|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$549.09
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.41 |
| Max. Negotiated Rate |
$494.18 |
| Rate for Payer: Aetna Commercial |
$466.73
|
| Rate for Payer: Aetna Commercial |
$173.94
|
| Rate for Payer: Aetna Medicare |
$142.76
|
| Rate for Payer: Aetna Medicare |
$53.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.95
|
| Rate for Payer: BCBS Complete |
$81.85
|
| Rate for Payer: BCBS Complete |
$219.64
|
| Rate for Payer: BCBS MAPPO |
$51.16
|
| Rate for Payer: BCBS MAPPO |
$137.27
|
| Rate for Payer: BCBS Trust/PPO |
$451.41
|
| Rate for Payer: BCBS Trust/PPO |
$168.23
|
| Rate for Payer: BCN Commercial |
$426.92
|
| Rate for Payer: BCN Commercial |
$159.10
|
| Rate for Payer: BCN Medicare Advantage |
$137.27
|
| Rate for Payer: BCN Medicare Advantage |
$51.16
|
| Rate for Payer: Cash Price |
$439.27
|
| Rate for Payer: Cash Price |
$163.70
|
| Rate for Payer: Cofinity Commercial |
$175.98
|
| Rate for Payer: Cofinity Commercial |
$472.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.27
|
| Rate for Payer: Healthscope Commercial |
$184.17
|
| Rate for Payer: Healthscope Commercial |
$494.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.94
|
| Rate for Payer: Nomi Health Commercial |
$450.25
|
| Rate for Payer: Nomi Health Commercial |
$167.80
|
| Rate for Payer: PACE Senior Care Partners |
$130.41
|
| Rate for Payer: PACE Senior Care Partners |
$48.60
|
| Rate for Payer: PACE SWMI |
$137.27
|
| Rate for Payer: PACE SWMI |
$51.16
|
| Rate for Payer: PHP Commercial |
$466.73
|
| Rate for Payer: PHP Commercial |
$173.94
|
| Rate for Payer: PHP Medicare Advantage |
$51.16
|
| Rate for Payer: PHP Medicare Advantage |
$137.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.01
|
| Rate for Payer: Priority Health HMO/PPO |
$178.03
|
| Rate for Payer: Priority Health HMO/PPO |
$477.71
|
| Rate for Payer: Priority Health Medicare |
$138.65
|
| Rate for Payer: Priority Health Medicare |
$51.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.10
|
| Rate for Payer: Railroad Medicare Medicare |
$51.16
|
| Rate for Payer: Railroad Medicare Medicare |
$137.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.20
|
| Rate for Payer: UHC Core |
$458.49
|
| Rate for Payer: UHC Core |
$170.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.16
|
| Rate for Payer: UHC Exchange |
$51.16
|
| Rate for Payer: UHC Exchange |
$137.27
|
| Rate for Payer: UHC Medicare Advantage |
$51.16
|
| Rate for Payer: UHC Medicare Advantage |
$137.27
|
| Rate for Payer: VA VA |
$51.16
|
| Rate for Payer: VA VA |
$137.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.47
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$204.63
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$184.17 |
| Rate for Payer: Aetna Commercial |
$173.94
|
| Rate for Payer: Aetna Commercial |
$466.73
|
| Rate for Payer: BCBS Trust/PPO |
$167.04
|
| Rate for Payer: BCBS Trust/PPO |
$448.22
|
| Rate for Payer: BCN Commercial |
$158.14
|
| Rate for Payer: BCN Commercial |
$424.34
|
| Rate for Payer: Cash Price |
$163.70
|
| Rate for Payer: Cash Price |
$439.27
|
| Rate for Payer: Cofinity Commercial |
$472.22
|
| Rate for Payer: Cofinity Commercial |
$175.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.70
|
| Rate for Payer: Healthscope Commercial |
$184.17
|
| Rate for Payer: Healthscope Commercial |
$494.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.73
|
| Rate for Payer: Nomi Health Commercial |
$167.80
|
| Rate for Payer: Nomi Health Commercial |
$450.25
|
| Rate for Payer: PHP Commercial |
$173.94
|
| Rate for Payer: PHP Commercial |
$466.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.01
|
| Rate for Payer: Priority Health HMO/PPO |
$477.71
|
| Rate for Payer: Priority Health HMO/PPO |
$178.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.20
|
| Rate for Payer: UHC Core |
$170.87
|
| Rate for Payer: UHC Core |
$458.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.82
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$107.15
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna Commercial |
$91.08
|
| Rate for Payer: Aetna Medicare |
$27.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.48
|
| Rate for Payer: BCBS Complete |
$42.86
|
| Rate for Payer: BCBS MAPPO |
$26.79
|
| Rate for Payer: BCBS Trust/PPO |
$88.09
|
| Rate for Payer: BCN Commercial |
$83.31
|
| Rate for Payer: BCN Medicare Advantage |
$26.79
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cofinity Commercial |
$92.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.79
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.08
|
| Rate for Payer: Nomi Health Commercial |
