|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.86
|
|
|
Service Code
|
HCPCS J1643
|
| Hospital Charge Code |
10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna Commercial |
$12.47
|
| Rate for Payer: Aetna Medicare |
$6.93
|
| Rate for Payer: ASR ASR |
$13.44
|
| Rate for Payer: ASR Commercial |
$13.44
|
| Rate for Payer: BCBS Complete |
$5.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.35
|
| Rate for Payer: BCN Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.09
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Whirlpool |
$13.44
|
| Rate for Payer: Mclaren Commercial |
$12.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.78
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.14
|
| Rate for Payer: Priority Health Narrow Network |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.20
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.98
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna Commercial |
$11.46
|
| Rate for Payer: Aetna Commercial |
$10.47
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Medicare |
$8.49
|
| Rate for Payer: Aetna Medicare |
$6.33
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: ASR ASR |
$12.32
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR ASR |
$16.47
|
| Rate for Payer: ASR ASR |
$12.88
|
| Rate for Payer: ASR ASR |
$12.29
|
| Rate for Payer: ASR ASR |
$12.35
|
| Rate for Payer: ASR ASR |
$11.28
|
| Rate for Payer: ASR Commercial |
$12.32
|
| Rate for Payer: ASR Commercial |
$11.28
|
| Rate for Payer: ASR Commercial |
$12.88
|
| Rate for Payer: ASR Commercial |
$16.47
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: ASR Commercial |
$12.29
|
| Rate for Payer: ASR Commercial |
$12.35
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS Complete |
$5.08
|
| Rate for Payer: BCBS Complete |
$5.07
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$10.42
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$10.38
|
| Rate for Payer: BCBS Trust/PPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.90
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Commercial |
$10.30
|
| Rate for Payer: BCN Commercial |
$13.16
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: BCN Commercial |
$9.82
|
| Rate for Payer: BCN Commercial |
$9.02
|
| Rate for Payer: BCN Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$11.63
|
| Rate for Payer: Healthscope Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$12.70
|
| Rate for Payer: Healthscope Whirlpool |
$12.32
|
| Rate for Payer: Healthscope Whirlpool |
$11.28
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Healthscope Whirlpool |
$12.88
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Healthscope Whirlpool |
$16.47
|
| Rate for Payer: Healthscope Whirlpool |
$12.29
|
| Rate for Payer: Mclaren Commercial |
$11.43
|
| Rate for Payer: Mclaren Commercial |
$11.95
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$15.28
|
| Rate for Payer: Mclaren Commercial |
$11.46
|
| Rate for Payer: Mclaren Commercial |
$10.47
|
| Rate for Payer: Mclaren Commercial |
$11.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.43
|
| Rate for Payer: Nomi Health Commercial |
$10.41
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$10.89
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Nomi Health Commercial |
$10.39
|
| Rate for Payer: Nomi Health Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.10
|
| Rate for Payer: Priority Health Narrow Network |
$8.88
|
| Rate for Payer: Priority Health Narrow Network |
$8.92
|
| Rate for Payer: Priority Health Narrow Network |
$8.90
|
| Rate for Payer: Priority Health Narrow Network |
$8.15
|
| Rate for Payer: Priority Health Narrow Network |
$11.67
|
| Rate for Payer: Priority Health Narrow Network |
$9.31
|
| Rate for Payer: Priority Health Narrow Network |
$11.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.67
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$12.67 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Commercial |
$11.46
|
| Rate for Payer: Aetna Commercial |
$11.43
|
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$10.47
|
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$12.35
|
| Rate for Payer: ASR ASR |
$12.32
|
| Rate for Payer: ASR ASR |
$16.47
|
| Rate for Payer: ASR ASR |
$12.88
|
| Rate for Payer: ASR ASR |
$12.29
|
| Rate for Payer: ASR ASR |
$11.28
|
| Rate for Payer: ASR ASR |
$16.15
|
| Rate for Payer: ASR Commercial |
$16.47
|
| Rate for Payer: ASR Commercial |
$16.15
|
| Rate for Payer: ASR Commercial |
$12.32
|
| Rate for Payer: ASR Commercial |
$12.88
|
| Rate for Payer: ASR Commercial |
$12.35
|
| Rate for Payer: ASR Commercial |
$12.29
|
| Rate for Payer: ASR Commercial |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$10.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.48
|
| Rate for Payer: BCBS Trust/PPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$10.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.84
|
| Rate for Payer: BCN Commercial |
$9.85
|
| Rate for Payer: BCN Commercial |
$13.16
|
| Rate for Payer: BCN Commercial |
$10.30
|
| Rate for Payer: BCN Commercial |
$9.02
|
| Rate for Payer: BCN Commercial |
$9.82
|
| Rate for Payer: BCN Commercial |
$12.91
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cash Price |
$10.14
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$11.91
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$12.70
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$11.63
|
| Rate for Payer: Healthscope Whirlpool |
$16.15
|
