|
HC GUIDING CATHETER LVL 3
|
Facility
|
IP
|
$330.88
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.62 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna Commercial |
$297.79
|
| Rate for Payer: ASR ASR |
$320.95
|
| Rate for Payer: BCBS Trust/PPO |
$256.53
|
| Rate for Payer: BCN Commercial |
$256.53
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$311.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Healthscope Whirlpool |
$320.95
|
| Rate for Payer: Mclaren Commercial |
$297.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.17
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
OP
|
$3,522.11
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,408.84 |
| Max. Negotiated Rate |
$3,522.11 |
| Rate for Payer: Aetna Commercial |
$3,169.90
|
| Rate for Payer: ASR ASR |
$3,416.45
|
| Rate for Payer: BCBS Complete |
$1,408.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,730.69
|
| Rate for Payer: BCN Commercial |
$2,730.69
|
| Rate for Payer: Cash Price |
$2,817.69
|
| Rate for Payer: Cofinity Commercial |
$3,310.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,817.69
|
| Rate for Payer: Healthscope Commercial |
$3,522.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,416.45
|
| Rate for Payer: Mclaren Commercial |
$3,169.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,993.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,465.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,205.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,500.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,099.46
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,522.11
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.48 |
| Max. Negotiated Rate |
$3,522.11 |
| Rate for Payer: Aetna Commercial |
$3,169.90
|
| Rate for Payer: ASR ASR |
$3,416.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,730.69
|
| Rate for Payer: BCN Commercial |
$2,730.69
|
| Rate for Payer: Cash Price |
$2,817.69
|
| Rate for Payer: Cofinity Commercial |
$3,310.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,817.69
|
| Rate for Payer: Healthscope Commercial |
$3,522.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,416.45
|
| Rate for Payer: Mclaren Commercial |
$3,169.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,993.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,465.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,099.46
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$480.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$480.90 |
| Rate for Payer: Aetna Commercial |
$432.81
|
| Rate for Payer: ASR ASR |
$466.47
|
| Rate for Payer: BCBS Trust/PPO |
$372.84
|
| Rate for Payer: BCN Commercial |
$372.84
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$452.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$480.90
|
| Rate for Payer: Healthscope Whirlpool |
$466.47
|
| Rate for Payer: Mclaren Commercial |
$432.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.19
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
OP
|
$480.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$480.90 |
| Rate for Payer: Aetna Commercial |
$432.81
|
| Rate for Payer: ASR ASR |
$466.47
|
| Rate for Payer: BCBS Complete |
$192.36
|
| Rate for Payer: BCBS Trust/PPO |
$372.84
|
| Rate for Payer: BCN Commercial |
$372.84
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$452.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$480.90
|
| Rate for Payer: Healthscope Whirlpool |
$466.47
|
| Rate for Payer: Mclaren Commercial |
$432.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.62
|
| Rate for Payer: Priority Health Narrow Network |
$341.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.19
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,006.87 |
| Max. Negotiated Rate |
$4,295.53 |
| Rate for Payer: Aetna Commercial |
$3,865.98
|
| Rate for Payer: ASR ASR |
$4,166.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,330.32
|
| Rate for Payer: BCN Commercial |
$3,330.32
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$4,037.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$4,295.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,166.66
|
| Rate for Payer: Mclaren Commercial |
$3,865.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,006.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,780.07
|
|
|
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 |
$4,295.53 |
| Rate for Payer: Aetna Commercial |
$3,865.98
|
| Rate for Payer: ASR ASR |
$4,166.66
|
| Rate for Payer: BCBS Complete |
$1,718.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,330.32
|
| Rate for Payer: BCN Commercial |
$3,330.32
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$4,037.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$4,295.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,166.66
|
| Rate for Payer: Mclaren Commercial |
$3,865.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,006.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,908.93
|
| Rate for Payer: Priority Health Narrow Network |
$3,049.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,780.07
|
|
|
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 |
$3,998.50 |
| Max. Negotiated Rate |
$5,712.15 |
| Rate for Payer: Aetna Commercial |
$5,140.94
|
| Rate for Payer: ASR ASR |
$5,540.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,428.63
|
| Rate for Payer: BCN Commercial |
$4,428.63
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$5,369.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,712.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,540.79
|
| Rate for Payer: Mclaren Commercial |
$5,140.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,998.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,026.69
|
|
|
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 |
$2,284.86 |
| Max. Negotiated Rate |
$5,712.15 |
| Rate for Payer: Aetna Commercial |
$5,140.94
|
| Rate for Payer: ASR ASR |
$5,540.79
|
| Rate for Payer: BCBS Complete |
$2,284.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,428.63
|
| Rate for Payer: BCN Commercial |
$4,428.63
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$5,369.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,712.15