$87.86
|
| Rate for Payer: PACE Senior Care Partners |
$25.45
|
| Rate for Payer: PACE SWMI |
$26.79
|
| Rate for Payer: PHP Commercial |
$91.08
|
| Rate for Payer: PHP Medicare Advantage |
$26.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.65
|
| Rate for Payer: Priority Health HMO/PPO |
$93.22
|
| Rate for Payer: Priority Health Medicare |
$27.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.79
|
| Rate for Payer: Railroad Medicare Medicare |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.29
|
| Rate for Payer: UHC Core |
$89.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.79
|
| Rate for Payer: UHC Exchange |
$26.79
|
| Rate for Payer: UHC Medicare Advantage |
$26.79
|
| Rate for Payer: VA VA |
$26.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.36
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$107.15
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Aetna Commercial |
$91.08
|
| Rate for Payer: BCBS Trust/PPO |
$87.47
|
| Rate for Payer: BCN Commercial |
$82.81
|
| Rate for Payer: Cash Price |
$85.72
|
| Rate for Payer: Cofinity Commercial |
$92.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.72
|
| Rate for Payer: Healthscope Commercial |
$96.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.08
|
| Rate for Payer: Nomi Health Commercial |
$87.86
|
| Rate for Payer: PHP Commercial |
$91.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.65
|
| Rate for Payer: Priority Health HMO/PPO |
$93.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.29
|
| Rate for Payer: UHC Core |
$89.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.36
|
|
|
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 |
$102.47 |
| Max. Negotiated Rate |
$388.31 |
| Rate for Payer: Aetna Commercial |
$366.74
|
| Rate for Payer: Aetna Medicare |
$112.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.83
|
| Rate for Payer: BCBS Complete |
$172.58
|
| Rate for Payer: BCBS MAPPO |
$107.86
|
| Rate for Payer: BCBS Trust/PPO |
$354.70
|
| Rate for Payer: BCN Commercial |
$335.46
|
| Rate for Payer: BCN Medicare Advantage |
$107.86
|
| Rate for Payer: Cash Price |
$345.17
|
| Rate for Payer: Cofinity Commercial |
$371.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.86
|
| Rate for Payer: Healthscope Commercial |
$388.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.74
|
| Rate for Payer: Nomi Health Commercial |
$353.80
|
| Rate for Payer: PACE Senior Care Partners |
$102.47
|
| Rate for Payer: PACE SWMI |
$107.86
|
| Rate for Payer: PHP Commercial |
$366.74
|
| Rate for Payer: PHP Medicare Advantage |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.45
|
| Rate for Payer: Priority Health HMO/PPO |
$375.37
|
| Rate for Payer: Priority Health Medicare |
$108.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.08
|
| Rate for Payer: Railroad Medicare Medicare |
$107.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.68
|
| Rate for Payer: UHC Core |
$360.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.86
|
| Rate for Payer: UHC Exchange |
$107.86
|
| Rate for Payer: UHC Medicare Advantage |
$107.86
|
| Rate for Payer: VA VA |
$107.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.60
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$5.47
|
|
|
Service Code
|
NDC 09900001820
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$4.47
|
| Rate for Payer: BCN Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Nomi Health Commercial |
$4.49
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.56
|
| Rate for Payer: Priority Health HMO/PPO |
$4.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.81
|
| Rate for Payer: UHC Core |
$4.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.10
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
NDC 54838050115
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$83.79 |
| Rate for Payer: Aetna Commercial |
$79.14
|
| Rate for Payer: BCBS Trust/PPO |
$76.00
|
| Rate for Payer: BCN Commercial |
$71.95
|
| Rate for Payer: Cash Price |
$74.48
|
| Rate for Payer: Cofinity Commercial |
$80.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.48
|
| Rate for Payer: Healthscope Commercial |
$83.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.14
|
| Rate for Payer: Nomi Health Commercial |
$76.34
|
| Rate for Payer: PHP Commercial |
$79.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.52
|
| Rate for Payer: Priority Health HMO/PPO |
$81.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.93
|
| Rate for Payer: UHC Core |
$77.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
|
|
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 |
$158.57 |
| Max. Negotiated Rate |
$219.56 |