| Rate for Payer: Healthscope Whirlpool |
$12.88
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Healthscope Whirlpool |
$12.29
|
| Rate for Payer: Healthscope Whirlpool |
$12.32
|
| Rate for Payer: Healthscope Whirlpool |
$11.28
|
| Rate for Payer: Healthscope Whirlpool |
$16.47
|
| Rate for Payer: Mclaren Commercial |
$11.95
|
| Rate for Payer: Mclaren Commercial |
$15.28
|
| Rate for Payer: Mclaren Commercial |
$10.47
|
| Rate for Payer: Mclaren Commercial |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$11.43
|
| Rate for Payer: Mclaren Commercial |
$11.40
|
| Rate for Payer: Mclaren Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Nomi Health Commercial |
$10.44
|
| Rate for Payer: Nomi Health Commercial |
$10.41
|
| Rate for Payer: Nomi Health Commercial |
$10.39
|
| Rate for Payer: Nomi Health Commercial |
$10.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.18
|
|
|
HEPARIN (PORCINE) IN D5W 25,000 UNIT/250 ML (UNITS/HR)
|
Facility
|
IP
|
$99.69
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
164950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$99.69 |
| Rate for Payer: Aetna Commercial |
$89.72
|
| Rate for Payer: Aetna Commercial |
$93.05
|
| Rate for Payer: ASR ASR |
$100.29
|
| Rate for Payer: ASR ASR |
$96.70
|
| Rate for Payer: ASR Commercial |
$100.29
|
| Rate for Payer: ASR Commercial |
$96.70
|
| Rate for Payer: BCBS Trust/PPO |
$84.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.24
|
| Rate for Payer: BCN Commercial |
$77.29
|
| Rate for Payer: BCN Commercial |
$80.16
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$97.19
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.75
|
| Rate for Payer: Healthscope Commercial |
$103.39
|
| Rate for Payer: Healthscope Commercial |
$99.69
|
| Rate for Payer: Healthscope Whirlpool |
$96.70
|
| Rate for Payer: Healthscope Whirlpool |
$100.29
|
| Rate for Payer: Mclaren Commercial |
$93.05
|
| Rate for Payer: Mclaren Commercial |
$89.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.88
|
| Rate for Payer: Nomi Health Commercial |
$81.75
|
| Rate for Payer: Nomi Health Commercial |
$84.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.73
|
|
|
HEPARIN (PORCINE) IN D5W 25,000 UNIT/250 ML (UNITS/HR)
|
Facility
|
OP
|
$103.39
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
164950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$103.39 |
| Rate for Payer: Aetna Commercial |
$93.05
|
| Rate for Payer: Aetna Commercial |
$89.72
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: ASR ASR |
$100.29
|
| Rate for Payer: ASR ASR |
$96.70
|
| Rate for Payer: ASR Commercial |
$96.70
|
| Rate for Payer: ASR Commercial |
$100.29
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: BCBS Complete |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$84.67
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$77.29
|
| Rate for Payer: BCN Commercial |
$80.16
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cofinity Commercial |
$97.19
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.75
|
| Rate for Payer: Healthscope Commercial |
$103.39
|
| Rate for Payer: Healthscope Commercial |
$99.69
|
| Rate for Payer: Healthscope Whirlpool |
$100.29
|
| Rate for Payer: Healthscope Whirlpool |
$96.70
|
| Rate for Payer: Mclaren Commercial |
$93.05
|
| Rate for Payer: Mclaren Commercial |
$89.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.88
|
| Rate for Payer: Nomi Health Commercial |
$84.78
|
| Rate for Payer: Nomi Health Commercial |
$81.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.35
|
| Rate for Payer: Priority Health Narrow Network |
$69.88
|
| Rate for Payer: Priority Health Narrow Network |
$72.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.98
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
116327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: ASR ASR |
$10.67
|
| Rate for Payer: ASR ASR |
$10.19
|
| Rate for Payer: ASR ASR |
$12.61
|
| Rate for Payer: ASR Commercial |
$12.61
|
| Rate for Payer: ASR Commercial |
$10.67
|
| Rate for Payer: ASR Commercial |
$10.19
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCBS Trust/PPO |
$10.65
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Healthscope Whirlpool |
$10.67
|
| Rate for Payer: Healthscope Whirlpool |
$10.19
|
| Rate for Payer: Healthscope Whirlpool |
$12.61
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Mclaren Commercial |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$11.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$10.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.39
|
| Rate for Payer: Priority Health Narrow Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.36
|
| Rate for Payer: Priority Health Narrow Network |
$7.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.44
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
116327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: ASR ASR |
$10.19
|
| Rate for Payer: ASR ASR |
$10.67
|
| Rate for Payer: ASR ASR |
$12.61
|
| Rate for Payer: ASR Commercial |
$10.67
|
| Rate for Payer: ASR Commercial |
$10.19
|
| Rate for Payer: ASR Commercial |
$12.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCBS Trust/PPO |
$8.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.96
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$10.08
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$13.00
|
| Rate for Payer: Healthscope Whirlpool |
$10.67
|
| Rate for Payer: Healthscope Whirlpool |
$10.19
|
| Rate for Payer: Healthscope Whirlpool |
$12.61
|