|
| Rate for Payer: Healthscope Whirlpool |
$5,540.79
|
| Rate for Payer: Mclaren Commercial |
$5,140.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,998.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,198.06
|
| Rate for Payer: Priority Health Narrow Network |
$4,055.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,026.69
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.70
|
| Rate for Payer: Priority Health Narrow Network |
$23.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: ASR ASR |
$31.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.31
|
| Rate for Payer: BCN Commercial |
$25.31
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$30.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.66
|
| Rate for Payer: Mclaren Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.72
|
|
|
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 |
$22.00 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$114.89
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
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 |
$103.73 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: BCBS Trust/PPO |
$114.89
|
| Rate for Payer: BCN Commercial |
$114.89
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$148.19
|
| Rate for Payer: Healthscope Whirlpool |
$143.74
|
| Rate for Payer: Mclaren Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.41
|
|
|
HC HAI PICC FLUSH
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HAI PICC FLUSH
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HAI PORTA CATH ACCESS
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$126.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$134.71
|
| Rate for Payer: Healthscope Whirlpool |
$130.67
|
| Rate for Payer: Mclaren Commercial |
$121.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Medicare |
$15.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.72
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$80.63
|
| Rate for Payer: BCN Commercial |
$80.63
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$104.00
|
| Rate for Payer: Healthscope Whirlpool |
$100.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.78
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Medicaid |
$9.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.40
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$17.36
|
| Rate for Payer: PHP Medicaid |
$8.63
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.75
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Narrow Network |
$86.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: VA VA |
$15.78
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Trust/PPO |
$80.63
|
| Rate for Payer: BCN Commercial |
$80.63
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$104.00
|
| Rate for Payer: Healthscope Whirlpool |
$100.88
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,460.76
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,722.53 |
| Max. Negotiated Rate |
$2,460.76 |
| Rate for Payer: Aetna Commercial |
$2,214.68
|
| Rate for Payer: ASR ASR |
$2,386.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,907.83
|
| Rate for Payer: BCN Commercial |
$1,907.83
|
| Rate for Payer: Cash Price |
$1,968.61
|
| Rate for Payer: Cofinity Commercial |
$2,313.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.61
|
| Rate for Payer: Healthscope Commercial |
$2,460.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,386.94
|
| Rate for Payer: Mclaren Commercial |
$2,214.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,165.47
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,460.76
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$984.30 |
| Max. Negotiated Rate |
$2,460.76 |
| Rate for Payer: Aetna Commercial |
$2,214.68
|
| Rate for Payer: ASR ASR |
$2,386.94
|
| Rate for Payer: BCBS Complete |
$984.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,907.83
|
| Rate for Payer: BCN Commercial |
$1,907.83
|
| Rate for Payer: Cash Price |
$1,968.61
|
| Rate for Payer: Cofinity Commercial |
$2,313.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,968.61
|
| Rate for Payer: Healthscope Commercial |
$2,460.76
|
| Rate for Payer: Healthscope Whirlpool |
$2,386.94
|
| Rate for Payer: Mclaren Commercial |
$2,214.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,091.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,239.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,747.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,165.47
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,162.09
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,464.84 |
| Max. Negotiated Rate |
$6,162.09 |
| Rate for Payer: Aetna Commercial |
$5,545.88
|
| Rate for Payer: ASR ASR |
$5,977.23
|
| Rate for Payer: BCBS Complete |
$2,464.84
|
| Rate for Payer: BCBS Trust/PPO |
$4,777.47
|
| Rate for Payer: BCN Commercial |
$4,777.47
|
| Rate for Payer: Cash Price |
$4,929.67
|
| Rate for Payer: Cofinity Commercial |
$5,792.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,929.67
|
| Rate for Payer: Healthscope Commercial |
$6,162.09
|
| Rate for Payer: Healthscope Whirlpool |
$5,977.23
|
| Rate for Payer: Mclaren Commercial |
$5,545.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,237.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,607.50
|
| Rate for Payer: Priority Health Narrow Network |
$4,375.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,422.64
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,162.09
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,313.46 |
| Max. Negotiated Rate |
$6,162.09 |
| Rate for Payer: Aetna Commercial |
$5,545.88
|
| Rate for Payer: ASR ASR |
$5,977.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,777.47
|
| Rate for Payer: BCN Commercial |
$4,777.47
|
| Rate for Payer: Cash Price |
$4,929.67
|
| Rate for Payer: Cofinity Commercial |
$5,792.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,929.67
|
| Rate for Payer: Healthscope Commercial |
$6,162.09
|
| Rate for Payer: Healthscope Whirlpool |
$5,977.23
|
| Rate for Payer: Mclaren Commercial |
$5,545.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,237.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,422.64
|
|