| Rate for Payer: Aetna Commercial |
$207.37
|
| Rate for Payer: BCBS Trust/PPO |
$199.14
|
| Rate for Payer: BCN Commercial |
$188.53
|
| Rate for Payer: Cash Price |
$195.17
|
| Rate for Payer: Cofinity Commercial |
$209.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.17
|
| Rate for Payer: Healthscope Commercial |
$219.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.37
|
| Rate for Payer: Nomi Health Commercial |
$200.05
|
| Rate for Payer: PHP Commercial |
$207.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.57
|
| Rate for Payer: Priority Health HMO/PPO |
$212.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.68
|
| Rate for Payer: UHC Core |
$203.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.97
|
|
|
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 |
$57.94 |
| Max. Negotiated Rate |
$219.56 |
| Rate for Payer: Aetna Commercial |
$207.37
|
| Rate for Payer: Aetna Medicare |
$63.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.24
|
| Rate for Payer: BCBS Complete |
$97.58
|
| Rate for Payer: BCBS MAPPO |
$60.99
|
| Rate for Payer: BCBS Trust/PPO |
$200.56
|
| Rate for Payer: BCN Commercial |
$189.68
|
| Rate for Payer: BCN Medicare Advantage |
$60.99
|
| Rate for Payer: Cash Price |
$195.17
|
| Rate for Payer: Cofinity Commercial |
$209.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.99
|
| Rate for Payer: Healthscope Commercial |
$219.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.37
|
| Rate for Payer: Nomi Health Commercial |
$200.05
|
| Rate for Payer: PACE Senior Care Partners |
$57.94
|
| Rate for Payer: PACE SWMI |
$60.99
|
| Rate for Payer: PHP Commercial |
$207.37
|
| Rate for Payer: PHP Medicare Advantage |
$60.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.57
|
| Rate for Payer: Priority Health HMO/PPO |
$212.25
|
| Rate for Payer: Priority Health Medicare |
$61.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.45
|
| Rate for Payer: Railroad Medicare Medicare |
$60.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.68
|
| Rate for Payer: UHC Core |
$203.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.99
|
| Rate for Payer: UHC Exchange |
$60.99
|
| Rate for Payer: UHC Medicare Advantage |
$60.99
|
| Rate for Payer: VA VA |
$60.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.97
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$93.10
|
|
|
Service Code
|
NDC 54838050115
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$83.79 |
| Rate for Payer: Aetna Commercial |
$79.14
|
| Rate for Payer: Aetna Medicare |
$24.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.09
|
| Rate for Payer: BCBS Complete |
$37.24
|
| Rate for Payer: BCBS MAPPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$76.54
|
| Rate for Payer: BCN Commercial |
$72.39
|
| Rate for Payer: BCN Medicare Advantage |
$23.28
|
| Rate for Payer: Cash Price |
$74.48
|
| Rate for Payer: Cofinity Commercial |
$80.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.28
|
| Rate for Payer: Healthscope Commercial |
$83.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.14
|
| Rate for Payer: Nomi Health Commercial |
$76.34
|
| Rate for Payer: PACE Senior Care Partners |
$22.11
|
| Rate for Payer: PACE SWMI |
$23.28
|
| Rate for Payer: PHP Commercial |
$79.14
|
| Rate for Payer: PHP Medicare Advantage |
$23.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.52
|
| Rate for Payer: Priority Health HMO/PPO |
$81.00
|
| Rate for Payer: Priority Health Medicare |
$23.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.38
|
| Rate for Payer: Railroad Medicare Medicare |
$23.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.93
|
| Rate for Payer: UHC Core |
$77.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.28
|
| Rate for Payer: UHC Exchange |
$23.28
|
| Rate for Payer: UHC Medicare Advantage |
$23.28
|
| Rate for Payer: VA VA |
$23.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
OP
|
$5.47
|
|
|
Service Code
|
NDC 09900001820
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.71
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.50
|
| Rate for Payer: BCN Commercial |
$4.25
|
| Rate for Payer: BCN Medicare Advantage |
$1.37
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Nomi Health Commercial |
$4.49
|
| Rate for Payer: PACE Senior Care Partners |
$1.30
|
| Rate for Payer: PACE SWMI |
$1.37
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.56
|
| Rate for Payer: Priority Health HMO/PPO |
$4.76
|
| Rate for Payer: Priority Health Medicare |
$1.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.81
|
| Rate for Payer: UHC Core |
$4.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Medicare Advantage |
$1.37
|
