash Price |
$816.72
|
| Rate for Payer: Cofinity Commercial |
$959.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.72
|
| Rate for Payer: Healthscope Commercial |
$1,020.90
|
| Rate for Payer: Healthscope Whirlpool |
$990.27
|
| Rate for Payer: Mclaren Commercial |
$918.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.76
|
| Rate for Payer: Nomi Health Commercial |
$837.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.39
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
OP
|
$1,020.90
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.36 |
| Max. Negotiated Rate |
$1,020.90 |
| Rate for Payer: Aetna Commercial |
$918.81
|
| Rate for Payer: Aetna Medicare |
$510.45
|
| Rate for Payer: ASR ASR |
$990.27
|
| Rate for Payer: ASR Commercial |
$990.27
|
| Rate for Payer: BCBS Complete |
$408.36
|
| Rate for Payer: BCBS Trust/PPO |
$836.02
|
| Rate for Payer: BCN Commercial |
$791.50
|
| Rate for Payer: Cash Price |
$816.72
|
| Rate for Payer: Cofinity Commercial |
$959.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.72
|
| Rate for Payer: Healthscope Commercial |
$1,020.90
|
| Rate for Payer: Healthscope Whirlpool |
$990.27
|
| Rate for Payer: Mclaren Commercial |
$918.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.76
|
| Rate for Payer: Nomi Health Commercial |
$837.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.51
|
| Rate for Payer: Priority Health Narrow Network |
$715.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.39
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
OP
|
$5,871.33
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,348.53 |
| Max. Negotiated Rate |
$5,871.33 |
| Rate for Payer: Aetna Commercial |
$5,284.20
|
| Rate for Payer: Aetna Medicare |
$2,935.66
|
| Rate for Payer: ASR ASR |
$5,695.19
|
| Rate for Payer: ASR Commercial |
$5,695.19
|
| Rate for Payer: BCBS Complete |
$2,348.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,808.03
|
| Rate for Payer: BCN Commercial |
$4,552.04
|
| Rate for Payer: Cash Price |
$4,697.06
|
| Rate for Payer: Cofinity Commercial |
$5,519.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,697.06
|
| Rate for Payer: Healthscope Commercial |
$5,871.33
|
| Rate for Payer: Healthscope Whirlpool |
$5,695.19
|
| Rate for Payer: Mclaren Commercial |
$5,284.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,990.63
|
| Rate for Payer: Nomi Health Commercial |
$4,814.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,816.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,144.46
|
| Rate for Payer: Priority Health Narrow Network |
$4,115.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,166.77
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
IP
|
$5,871.33
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,816.36 |
| Max. Negotiated Rate |
$5,871.33 |
| Rate for Payer: Aetna Commercial |
$5,284.20
|
| Rate for Payer: ASR ASR |
$5,695.19
|
| Rate for Payer: ASR Commercial |
$5,695.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,784.55
|
| Rate for Payer: BCN Commercial |
$4,552.04
|
| Rate for Payer: Cash Price |
$4,697.06
|
| Rate for Payer: Cofinity Commercial |
$5,519.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,697.06
|
| Rate for Payer: Healthscope Commercial |
$5,871.33
|
| Rate for Payer: Healthscope Whirlpool |
$5,695.19
|
| Rate for Payer: Mclaren Commercial |
$5,284.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,990.63
|
| Rate for Payer: Nomi Health Commercial |
$4,814.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,816.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,166.77
|
|
|
HEARING AID RESTOCKING FEE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00663
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.82
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
112939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Aetna Commercial |
$24.14
|
| Rate for Payer: ASR ASR |
$26.02
|
| Rate for Payer: ASR Commercial |
$26.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.86
|
| Rate for Payer: BCN Commercial |
$20.79
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$26.82
|
| Rate for Payer: Healthscope Whirlpool |
$26.02
|
| Rate for Payer: Mclaren Commercial |
$24.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.80
|
| Rate for Payer: Nomi Health Commercial |
$21.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.60
|
|
|
HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.82
