|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
NDC 904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.52 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: ASR ASR |
$364.10
|
| Rate for Payer: BCBS Trust/PPO |
$308.25
|
| Rate for Payer: BCN Commercial |
$308.25
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$352.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$364.10
|
| Rate for Payer: Healthscope Whirlpool |
$375.36
|
| Rate for Payer: Mclaren Commercial |
$337.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.32
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$375.36
|
|
|
Service Code
|
NDC 904678261
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.88 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: Aetna Medicare |
$138.88
|
| Rate for Payer: ASR ASR |
$364.10
|
| Rate for Payer: BCBS Complete |
$150.14
|
| Rate for Payer: BCBS Trust/PPO |
$309.48
|
| Rate for Payer: BCN Commercial |
$309.48
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$352.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$364.10
|
| Rate for Payer: Healthscope Whirlpool |
$375.36
|
| Rate for Payer: Mclaren Commercial |
$337.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.06
|
| Rate for Payer: Nomi Health Commercial |
$307.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$328.89
|
| Rate for Payer: Priority Health Narrow Network |
$263.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$330.32
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$107.14
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$96.43
|
| Rate for Payer: Aetna Medicare |
$39.64
|
| Rate for Payer: ASR ASR |
$103.93
|
| Rate for Payer: BCBS Complete |
$42.86
|
| Rate for Payer: BCBS Trust/PPO |
$88.34
|
| Rate for Payer: BCN Commercial |
$88.34
|
| Rate for Payer: Cash Price |
$85.71
|
| Rate for Payer: Cash Price |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$100.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.71
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Healthscope Whirlpool |
$107.14
|
| Rate for Payer: Mclaren Commercial |
$96.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.07
|
| Rate for Payer: Nomi Health Commercial |
$87.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.09
|
| Rate for Payer: Priority Health Narrow Network |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.29
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$107.14
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$96.43
|
| Rate for Payer: ASR ASR |
$103.93
|
| Rate for Payer: BCBS Trust/PPO |
$87.99
|
| Rate for Payer: BCN Commercial |
$87.99
|
| Rate for Payer: Cash Price |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$100.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.71
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Healthscope Whirlpool |
$107.14
|
| Rate for Payer: Mclaren Commercial |
$96.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.07
|
| Rate for Payer: Nomi Health Commercial |
$87.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.29
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Commercial |
$10.67
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$4.39
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: ASR ASR |
$23.36
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: ASR ASR |
$11.51
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: BCBS Complete |
$4.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.78
|
| Rate for Payer: BCBS Trust/PPO |
$19.86
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: BCN Commercial |
$9.78
|
| Rate for Payer: BCN Commercial |
$19.86
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$23.36
|
| Rate for Payer: Healthscope Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.51
|
| Rate for Payer: Healthscope Whirlpool |
$11.86
|
| Rate for Payer: Healthscope Whirlpool |
$10.66
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$21.68
|
| Rate for Payer: Mclaren Commercial |
$10.67
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Nomi Health Commercial |
$8.74
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.76
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: Priority Health Narrow Network |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.66
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Commercial |
$10.67
|
| Rate for Payer: ASR ASR |
$23.36
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: ASR ASR |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$19.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$9.74
|
| Rate for Payer: BCN Commercial |
$9.74
|
| Rate for Payer: BCN Commercial |
$8.75
|
| Rate for Payer: BCN Commercial |
$19.78
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Healthscope Commercial |
$11.51
|
| Rate for Payer: Healthscope Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$23.36
|
| Rate for Payer: Healthscope Whirlpool |
$11.86
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.66
|
| Rate for Payer: Mclaren Commercial |
$10.67
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: Mclaren Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.06
|
| Rate for Payer: Nomi Health Commercial |
$9.73
|
| Rate for Payer: Nomi Health Commercial |
$8.74
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$7,311.05
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$6,610.06 |
| Max. Negotiated Rate |
$7,311.05 |
| Rate for Payer: BCBS Complete |
