|
HC GUIDING CATHETER LVL 4
|
Facility
|
OP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.21 |
| Max. Negotiated Rate |
$490.52 |
| Rate for Payer: Aetna Commercial |
$441.47
|
| Rate for Payer: Aetna Medicare |
$245.26
|
| Rate for Payer: ASR ASR |
$475.80
|
| Rate for Payer: ASR Commercial |
$475.80
|
| Rate for Payer: BCBS Complete |
$196.21
|
| Rate for Payer: BCBS Trust/PPO |
$401.69
|
| Rate for Payer: BCN Commercial |
$380.30
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$461.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$490.52
|
| Rate for Payer: Healthscope Whirlpool |
$475.80
|
| Rate for Payer: Mclaren Commercial |
$441.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: Nomi Health Commercial |
$402.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.79
|
| Rate for Payer: Priority Health Narrow Network |
$343.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.66
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,792.09 |
| 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: ASR Commercial |
$4,166.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,500.43
|
| 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 Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| 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: Aetna Medicare |
$2,147.76
|
| Rate for Payer: ASR ASR |
$4,166.66
|
| Rate for Payer: ASR Commercial |
$4,166.66
|
| Rate for Payer: BCBS Complete |
$1,718.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,517.61
|
| 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 Commercial |
$3,651.20
|
| Rate for Payer: Nomi Health Commercial |
$3,522.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,792.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,763.74
|
| Rate for Payer: Priority Health Narrow Network |
$3,011.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,780.07
|
|
|
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: Aetna Medicare |
$2,856.07
|
| Rate for Payer: ASR ASR |
$5,540.79
|
| Rate for Payer: ASR Commercial |
$5,540.79
|
| Rate for Payer: BCBS Complete |
$2,284.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,677.68
|
| 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 Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,004.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,004.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,026.69
|
|
|
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 |
$3,712.90 |
| 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: ASR Commercial |
$5,540.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,654.83
|
| 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 Commercial |
$4,855.33
|
| Rate for Payer: Nomi Health Commercial |
$4,683.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,712.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,026.69
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
OP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.12 |
| Max. Negotiated Rate |
$662.80 |
| Rate for Payer: Aetna Commercial |
$596.52
|
| Rate for Payer: Aetna Medicare |
$331.40
|
| Rate for Payer: ASR ASR |
$642.92
|
| Rate for Payer: ASR Commercial |
$642.92
|
| Rate for Payer: BCBS Complete |
$265.12
|
| Rate for Payer: BCBS Trust/PPO |
$542.77
|
| Rate for Payer: BCN Commercial |
$513.87
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$623.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$662.80
|
| Rate for Payer: Healthscope Whirlpool |
$642.92
|
| Rate for Payer: Mclaren Commercial |
$596.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.75
|
| Rate for Payer: Priority Health Narrow Network |
$464.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.26
|
|
|
HC GUIDING CATHETER LVL 6
|
Facility
|
IP
|
$662.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.82 |
| Max. Negotiated Rate |
$662.80 |
| Rate for Payer: Aetna Commercial |
$596.52
|
| Rate for Payer: ASR ASR |
$642.92
|
| Rate for Payer: ASR Commercial |
$642.92
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$513.87
|
| Rate for Payer: Cash Price |
$530.24
|
| Rate for Payer: Cofinity Commercial |
$623.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.24
|
| Rate for Payer: Healthscope Commercial |
$662.80
|
| Rate for Payer: Healthscope Whirlpool |
$642.92
|
| Rate for Payer: Mclaren Commercial |
$596.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.38
|
| Rate for Payer: Nomi Health Commercial |
$543.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.26
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$33.29 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: ASR ASR |
$32.29
|
| Rate for Payer: ASR Commercial |
$32.29
|
| Rate for Payer: BCBS Complete |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$27.26
|
| Rate for Payer: BCN Commercial |
$25.81
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$33.29
|
| Rate for Payer: Healthscope Whirlpool |
$32.29
|
| Rate for Payer: Mclaren Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.17
|
| Rate for Payer: Priority Health Narrow Network |
$23.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.30
|
|
|
HC HAEMOPHILUS INFLUENZAE TYPE B VACCINE (HIB) PRP-T CONJUGATE, 4 DOSE IM
