|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$415.15
|
|
|
Service Code
|
NDC 00904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.54 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$352.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.85
|
| Rate for Payer: Cash Price |
$332.12
|
| Rate for Payer: Cofinity Commercial |
$290.60
|
| Rate for Payer: Cofinity Commercial |
$357.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.12
|
| Rate for Payer: Healthscope Commercial |
$373.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.88
|
| Rate for Payer: PHP Commercial |
$352.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.85
|
| Rate for Payer: Priority Health SBD |
$261.54
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 51079073620
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.44 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.24 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna Medicare |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.64
|
| Rate for Payer: BCBS Complete |
$170.24
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health SBD |
$268.13
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.13 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.64
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health SBD |
$268.13
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$431.46
|
|
|
Service Code
|
NDC 54838050140
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.58 |
| Max. Negotiated Rate |
$388.31 |
| Rate for Payer: Aetna Commercial |
$366.74
|
| Rate for Payer: Aetna Medicare |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.45
|
| Rate for Payer: BCBS Complete |
$172.58
|
| Rate for Payer: Cash Price |
$345.17
|
| Rate for Payer: Cofinity Commercial |
$302.02
|
| Rate for Payer: Cofinity Commercial |
$371.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.17
|
| Rate for Payer: Healthscope Commercial |
$388.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.74
|
| Rate for Payer: PHP Commercial |
$366.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.45
|
| Rate for Payer: Priority Health SBD |
$271.82
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$243.96
|
|
|
Service Code
|
NDC 00121058104
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$219.56 |
| Rate for Payer: Aetna Commercial |
$207.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.57
|
| Rate for Payer: Cash Price |
$195.17
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$209.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.17
|
| Rate for Payer: Healthscope Commercial |
$219.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.37
|
| Rate for Payer: PHP Commercial |
$207.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.57
|
| Rate for Payer: Priority Health SBD |
$153.69
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$431.46
|
|
|
Service Code
|
NDC 54838050140
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.82 |
| Max. Negotiated Rate |
$388.31 |
| Rate for Payer: Aetna Commercial |
$366.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.45
|
| Rate for Payer: Cash Price |
$345.17
|
| Rate for Payer: Cofinity Commercial |
$302.02
|
| Rate for Payer: Cofinity Commercial |
$371.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.17
|
| Rate for Payer: Healthscope Commercial |
$388.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.74
|
| Rate for Payer: PHP Commercial |
$366.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.45
|
| Rate for Payer: Priority Health SBD |
$271.82
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$243.96
|
|
|
Service Code
|
NDC 00121058104
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$219.56 |
| Rate for Payer: Aetna Commercial |
$207.37
|
| Rate for Payer: Aetna Medicare |
$121.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.57
|
| Rate for Payer: BCBS Complete |
$97.58
|
| Rate for Payer: Cash Price |
$195.17
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$209.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.17
|
| Rate for Payer: Healthscope Commercial |
$219.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.37
|
| Rate for Payer: PHP Commercial |
$207.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.57
|
| Rate for Payer: Priority Health SBD |
$153.69
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.27
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: Priority Health SBD |
$8.11
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.27
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: Priority Health SBD |
$14.66
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health SBD |
$41.30
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$30.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.60
|
| Rate for Payer: BCBS Complete |
$16.48
|
| Rate for Payer: BCBS MAPPO |
$29.28
|
| Rate for Payer: BCBS Trust/PPO |
$25.92
|
| Rate for Payer: BCN Commercial |
$25.92
|
| Rate for Payer: BCN Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.28
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Mclaren Medicaid |
$15.69
|
| Rate for Payer: Mclaren Medicare |
$29.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.74
|
| Rate for Payer: Meridian Medicaid |
$16.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$43.92
|
| Rate for Payer: PACE Medicare |
$27.82
|
| Rate for Payer: PACE SWMI |
$29.28
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: PHP Medicare Advantage |
$29.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.12
|
| Rate for Payer: Priority Health Medicare |
$29.28
|
| Rate for Payer: Priority Health Narrow Network |
$24.10
|
| Rate for Payer: Priority Health SBD |
$41.30
|
| Rate for Payer: Railroad Medicare Medicare |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.28
|
| Rate for Payer: UHC Medicare Advantage |
$29.28
|
| Rate for Payer: UHCCP Medicaid |
$16.48
|
| Rate for Payer: VA VA |
$29.28
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$6.89
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Aetna Commercial |
$5.86
|
| Rate for Payer: Aetna Medicare |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.48
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.86
|
| Rate for Payer: PHP Commercial |
$5.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: Priority Health SBD |
$4.34
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$6.89
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Aetna Commercial |
$5.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.48
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$5.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$6.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.86
|
| Rate for Payer: PHP Commercial |
$5.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: Priority Health SBD |
$4.34
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.97
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health SBD |
$175.40
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna Medicare |
$139.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.97
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health SBD |
$175.40
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health SBD |
$47.19
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$36.98
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Cofinity Commercial |
$52.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.77
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$33.42
|
| Rate for Payer: Priority Health SBD |
$47.19
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.77
|
| Rate for Payer: UHC Medicare Advantage |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$23.52
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.49
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health SBD |
$54.75
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: Aetna Medicare |
$43.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: BCBS Complete |
$23.51
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$36.98
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Mclaren Medicaid |
$22.39
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: Meridian Medicaid |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.77
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$33.42
|
| Rate for Payer: Priority Health SBD |
$54.75
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.77
|
| Rate for Payer: UHC Medicare Advantage |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$23.52
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,552.14
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$977.85 |
| Max. Negotiated Rate |
$1,396.93 |
| Rate for Payer: Aetna Commercial |
$1,319.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.89
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,086.50
|
| Rate for Payer: Cofinity Commercial |
$1,334.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,086.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Healthscope Commercial |
$1,396.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: PHP Commercial |
$1,319.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: Priority Health SBD |
$977.85
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,552.14
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$192.21 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Commercial |
$1,319.32
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$631.99
|
| Rate for Payer: BCN Commercial |
$631.99
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,086.50
|
| Rate for Payer: Cofinity Commercial |
$1,334.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,086.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,396.93
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$1,319.32
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Priority Health SBD |
$977.85
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.21
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$292.69
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
OP
|
$825.55
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$701.72
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$329.29
|
| Rate for Payer: BCN Commercial |
$329.29
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cash Price |
$660.44
|
| Rate for Payer: Cofinity Commercial |
$709.97
|
| Rate for Payer: Cofinity Commercial |
$577.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$577.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$743.00
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.72
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$701.72
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$520.10
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$610.91
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