$7,311.05
|
| Rate for Payer: Mclaren Medicaid |
$6,962.90
|
| Rate for Payer: Meridian Medicaid |
$7,311.05
|
| Rate for Payer: PHP Medicaid |
$6,610.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,962.90
|
| Rate for Payer: UHC Medicaid |
$6,962.90
|
| Rate for Payer: UHCCP Medicaid |
$6,962.90
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$6,666.92
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$6,027.69 |
| Max. Negotiated Rate |
$6,666.92 |
| Rate for Payer: BCBS Complete |
$6,666.92
|
| Rate for Payer: Mclaren Medicaid |
$6,349.45
|
| Rate for Payer: Meridian Medicaid |
$6,666.92
|
| Rate for Payer: PHP Medicaid |
$6,027.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,349.45
|
| Rate for Payer: UHC Medicaid |
$6,349.45
|
| Rate for Payer: UHCCP Medicaid |
$6,349.45
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$11,325.15
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$10,239.29 |
| Max. Negotiated Rate |
$11,325.15 |
| Rate for Payer: BCBS Complete |
$11,325.15
|
| Rate for Payer: Mclaren Medicaid |
$10,785.86
|
| Rate for Payer: Meridian Medicaid |
$11,325.15
|
| Rate for Payer: PHP Medicaid |
$10,239.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,785.86
|
| Rate for Payer: UHC Medicaid |
$10,785.86
|
| Rate for Payer: UHCCP Medicaid |
$10,785.86
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$16,045.51
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$14,507.06 |
| Max. Negotiated Rate |
$16,045.51 |
| Rate for Payer: BCBS Complete |
$16,045.51
|
| Rate for Payer: Mclaren Medicaid |
$15,281.44
|
| Rate for Payer: Meridian Medicaid |
$16,045.51
|
| Rate for Payer: PHP Medicaid |
$14,507.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,281.44
|
| Rate for Payer: UHC Medicaid |
$15,281.44
|
| Rate for Payer: UHCCP Medicaid |
$15,281.44
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$21,628.99
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$12,436.80 |
| Max. Negotiated Rate |
$21,628.99 |
| Rate for Payer: Aetna Medicare |
$13,091.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,364.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,364.21
|
| Rate for Payer: BCBS MAPPO |
$13,091.37
|
| Rate for Payer: BCN Medicare Advantage |
$13,091.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,091.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,091.37
|
| Rate for Payer: Mclaren Medicare |
$13,091.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,745.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,055.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,400.51
|
| Rate for Payer: PACE Medicare |
$12,436.80
|
| Rate for Payer: PACE SWMI |
$13,091.37
|
| Rate for Payer: PHP Commercial |
$14,400.51
|
| Rate for Payer: PHP Medicare Advantage |
$13,091.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21,628.99
|
| Rate for Payer: Priority Health Medicare |
$13,091.37
|
| Rate for Payer: Priority Health Narrow Network |
$17,303.19
|
| Rate for Payer: Railroad Medicare Medicare |
$13,091.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,091.37
|
| Rate for Payer: UHC Exchange |
$20,291.62
|
| Rate for Payer: UHCCP DNSP |
$13,091.37
|
| Rate for Payer: VA VA |
$13,091.37
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,130.26
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$8,660.49 |
| Max. Negotiated Rate |
$14,130.26 |
| Rate for Payer: Aetna Medicare |
$9,116.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,395.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,395.38
|
| Rate for Payer: BCBS MAPPO |
$9,116.30
|
| Rate for Payer: BCN Medicare Advantage |
$9,116.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,116.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,116.30
|
| Rate for Payer: Mclaren Medicare |
$9,116.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,572.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,483.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,027.93
|
| Rate for Payer: PACE Medicare |
$8,660.49
|
| Rate for Payer: PACE SWMI |
$9,116.30
|
| Rate for Payer: PHP Commercial |
$10,027.93
|
| Rate for Payer: PHP Medicare Advantage |
$9,116.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,045.18
|
| Rate for Payer: Priority Health Medicare |
$9,116.30
|
| Rate for Payer: Priority Health Narrow Network |
$11,236.14
|
| Rate for Payer: Railroad Medicare Medicare |
$9,116.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,116.30
|
| Rate for Payer: UHC Exchange |
$14,130.26
|
| Rate for Payer: UHCCP DNSP |
$9,116.30
|
| Rate for Payer: VA VA |
$9,116.30
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$26,987.12
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$15,104.87 |
| Max. Negotiated Rate |
$26,987.12 |
| Rate for Payer: Aetna Medicare |
$15,899.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,874.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,874.83
|
| Rate for Payer: BCBS MAPPO |
$15,899.86
|
| Rate for Payer: BCN Medicare Advantage |
$15,899.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,899.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,899.86
|
| Rate for Payer: Mclaren Medicare |
$15,899.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,694.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,284.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,489.85
|
| Rate for Payer: PACE Medicare |
$15,104.87
|
| Rate for Payer: PACE SWMI |
$15,899.86
|