| Rate for Payer: Mclaren Commercial |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$9.45
|
| Rate for Payer: Mclaren Commercial |
$11.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$10.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.24
|
|
|
HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$495.65
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
116868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.93 |
| Max. Negotiated Rate |
$495.65 |
| Rate for Payer: Aetna Commercial |
$446.08
|
| Rate for Payer: Aetna Medicare |
$134.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.74
|
| Rate for Payer: ASR ASR |
$480.78
|
| Rate for Payer: ASR Commercial |
$480.78
|
| Rate for Payer: BCBS Complete |
$75.52
|
| Rate for Payer: BCBS MAPPO |
$134.19
|
| Rate for Payer: BCBS Trust/PPO |
$405.89
|
| Rate for Payer: BCN Commercial |
$384.28
|
| Rate for Payer: BCN Medicare Advantage |
$134.19
|
| Rate for Payer: Cash Price |
$396.52
|
| Rate for Payer: Cash Price |
$396.52
|
| Rate for Payer: Cofinity Commercial |
$465.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.19
|
| Rate for Payer: Healthscope Commercial |
$495.65
|
| Rate for Payer: Healthscope Whirlpool |
$480.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$134.19
|
| Rate for Payer: Mclaren Commercial |
$446.08
|
| Rate for Payer: Mclaren Medicaid |
$71.93
|
| Rate for Payer: Mclaren Medicare |
$134.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.90
|
| Rate for Payer: Meridian Medicaid |
$75.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.30
|
| Rate for Payer: Nomi Health Commercial |
$406.43
|
| Rate for Payer: PACE Medicare |
$127.48
|
| Rate for Payer: PACE SWMI |
$134.19
|
| Rate for Payer: PHP Commercial |
$147.61
|
| Rate for Payer: PHP Medicaid |
$71.93
|
| Rate for Payer: PHP Medicare Advantage |
$134.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.29
|
| Rate for Payer: Priority Health Medicare |
$134.19
|
| Rate for Payer: Priority Health Narrow Network |
$347.45
|
| Rate for Payer: Railroad Medicare Medicare |
$134.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.19
|
| Rate for Payer: UHC Exchange |
$207.99
|
| Rate for Payer: UHC Medicare Advantage |
$134.19
|
| Rate for Payer: UHCCP DNSP |
$134.19
|
| Rate for Payer: UHCCP Medicaid |
$71.93
|
| Rate for Payer: VA VA |
$134.19
|
|
|
HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$495.65
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
116868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.17 |
| Max. Negotiated Rate |
$495.65 |
| Rate for Payer: Aetna Commercial |
$446.08
|
| Rate for Payer: ASR ASR |
$480.78
|
| Rate for Payer: ASR Commercial |
$480.78
|
| Rate for Payer: BCBS Trust/PPO |
$403.91
|
| Rate for Payer: BCN Commercial |
$384.28
|
| Rate for Payer: Cash Price |
$396.52
|
| Rate for Payer: Cofinity Commercial |
$465.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.52
|
| Rate for Payer: Healthscope Commercial |
$495.65
|
| Rate for Payer: Healthscope Whirlpool |
$480.78
|
| Rate for Payer: Mclaren Commercial |
$446.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.30
|
| Rate for Payer: Nomi Health Commercial |
$406.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.17
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$98.31
|
|
|
Service Code
|
NDC 00409724813
|
| Hospital Charge Code |
25174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: ASR Commercial |
$95.36
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$76.22
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$98.31
|
| Rate for Payer: Healthscope Whirlpool |
$95.36
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.14
|
| Rate for Payer: Priority Health Narrow Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$98.31
|
|
|
Service Code
|
NDC 00409724813
|
| Hospital Charge Code |
25174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: ASR Commercial |
$95.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.11
|
| Rate for Payer: BCN Commercial |
$76.22
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$98.31
|
| Rate for Payer: Healthscope Whirlpool |
$95.36
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$98.31
|
|
|
Service Code
|
NDC 00409724803
|
| Hospital Charge Code |
25174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: ASR Commercial |
$95.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.11
|
| Rate for Payer: BCN Commercial |
$76.22
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$98.31
|
| Rate for Payer: Healthscope Whirlpool |
$95.36
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$98.31
|
|
|
Service Code
|
NDC 00409724803
|
| Hospital Charge Code |
25174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: ASR Commercial |
$95.36
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: BCBS Trust/PPO |
$80.51
|
| Rate for Payer: BCN Commercial |
$76.22
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$98.31
|
| Rate for Payer: Healthscope Whirlpool |
$95.36
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.14
|
| Rate for Payer: Priority Health Narrow Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
IP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: ASR ASR |
$12.10
|
| Rate for Payer: ASR Commercial |
$12.10
|
| Rate for Payer: BCBS Trust/PPO |
$10.16
|
| Rate for Payer: BCN Commercial |
$9.67
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.47
|
| Rate for Payer: Healthscope Whirlpool |
$12.10
|
| Rate for Payer: Mclaren Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.97