| Rate for Payer: VA VA |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.10
|
|
|
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 |
$280.45 |
| Max. Negotiated Rate |
$388.31 |
| Rate for Payer: Aetna Commercial |
$366.74
|
| Rate for Payer: BCBS Trust/PPO |
$352.20
|
| Rate for Payer: BCN Commercial |
$333.43
|
| Rate for Payer: Cash Price |
$345.17
|
| Rate for Payer: Cofinity Commercial |
$371.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.17
|
| Rate for Payer: Healthscope Commercial |
$388.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.74
|
| Rate for Payer: Nomi Health Commercial |
$353.80
|
| Rate for Payer: PHP Commercial |
$366.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.45
|
| Rate for Payer: Priority Health HMO/PPO |
$375.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.68
|
| Rate for Payer: UHC Core |
$360.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.60
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.53
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: Aetna Medicare |
$3.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.73
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS Complete |
$4.21
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$2.63
|
| Rate for Payer: BCBS MAPPO |
$3.22
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCBS Trust/PPO |
$12.45
|
| Rate for Payer: BCN Commercial |
$10.01
|
| Rate for Payer: BCN Commercial |
$11.78
|
| Rate for Payer: BCN Commercial |
$8.19
|
| Rate for Payer: BCN Medicare Advantage |
$2.63
|
| Rate for Payer: BCN Medicare Advantage |
$3.22
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.95
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: PACE Senior Care Partners |
$3.60
|
| Rate for Payer: PACE Senior Care Partners |
$2.50
|
| Rate for Payer: PACE Senior Care Partners |
$3.06
|
| Rate for Payer: PACE SWMI |
$3.22
|
| Rate for Payer: PACE SWMI |
$2.63
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: PHP Medicare Advantage |
$3.22
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: PHP Medicare Advantage |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| 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 HMO/PPO |
$13.18
|
| Rate for Payer: Priority Health HMO/PPO |
$9.16
|
| Rate for Payer: Priority Health HMO/PPO |
$11.21
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Priority Health Medicare |
$3.83
|
| Rate for Payer: Priority Health Medicare |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3.22
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.27
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: UHC Core |
$8.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.22
|
| Rate for Payer: UHC Exchange |
$3.22
|
| Rate for Payer: UHC Exchange |
$2.63
|
| Rate for Payer: UHC Exchange |
$3.79
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
| Rate for Payer: UHC Medicare Advantage |
$3.22
|
| Rate for Payer: UHC Medicare Advantage |
$3.79
|
| Rate for Payer: VA VA |
$3.22
|
| Rate for Payer: VA VA |
$3.79
|
| Rate for Payer: VA VA |
$2.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.53
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$10.51
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.37
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| 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 |
$12.88
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Nomi Health Commercial |
$12.42
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health HMO/PPO |
$13.18
|
| Rate for Payer: Priority Health HMO/PPO |
$11.21
|
| Rate for Payer: Priority Health HMO/PPO |
$9.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.27
|
| Rate for Payer: UHC Core |
$8.79
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: BCBS Trust/PPO |
$53.51
|
| Rate for Payer: BCN Commercial |
$50.66
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.68
|
| Rate for Payer: UHC Core |
$54.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: BCBS Complete |
$22.23
|
| Rate for Payer: BCBS MAPPO |
$16.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.89
|
| Rate for Payer: BCN Commercial |
$50.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.39
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Mclaren Medicaid |
$21.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.21
|
| Rate for Payer: Meridian Medicaid |
$22.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.57
|
| Rate for Payer: PACE SWMI |
$16.39
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.03
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.68
|
| Rate for Payer: UHC Core |
$54.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.39
|
| Rate for Payer: UHC Exchange |