| Rate for Payer: PHP Commercial |
$17,489.85
|
| Rate for Payer: PHP Medicare Advantage |
$15,899.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,987.12
|
| Rate for Payer: Priority Health Medicare |
$15,899.86
|
| Rate for Payer: Priority Health Narrow Network |
$21,589.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15,899.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,899.86
|
| Rate for Payer: UHC Exchange |
$24,644.78
|
| Rate for Payer: UHCCP DNSP |
$15,899.86
|
| Rate for Payer: VA VA |
$15,899.86
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$66.86
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$60.17
|
| Rate for Payer: Aetna Medicare |
$29.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.60
|
| Rate for Payer: ASR ASR |
$64.85
|
| Rate for Payer: BCBS Complete |
$16.08
|
| Rate for Payer: BCBS MAPPO |
$29.28
|
| Rate for Payer: BCBS Trust/PPO |
$55.13
|
| Rate for Payer: BCN Commercial |
$55.13
|
| Rate for Payer: BCN Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.28
|
| Rate for Payer: Healthscope Commercial |
$64.85
|
| Rate for Payer: Healthscope Whirlpool |
$66.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.28
|
| Rate for Payer: Mclaren Commercial |
$60.17
|
| Rate for Payer: Mclaren Medicaid |
$29.28
|
| 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 |
$16.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PACE Medicare |
$27.82
|
| Rate for Payer: PACE SWMI |
$29.28
|
| Rate for Payer: PHP Commercial |
$32.21
|
| Rate for Payer: PHP Medicaid |
$15.69
|
| Rate for Payer: PHP Medicare Advantage |
$29.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.58
|
| Rate for Payer: Priority Health Medicare |
$29.28
|
| Rate for Payer: Priority Health Narrow Network |
$46.87
|
| Rate for Payer: Railroad Medicare Medicare |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.28
|
| Rate for Payer: UHC Exchange |
$45.38
|
| Rate for Payer: UHC Medicaid |
$15.31
|
| Rate for Payer: UHCCP DNSP |
$29.28
|
| Rate for Payer: UHCCP Medicaid |
$15.31
|
| Rate for Payer: VA VA |
$29.28
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$60.17
|
| Rate for Payer: ASR ASR |
$64.85
|
| Rate for Payer: BCBS Trust/PPO |
$54.91
|
| Rate for Payer: BCN Commercial |
$54.91
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Commercial |
$62.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Healthscope Commercial |
$64.85
|
| Rate for Payer: Healthscope Whirlpool |
$66.86
|
| Rate for Payer: Mclaren Commercial |
$60.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.84
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$7.03
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: ASR ASR |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.77
|
| Rate for Payer: BCN Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Healthscope Whirlpool |
$7.03
|
| Rate for Payer: Mclaren Commercial |
$6.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.98
|
| Rate for Payer: Nomi Health Commercial |
$5.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.19
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$7.03
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: ASR ASR |
$6.82
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cofinity Commercial |
$6.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Healthscope Whirlpool |
$7.03
|
| Rate for Payer: Mclaren Commercial |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.98
|
| Rate for Payer: Nomi Health Commercial |
$5.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.16
|
| Rate for Payer: Priority Health Narrow Network |
$4.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.19
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$283.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.99 |
| Max. Negotiated Rate |
$283.98 |
| Rate for Payer: Aetna Commercial |
$255.58
|
| Rate for Payer: ASR ASR |
$275.46
|
| Rate for Payer: BCBS Trust/PPO |
$233.20
|
| Rate for Payer: BCN Commercial |
$233.20
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cofinity Commercial |
$266.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.18
|
| Rate for Payer: Healthscope Commercial |
$275.46
|
| Rate for Payer: Healthscope Whirlpool |
$283.98
|
| Rate for Payer: Mclaren Commercial |
$255.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.38
|
| Rate for Payer: Nomi Health Commercial |
$232.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.90
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$283.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$283.98 |
| Rate for Payer: Aetna Commercial |
$255.58
|
| Rate for Payer: Aetna Medicare |
$105.07
|
| Rate for Payer: ASR ASR |
$275.46
|
| Rate for Payer: BCBS Complete |
$113.59
|
| Rate for Payer: BCBS Trust/PPO |
$234.14
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: Cash Price |
$227.18
|
| Rate for Payer: Cofinity Commercial |
$266.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.18
|
| Rate for Payer: Healthscope Commercial |
$275.46
|
| Rate for Payer: Healthscope Whirlpool |
$283.98
|
| Rate for Payer: Mclaren Commercial |
$255.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.38
|
| Rate for Payer: Nomi Health Commercial |
$232.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$248.82
|
| Rate for Payer: Priority Health Narrow Network |
$199.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.90
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$76.41