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
63600069
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$33.29 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: ASR ASR |
$32.29
|
| Rate for Payer: ASR Commercial |
$32.29
|
| Rate for Payer: BCBS Trust/PPO |
$27.13
|
| Rate for Payer: BCN Commercial |
$25.81
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$33.29
|
| Rate for Payer: Healthscope Whirlpool |
$32.29
|
| Rate for Payer: Mclaren Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.30
|
|
|
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 |
$59.28 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: Aetna Medicare |
$74.09
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: ASR Commercial |
$143.74
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$121.35
|
| 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 Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.84
|
| Rate for Payer: Priority Health Narrow Network |
$103.88
|
| 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 |
$96.32 |
| Max. Negotiated Rate |
$148.19 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: ASR ASR |
$143.74
|
| Rate for Payer: ASR Commercial |
$143.74
|
| Rate for Payer: BCBS Trust/PPO |
$120.76
|
| 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 Commercial |
$125.96
|
| Rate for Payer: Nomi Health Commercial |
$121.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| 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 |
$87.56 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$109.78
|
| 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 Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| 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 |
$53.88 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$110.31
|
| 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 Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.03
|
| Rate for Payer: Priority Health Narrow Network |
$94.43
|
| 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 |
$53.88 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: Aetna Medicare |
$67.36
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Trust/PPO |
$110.31
|
| 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 Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.03
|
| Rate for Payer: Priority Health Narrow Network |
$94.43
|
| 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 |
$87.56 |
| Max. Negotiated Rate |
$134.71 |
| Rate for Payer: Aetna Commercial |
$121.24
|
| Rate for Payer: ASR ASR |
$130.67
|
| Rate for Payer: ASR Commercial |
$130.67
|
| Rate for Payer: BCBS Trust/PPO |
$109.78
|
| 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 Commercial |
$114.50
|
| Rate for Payer: Nomi Health Commercial |
$110.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.54
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Medicare |
$15.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.73
|
| Rate for Payer: ASR ASR |
$102.90
|
| Rate for Payer: ASR Commercial |
$102.90
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$86.87
|
| Rate for Payer: BCN Commercial |
$82.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$99.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$106.08
|
| Rate for Payer: Healthscope Whirlpool |
$102.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.78
|
| Rate for Payer: Mclaren Commercial |
$95.47
|
| Rate for Payer: Mclaren Medicaid |
$8.46
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: Meridian Medicaid |
$8.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| 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 |
$8.46
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Narrow Network |
$74.36
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Exchange |
$24.46
|
| Rate for Payer: UHC Medicare Advantage |
$15.78
|
| Rate for Payer: UHCCP DNSP |
$15.78
|
| Rate for Payer: UHCCP Medicaid |
$8.46
|
| Rate for Payer: VA VA |
$15.78
|
|
|
HC HALOPERIDOL LEVEL
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
30100031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: ASR ASR |
$102.90
|
| Rate for Payer: ASR Commercial |
$102.90
|
| Rate for Payer: BCBS Trust/PPO |
$86.44
|
| Rate for Payer: BCN Commercial |
$82.24
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$99.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$106.08
|
| Rate for Payer: Healthscope Whirlpool |
$102.90
|
| Rate for Payer: Mclaren Commercial |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.17
|
| Rate for Payer: Nomi Health Commercial |
$86.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.35
|
|
|
HC HALO RING APPLICATION
|
Facility
|
OP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,003.99 |
| Max. Negotiated Rate |
$2,509.98 |
| Rate for Payer: Aetna Commercial |
$2,258.98
|
| Rate for Payer: Aetna Medicare |
$1,254.99
|
| Rate for Payer: ASR ASR |
$2,434.68
|
| Rate for Payer: ASR Commercial |
$2,434.68
|
| Rate for Payer: BCBS Complete |
$1,003.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,055.42
|
| Rate for Payer: BCN Commercial |
$1,945.99
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$2,359.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,509.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,434.68
