|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.31 |
| Max. Negotiated Rate |
$3,233.30 |
| Rate for Payer: Aetna Commercial |
$3,053.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,335.16
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$2,514.78
|
| Rate for Payer: Cofinity Commercial |
$3,089.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,514.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,233.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: PHP Commercial |
$3,053.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health SBD |
$2,263.31
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.03 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.84
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$441.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: PHP Commercial |
$416.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health SBD |
$309.03
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
OP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: Aetna Medicare |
$245.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.84
|
| Rate for Payer: BCBS Complete |
$196.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$441.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: PHP Commercial |
$416.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health SBD |
$309.03
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
OP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,718.21 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: Aetna Medicare |
$2,147.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,792.09
|
| Rate for Payer: BCBS Complete |
$1,718.21
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$3,006.87
|
| Rate for Payer: Cofinity Commercial |
$3,694.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,006.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$3,865.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: PHP Commercial |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| Rate for Payer: Priority Health SBD |
$2,706.18
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,706.18 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,792.09
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$3,006.87
|
| Rate for Payer: Cofinity Commercial |
$3,694.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,006.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$3,865.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,651.20
|
| Rate for Payer: PHP Commercial |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| Rate for Payer: Priority Health SBD |
$2,706.18
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
OP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: Aetna Medicare |
$2,856.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,712.90
|
| Rate for Payer: BCBS Complete |
$2,284.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$3,998.50
|
| Rate for Payer: Cofinity Commercial |
$4,912.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,998.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,140.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: PHP Commercial |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: Priority Health SBD |
$3,598.65
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
IP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,598.65 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,712.90
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$3,998.50
|
| Rate for Payer: Cofinity Commercial |
$4,912.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,998.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,140.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,855.33
|
| Rate for Payer: PHP Commercial |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: Priority Health SBD |
$3,598.65
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
OP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$596.52 |
| Rate for Payer: Aetna Commercial |
$563.38
|
| Rate for Payer: Aetna Medicare |
$331.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.82
|
| Rate for Payer: BCBS Complete |
$265.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$463.96
|
| Rate for Payer: Cofinity Commercial |
$570.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$596.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: PHP Commercial |
$563.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: Priority Health SBD |
$417.56
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
IP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.56 |
| Max. Negotiated Rate |
$596.52 |
| Rate for Payer: Aetna Commercial |
$563.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.82
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$463.96
|
| Rate for Payer: Cofinity Commercial |
$570.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$596.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: PHP Commercial |
$563.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: Priority Health SBD |
$417.56
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$52.64
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: BCBS Complete |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$36.24
|
| Rate for Payer: BCN Commercial |
$36.24
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna Medicare |
$74.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$49.38
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.38
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health SBD |
$93.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.21
|
|
|
HC HAI ESTABLISHED PATIENT LEVEL I
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health SBD |
$93.36
|
|
|
HC HAI PICC FLUSH
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$49.38
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.38
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.21
|
|
|
HC HAI PICC FLUSH
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.56
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$49.38
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.38
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health SBD |
$84.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.21
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.83 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.95
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health SBD |
$66.83
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCN Commercial |
$13.97
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Mclaren Medicaid |
$8.46
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: Meridian Medicaid |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.78
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Narrow Network |
$12.62
|
| Rate for Payer: Priority Health SBD |
$66.83
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: UHCCP Medicaid |
$8.88
|
| Rate for Payer: VA VA |
$15.78
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,003.99 |
| Max. Negotiated Rate |
$2,258.98 |
| Rate for Payer: Aetna Commercial |
$2,133.48
|
| Rate for Payer: Aetna Medicare |
$1,254.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.49
|
| Rate for Payer: BCBS Complete |
$1,003.99
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$1,756.99
|
| Rate for Payer: Cofinity Commercial |
$2,158.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: PHP Commercial |
$2,133.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health SBD |
$1,581.29
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,581.29 |
| Max. Negotiated Rate |
$2,258.98 |
| Rate for Payer: Aetna Commercial |
$2,133.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.49
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$1,756.99
|
| Rate for Payer: Cofinity Commercial |
$2,158.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,756.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: PHP Commercial |
$2,133.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health SBD |
$1,581.29
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,959.76 |
| Max. Negotiated Rate |
$5,656.80 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,085.46
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$4,399.73
|
| Rate for Payer: Cofinity Commercial |
$5,405.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,399.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: PHP Commercial |
$5,342.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: Priority Health SBD |
$3,959.76
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,514.13 |
| Max. Negotiated Rate |
$5,656.80 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Aetna Medicare |
$3,142.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,085.46
|
| Rate for Payer: BCBS Complete |
$2,514.13
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$4,399.73
|
| Rate for Payer: Cofinity Commercial |
$5,405.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,399.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: PHP Commercial |
$5,342.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: Priority Health SBD |
$3,959.76
|
|