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$76.41 |
| Rate for Payer: Aetna Commercial |
$68.77
|
| Rate for Payer: ASR ASR |
$74.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.75
|
| Rate for Payer: BCN Commercial |
$62.75
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Commercial |
$71.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$76.41
|
| Rate for Payer: Mclaren Commercial |
$68.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.24
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$76.41
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$76.41 |
| Rate for Payer: Aetna Commercial |
$68.77
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: ASR ASR |
$74.12
|
| Rate for Payer: BCBS Complete |
$22.94
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$63.00
|
| Rate for Payer: BCN Commercial |
$63.00
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cofinity Commercial |
$71.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$74.12
|
| Rate for Payer: Healthscope Whirlpool |
$76.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$68.77
|
| Rate for Payer: Mclaren Medicaid |
$41.77
|
| 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 |
$22.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$62.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.31
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicaid |
$22.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$53.56
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.77
|
| Rate for Payer: UHC Exchange |
$64.74
|
| Rate for Payer: UHC Medicaid |
$21.85
|
| Rate for Payer: UHCCP DNSP |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$21.85
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$88.65
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Aetna Commercial |
$79.78
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: ASR ASR |
$85.99
|
| Rate for Payer: BCBS Complete |
$22.94
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$73.09
|
| Rate for Payer: BCN Commercial |
$73.09
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$70.92
|
| Rate for Payer: Cash Price |
$70.92
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$85.99
|
| Rate for Payer: Healthscope Whirlpool |
$88.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$79.78
|
| Rate for Payer: Mclaren Medicaid |
$41.77
|
| 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 |
$22.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.35
|
| Rate for Payer: Nomi Health Commercial |
$72.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.49
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicaid |
$22.39
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77.68
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$62.14
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.77
|
| Rate for Payer: UHC Exchange |
$64.74
|
| Rate for Payer: UHC Medicaid |
$21.85
|
| Rate for Payer: UHCCP DNSP |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$21.85
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$88.65
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Aetna Commercial |
$79.78
|
| Rate for Payer: ASR ASR |
$85.99
|
| Rate for Payer: BCBS Trust/PPO |
$72.80
|
| Rate for Payer: BCN Commercial |
$72.80
|
| Rate for Payer: Cash Price |
$70.92
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.92
|
| Rate for Payer: Healthscope Commercial |
$85.99
|
| Rate for Payer: Healthscope Whirlpool |
$88.65
|
| Rate for Payer: Mclaren Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.35
|
| Rate for Payer: Nomi Health Commercial |
$72.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.01
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,583.18
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,187.38 |
| Max. Negotiated Rate |
$1,583.18 |
| Rate for Payer: Aetna Commercial |
$1,424.86
|
| Rate for Payer: ASR ASR |
$1,535.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.11
|
| Rate for Payer: BCN Commercial |
$1,300.11
|
| Rate for Payer: Cash Price |
$1,266.54
|
| Rate for Payer: Cofinity Commercial |
$1,488.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.54
|
| Rate for Payer: Healthscope Commercial |
$1,535.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.18
|
| Rate for Payer: Mclaren Commercial |
$1,424.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.70
|
| Rate for Payer: Nomi Health Commercial |
$1,298.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.20
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,583.18
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,583.18 |
| Rate for Payer: Aetna Commercial |
$1,424.86
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,535.68
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.33
|
| Rate for Payer: BCN Commercial |
$1,305.33
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,266.54
|
| Rate for Payer: Cash Price |
$1,266.54
|
| Rate for Payer: Cofinity Commercial |
$1,488.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,535.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,583.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$1,424.86
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.70
|
| Rate for Payer: Nomi Health Commercial |
$1,298.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.38
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,387.18
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.81
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