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
112939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: Aetna Commercial |
$24.14
|
| Rate for Payer: Aetna Medicare |
$13.41
|
| Rate for Payer: ASR ASR |
$26.02
|
| Rate for Payer: ASR Commercial |
$26.02
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.96
|
| Rate for Payer: BCN Commercial |
$20.79
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$26.82
|
| Rate for Payer: Healthscope Whirlpool |
$26.02
|
| Rate for Payer: Mclaren Commercial |
$24.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.80
|
| Rate for Payer: Nomi Health Commercial |
$21.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.50
|
| Rate for Payer: Priority Health Narrow Network |
$18.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.60
|
|
|
HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.87
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$25.18
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: ASR ASR |
$25.84
|
| Rate for Payer: ASR ASR |
$16.36
|
| Rate for Payer: ASR ASR |
$27.14
|
| Rate for Payer: ASR Commercial |
$27.14
|
| Rate for Payer: ASR Commercial |
$25.84
|
| Rate for Payer: ASR Commercial |
$16.36
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Complete |
$10.66
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$13.81
|
| Rate for Payer: BCBS Trust/PPO |
$21.82
|
| Rate for Payer: BCBS Trust/PPO |
$22.91
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: BCN Commercial |
$13.08
|
| Rate for Payer: BCN Commercial |
$20.65
|
| Rate for Payer: Cash Price |
$21.31
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Commercial |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$25.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$27.98
|
| Rate for Payer: Healthscope Whirlpool |
$25.84
|
| Rate for Payer: Healthscope Whirlpool |
$16.36
|
| Rate for Payer: Healthscope Whirlpool |
$27.14
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$23.98
|
| Rate for Payer: Mclaren Commercial |
$25.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.78
|
| Rate for Payer: Nomi Health Commercial |
$13.83
|
| Rate for Payer: Nomi Health Commercial |
$21.84
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.52
|
| Rate for Payer: Priority Health Narrow Network |
$19.61
|
| Rate for Payer: Priority Health Narrow Network |
$11.83
|
| Rate for Payer: Priority Health Narrow Network |
$18.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.62
|
|
|
HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$26.64
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10176
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$15.18
|
| Rate for Payer: Aetna Commercial |
$25.18
|
| Rate for Payer: ASR ASR |
$16.36
|
| Rate for Payer: ASR ASR |
$25.84
|
| Rate for Payer: ASR ASR |
$27.14
|
| Rate for Payer: ASR Commercial |
$25.84
|
| Rate for Payer: ASR Commercial |
$16.36
|
| Rate for Payer: ASR Commercial |
$27.14
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$21.71
|
| Rate for Payer: BCN Commercial |
$13.08
|
| Rate for Payer: BCN Commercial |
$21.69
|
| Rate for Payer: BCN Commercial |
$20.65
|
| Rate for Payer: Cash Price |
$21.31
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Commercial |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$25.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Healthscope Commercial |
$27.98
|
| Rate for Payer: Healthscope Whirlpool |
$25.84
|
| Rate for Payer: Healthscope Whirlpool |
$16.36
|
| Rate for Payer: Healthscope Whirlpool |
$27.14
|
| Rate for Payer: Mclaren Commercial |
$23.98
|
| Rate for Payer: Mclaren Commercial |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$25.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Nomi Health Commercial |
$21.84
|
| Rate for Payer: Nomi Health Commercial |
$13.83
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV
|
Facility
|
OP
|
$66.56
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$66.56 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Commercial |
$89.72
|
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: ASR ASR |
$64.56
|
| Rate for Payer: ASR ASR |
$96.70
|
| Rate for Payer: ASR Commercial |
$64.56
|
| Rate for Payer: ASR Commercial |
$96.70
|
| Rate for Payer: BCBS Complete |
$39.88
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$51.60
|
| Rate for Payer: BCN Commercial |
$77.29
|
| Rate for Payer: Cash Price |
$53.24