$16.39
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| Rate for Payer: UHCCP Medicaid |
$21.17
|
| Rate for Payer: VA VA |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$6.89
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Aetna Commercial |
$5.86
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.15
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$5.66
|
| Rate for Payer: BCN Commercial |
$5.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.72
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$5.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.86
|
| Rate for Payer: Nomi Health Commercial |
$5.65
|
| Rate for Payer: PACE Senior Care Partners |
$1.64
|
| Rate for Payer: PACE SWMI |
$1.72
|
| Rate for Payer: PHP Commercial |
$5.86
|
| Rate for Payer: PHP Medicare Advantage |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: Priority Health HMO/PPO |
$5.99
|
| Rate for Payer: Priority Health Medicare |
$1.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Core |
$5.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Medicare Advantage |
$1.72
|
| Rate for Payer: VA VA |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.17
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$6.89
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Aetna Commercial |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.62
|
| Rate for Payer: BCN Commercial |
$5.32
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cofinity Commercial |
$5.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.86
|
| Rate for Payer: Nomi Health Commercial |
$5.65
|
| Rate for Payer: PHP Commercial |
$5.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.48
|
| Rate for Payer: Priority Health HMO/PPO |
$5.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Core |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.17
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.97 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: BCBS Trust/PPO |
$227.27
|
| Rate for Payer: BCN Commercial |
$215.16
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: Nomi Health Commercial |
$228.30
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health HMO/PPO |
$242.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.00
|
| Rate for Payer: UHC Core |
$232.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.81
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$278.41
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna Medicare |
$72.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.00
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: BCBS MAPPO |
$69.60
|
| Rate for Payer: BCBS Trust/PPO |
$228.88
|
| Rate for Payer: BCN Commercial |
$216.46
|
| Rate for Payer: BCN Medicare Advantage |
$69.60
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.60
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.65
|
| Rate for Payer: Nomi Health Commercial |
$228.30
|
| Rate for Payer: PACE Senior Care Partners |
$66.12
|
| Rate for Payer: PACE SWMI |
$69.60
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: PHP Medicare Advantage |
$69.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.97
|
| Rate for Payer: Priority Health HMO/PPO |
$242.22
|
| Rate for Payer: Priority Health Medicare |
$70.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.53
|
| Rate for Payer: Railroad Medicare Medicare |
$69.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.00
|
| Rate for Payer: UHC Core |
$232.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.60
|
| Rate for Payer: UHC Exchange |
$69.60
|
| Rate for Payer: UHC Medicare Advantage |
$69.60
|
| Rate for Payer: VA VA |
$69.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.81
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$19.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.41
|
| Rate for Payer: BCBS Complete |
$31.71
|
| Rate for Payer: BCBS MAPPO |
$18.73
|
| Rate for Payer: BCBS Trust/PPO |
$61.58
|
| Rate for Payer: BCN Commercial |
$58.24
|
| Rate for Payer: BCN Medicare Advantage |
$18.73
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.73
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$30.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.66
|
| Rate for Payer: Meridian Medicaid |
$31.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: PACE Senior Care Partners |
$17.79
|
| Rate for Payer: PACE SWMI |
$18.73
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: PHP Medicare Advantage |
$18.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health HMO/PPO |
$65.17
|
| Rate for Payer: Priority Health Medicare |
$18.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.92
|
| Rate for Payer: UHC Core |