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
OP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: ASR ASR |
$12.10
|
| Rate for Payer: ASR Commercial |
$12.10
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.21
|
| Rate for Payer: BCN Commercial |
$9.67
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$12.47
|
| Rate for Payer: Healthscope Whirlpool |
$12.10
|
| Rate for Payer: Mclaren Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Narrow Network |
$8.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.97
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
OP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Aetna Commercial |
$24.44
|
| Rate for Payer: Aetna Medicare |
$13.58
|
| Rate for Payer: ASR ASR |
$26.35
|
| Rate for Payer: ASR Commercial |
$26.35
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$22.24
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$25.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Mclaren Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.09
|
| Rate for Payer: Nomi Health Commercial |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.80
|
| Rate for Payer: Priority Health Narrow Network |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.90
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
IP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Aetna Commercial |
$24.44
|
| Rate for Payer: ASR ASR |
$26.35
|
| Rate for Payer: ASR Commercial |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$22.13
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$25.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Mclaren Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.09
|
| Rate for Payer: Nomi Health Commercial |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.90
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: ASR ASR |
$9.49
|
| Rate for Payer: ASR Commercial |
$9.49
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.01
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$9.78
|
| Rate for Payer: Healthscope Whirlpool |
$9.49
|
| Rate for Payer: Mclaren Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.31
|
| Rate for Payer: Nomi Health Commercial |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.57
|
| Rate for Payer: Priority Health Narrow Network |
$6.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.61
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: ASR ASR |
$9.49
|
| Rate for Payer: ASR Commercial |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.97
|
| Rate for Payer: BCN Commercial |
$7.58
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$9.78
|
| Rate for Payer: Healthscope Whirlpool |
$9.49
|
| Rate for Payer: Mclaren Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.31
|
| Rate for Payer: Nomi Health Commercial |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.61
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
IP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$21.87 |
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR Commercial |
$21.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$21.87 |
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR Commercial |
$21.21
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.91
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.16
|
| Rate for Payer: Priority Health Narrow Network |
$15.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$20.22
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: ASR ASR |
$21.80
|
| Rate for Payer: ASR Commercial |
$21.80
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$17.42
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Healthscope Whirlpool |
$21.80
|
| Rate for Payer: Mclaren Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.69
|
| Rate for Payer: Priority Health Narrow Network |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.77
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$20.22
|
| Rate for Payer: ASR ASR |
$21.80
|
| Rate for Payer: ASR Commercial |
$21.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.31
|
| Rate for Payer: BCN Commercial |
$17.42
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Healthscope Whirlpool |
$21.80
|
| Rate for Payer: Mclaren Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.77
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$839.87 |
| Rate for Payer: Aetna Commercial |
$755.88
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$814.67
|
| Rate for Payer: ASR Commercial |
$814.67
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$687.77
|
| Rate for Payer: BCN Commercial |
$651.15
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$789.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$839.87
|
| Rate for Payer: Healthscope Whirlpool |
$814.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$755.88
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.89
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$588.75
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$545.92 |
| Max. Negotiated Rate |
$839.87 |
| Rate for Payer: Aetna Commercial |
$755.88
|
| Rate for Payer: ASR ASR |
$814.67
|
| Rate for Payer: ASR Commercial |
$814.67
|
| Rate for Payer: BCBS Trust/PPO |
$684.41
|
| Rate for Payer: BCN Commercial |
$651.15
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$789.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Healthscope Commercial |
$839.87
|
| Rate for Payer: Healthscope Whirlpool |
$814.67
|
| Rate for Payer: Mclaren Commercial |
$755.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$739.09
|
|