|
| Rate for Payer: Mclaren Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: Nomi Health Commercial |
$2,058.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,199.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,208.78
|
|
|
HC HALO RING APPLICATION
|
Facility
|
IP
|
$2,509.98
|
|
| Hospital Charge Code |
27000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,631.49 |
| Max. Negotiated Rate |
$2,509.98 |
| Rate for Payer: Aetna Commercial |
$2,258.98
|
| Rate for Payer: ASR ASR |
$2,434.68
|
| Rate for Payer: ASR Commercial |
$2,434.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.38
|
| Rate for Payer: BCN Commercial |
$1,945.99
|
| Rate for Payer: Cash Price |
$2,007.98
|
| Rate for Payer: Cofinity Commercial |
$2,359.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,007.98
|
| Rate for Payer: Healthscope Commercial |
$2,509.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,434.68
|
| Rate for Payer: Mclaren Commercial |
$2,258.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.48
|
| Rate for Payer: Nomi Health Commercial |
$2,058.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,631.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,208.78
|
|
|
HC HALO RING & VEST
|
Facility
|
OP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,514.13 |
| Max. Negotiated Rate |
$6,285.33 |
| Rate for Payer: Aetna Commercial |
$5,656.80
|
| Rate for Payer: Aetna Medicare |
$3,142.66
|
| Rate for Payer: ASR ASR |
$6,096.77
|
| Rate for Payer: ASR Commercial |
$6,096.77
|
| Rate for Payer: BCBS Complete |
$2,514.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,147.06
|
| Rate for Payer: BCN Commercial |
$4,873.02
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$5,908.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$6,285.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,096.77
|
| Rate for Payer: Mclaren Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: Nomi Health Commercial |
$5,153.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,507.21
|
| Rate for Payer: Priority Health Narrow Network |
$4,406.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,531.09
|
|
|
HC HALO RING & VEST
|
Facility
|
IP
|
$6,285.33
|
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,085.46 |
| Max. Negotiated Rate |
$6,285.33 |
| Rate for Payer: Aetna Commercial |
$5,656.80
|
| Rate for Payer: ASR ASR |
$6,096.77
|
| Rate for Payer: ASR Commercial |
$6,096.77
|
| Rate for Payer: BCBS Trust/PPO |
$5,121.92
|
| Rate for Payer: BCN Commercial |
$4,873.02
|
| Rate for Payer: Cash Price |
$5,028.26
|
| Rate for Payer: Cofinity Commercial |
$5,908.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,028.26
|
| Rate for Payer: Healthscope Commercial |
$6,285.33
|
| Rate for Payer: Healthscope Whirlpool |
$6,096.77
|
| Rate for Payer: Mclaren Commercial |
$5,656.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,342.53
|
| Rate for Payer: Nomi Health Commercial |
$5,153.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,531.09
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
IP
|
$5,766.18
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,748.02 |
| Max. Negotiated Rate |
$5,766.18 |
| Rate for Payer: Aetna Commercial |
$5,189.56
|
| Rate for Payer: ASR ASR |
$5,593.19
|
| Rate for Payer: ASR Commercial |
$5,593.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,698.86
|
| Rate for Payer: BCN Commercial |
$4,470.52
|
| Rate for Payer: Cash Price |
$4,612.94
|
| Rate for Payer: Cofinity Commercial |
$5,420.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,612.94
|
| Rate for Payer: Healthscope Commercial |
$5,766.18
|
| Rate for Payer: Healthscope Whirlpool |
$5,593.19
|
| Rate for Payer: Mclaren Commercial |
$5,189.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,901.25
|
| Rate for Payer: Nomi Health Commercial |
$4,728.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,748.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,074.24
|
|
|
HC HALO VEST APPLICATION
|
Facility
|
OP
|
$5,766.18
|
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,306.47 |
| Max. Negotiated Rate |
$5,766.18 |
| Rate for Payer: Aetna Commercial |
$5,189.56
|
| Rate for Payer: Aetna Medicare |
$2,883.09
|
| Rate for Payer: ASR ASR |
$5,593.19
|
| Rate for Payer: ASR Commercial |
$5,593.19
|
| Rate for Payer: BCBS Complete |
$2,306.47
|
| Rate for Payer: BCBS Trust/PPO |
$4,721.92
|
| Rate for Payer: BCN Commercial |
$4,470.52
|
| Rate for Payer: Cash Price |
$4,612.94
|
| Rate for Payer: Cofinity Commercial |
$5,420.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,612.94
|
| Rate for Payer: Healthscope Commercial |
$5,766.18
|
| Rate for Payer: Healthscope Whirlpool |
$5,593.19
|
| Rate for Payer: Mclaren Commercial |
$5,189.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,901.25
|
| Rate for Payer: Nomi Health Commercial |
$4,728.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,748.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,052.33
|
| Rate for Payer: Priority Health Narrow Network |
$4,042.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,074.24
|
|