$62.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.73
|
| Rate for Payer: UHC Exchange |
$18.73
|
| Rate for Payer: UHC Medicare Advantage |
$18.73
|
| Rate for Payer: UHCCP Medicaid |
$30.20
|
| Rate for Payer: VA VA |
$18.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.18
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.15
|
| Rate for Payer: BCN Commercial |
$57.89
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health HMO/PPO |
$65.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.92
|
| Rate for Payer: UHC Core |
$62.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.18
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: Aetna Medicare |
$22.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.16
|
| Rate for Payer: BCBS Complete |
$31.71
|
| Rate for Payer: BCBS MAPPO |
$21.73
|
| Rate for Payer: BCBS Trust/PPO |
$71.45
|
| Rate for Payer: BCN Commercial |
$67.57
|
| Rate for Payer: BCN Medicare Advantage |
$21.73
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.18
|
| Rate for Payer: Mclaren Medicaid |
$30.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.81
|
| Rate for Payer: Meridian Medicaid |
$31.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: PACE Senior Care Partners |
$20.64
|
| Rate for Payer: PACE SWMI |
$21.73
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health HMO/PPO |
$75.61
|
| Rate for Payer: Priority Health Medicare |
$21.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.23
|
| Rate for Payer: Railroad Medicare Medicare |
$21.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.48
|
| Rate for Payer: UHC Core |
$72.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.73
|
| Rate for Payer: UHC Exchange |
$21.73
|
| Rate for Payer: UHC Medicare Advantage |
$21.73
|
| Rate for Payer: UHCCP Medicaid |
$30.20
|
| Rate for Payer: VA VA |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.18
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$86.91
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Aetna Commercial |
$73.87
|
| Rate for Payer: BCBS Trust/PPO |
$70.94
|
| Rate for Payer: BCN Commercial |
$67.16
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: Cofinity Commercial |
$74.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.53
|
| Rate for Payer: Healthscope Commercial |
$78.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.87
|
| Rate for Payer: Nomi Health Commercial |
$71.27
|
| Rate for Payer: PHP Commercial |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.49
|
| Rate for Payer: Priority Health HMO/PPO |
$75.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.48
|
| Rate for Payer: UHC Core |
$72.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.18
|
|
|
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 |
$368.63 |
| Max. Negotiated Rate |
$1,396.93 |
| Rate for Payer: Aetna Commercial |
$1,319.32
|
| Rate for Payer: Aetna Medicare |
$403.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$485.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$485.04
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$388.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,276.01
|
| Rate for Payer: BCN Commercial |
$1,206.79
|
| Rate for Payer: BCN Medicare Advantage |
$388.04
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cash Price |
$1,241.71
|
| Rate for Payer: Cofinity Commercial |
$1,334.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,241.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.04
|
| Rate for Payer: Healthscope Commercial |
$1,396.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,164.10
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.44
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$446.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.32
|
| Rate for Payer: Nomi Health Commercial |
$1,272.75
|
| Rate for Payer: PACE Senior Care Partners |
$368.63
|
| Rate for Payer: PACE SWMI |
$388.04
|
| Rate for Payer: PHP Commercial |
$1,319.32
|
| Rate for Payer: PHP Medicare Advantage |
$388.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.89
|
| Rate for Payer: Priority Health HMO/PPO |
$1,350.36
|
| Rate for Payer: Priority Health Medicare |
$391.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,039.93
|
| Rate for Payer: Railroad Medicare Medicare |
$388.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,365.88
|
| Rate for Payer: UHC Core |
$1,296.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.04
|
| Rate for Payer: UHC Exchange |
$388.04
|
| Rate for Payer: UHC Medicare Advantage |
$388.04
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$388.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,164.10
|
|