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Cofinity Commercial |
$62.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.25
|
| Rate for Payer: Healthscope Commercial |
$66.56
|
| Rate for Payer: Healthscope Commercial |
$99.69
|
| Rate for Payer: Healthscope Whirlpool |
$64.56
|
| Rate for Payer: Healthscope Whirlpool |
$96.70
|
| Rate for Payer: Mclaren Commercial |
$59.90
|
| Rate for Payer: Mclaren Commercial |
$89.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.74
|
| Rate for Payer: Nomi Health Commercial |
$54.58
|
| Rate for Payer: Nomi Health Commercial |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.35
|
| Rate for Payer: Priority Health Narrow Network |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$69.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.73
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV
|
Facility
|
IP
|
$99.69
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
15846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$99.69 |
| Rate for Payer: Aetna Commercial |
$89.72
|
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: ASR ASR |
$64.56
|
| Rate for Payer: ASR ASR |
$96.70
|
| Rate for Payer: ASR Commercial |
$64.56
|
| Rate for Payer: ASR Commercial |
$96.70
|
| Rate for Payer: BCBS Trust/PPO |
$81.24
|
| Rate for Payer: BCBS Trust/PPO |
$54.24
|
| Rate for Payer: BCN Commercial |
$77.29
|
| Rate for Payer: BCN Commercial |
$51.60
|
| Rate for Payer: Cash Price |
$53.24
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cofinity Commercial |
$62.57
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.25
|
| Rate for Payer: Healthscope Commercial |
$66.56
|
| Rate for Payer: Healthscope Commercial |
$99.69
|
| Rate for Payer: Healthscope Whirlpool |
$64.56
|
| Rate for Payer: Healthscope Whirlpool |
$96.70
|
| Rate for Payer: Mclaren Commercial |
$89.72
|
| Rate for Payer: Mclaren Commercial |
$59.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.74
|
| Rate for Payer: Nomi Health Commercial |
$54.58
|
| Rate for Payer: Nomi Health Commercial |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.73
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) INFUSION CUSTOM
|
Facility
|
OP
|
$99.69
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
180233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$99.69 |
| Rate for Payer: Aetna Commercial |
$89.72
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: ASR ASR |
$96.70
|
| Rate for Payer: ASR Commercial |
$96.70
|
| Rate for Payer: BCBS Complete |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$77.29
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.75
|
| Rate for Payer: Healthscope Commercial |
$99.69
|
| Rate for Payer: Healthscope Whirlpool |
$96.70
|
| Rate for Payer: Mclaren Commercial |
$89.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.74
|
| Rate for Payer: Nomi Health Commercial |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.35
|
| Rate for Payer: Priority Health Narrow Network |
$69.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.73
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) INFUSION CUSTOM
|
Facility
|
IP
|
$99.69
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
180233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$99.69 |
| Rate for Payer: Aetna Commercial |
$89.72
|
| Rate for Payer: ASR ASR |
$96.70
|
| Rate for Payer: ASR Commercial |
$96.70
|
| Rate for Payer: BCBS Trust/PPO |
$81.24
|
| Rate for Payer: BCN Commercial |
$77.29
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.75
|
| Rate for Payer: Healthscope Commercial |
$99.69
|
| Rate for Payer: Healthscope Whirlpool |
$96.70
|
| Rate for Payer: Mclaren Commercial |
$89.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.74
|
| Rate for Payer: Nomi Health Commercial |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.73
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.86
|
|
|
Service Code
|
HCPCS J1643
|
| Hospital Charge Code |
10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna Commercial |
$12.47
|
| Rate for Payer: ASR ASR |
$13.44
|
| Rate for Payer: ASR Commercial |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.29
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.09
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Whirlpool |
$13.44
|
| Rate for Payer: Mclaren Commercial |
$12.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.78
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.20
|
|
