|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
IP
|
$49.18
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$49.18 |
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: ASR ASR |
$47.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.13
|
| Rate for Payer: BCN Commercial |
$38.13
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$46.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.34
|
| Rate for Payer: Healthscope Commercial |
$49.18
|
| Rate for Payer: Healthscope Whirlpool |
$47.70
|
| Rate for Payer: Mclaren Commercial |
$44.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.28
|
|
|
HAIR REMOVAL
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 00170
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
IP
|
$255.55
|
|
|
Service Code
|
NDC 51079-733-20
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna Commercial |
$230.00
|
| Rate for Payer: ASR ASR |
$247.88
|
| Rate for Payer: BCBS Trust/PPO |
$198.13
|
| Rate for Payer: BCN Commercial |
$198.13
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Commercial |
$240.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$255.55
|
| Rate for Payer: Healthscope Whirlpool |
$247.88
|
| Rate for Payer: Mclaren Commercial |
$230.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.88
|
|
|
HALOPERIDOL 0.5 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 51079-733-01
|
| Hospital Charge Code |
3578
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.30
|
| Rate for Payer: ASR ASR |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.98
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.48
|
| Rate for Payer: Mclaren Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.25
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$346.75
|
|
|
Service Code
|
NDC 68382-079-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.72 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Aetna Commercial |
$312.08
|
| Rate for Payer: ASR ASR |
$336.35
|
| Rate for Payer: BCBS Trust/PPO |
$268.84
|
| Rate for Payer: BCN Commercial |
$268.84
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cofinity Commercial |
$325.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.40
|
| Rate for Payer: Healthscope Commercial |
$346.75
|
| Rate for Payer: Healthscope Whirlpool |
$336.35
|
| Rate for Payer: Mclaren Commercial |
$312.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.14
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
NDC 51079-736-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: ASR ASR |
$2.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Healthscope Whirlpool |
$2.63
|
| Rate for Payer: Mclaren Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.38
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 0904-6782-61
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.95 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: ASR ASR |
$396.24
|
| Rate for Payer: BCBS Trust/PPO |
$316.71
|
| Rate for Payer: BCN Commercial |
$316.71
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$408.50
|
| Rate for Payer: Healthscope Whirlpool |
$396.24
|
| Rate for Payer: Mclaren Commercial |
$367.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.48
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$81.39
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$81.39 |
| Rate for Payer: Aetna Commercial |
$73.25
|
| Rate for Payer: ASR ASR |
$78.95
|
| Rate for Payer: BCBS Trust/PPO |
$63.10
|
| Rate for Payer: BCN Commercial |
$63.10
|
| Rate for Payer: Cash Price |
$65.11
|
| Rate for Payer: Cofinity Commercial |
$76.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.11
|
| Rate for Payer: Healthscope Commercial |
$81.39
|
| Rate for Payer: Healthscope Whirlpool |
$78.95
|
| Rate for Payer: Mclaren Commercial |
$73.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.62
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$9.48
|
| Rate for Payer: Aetna Commercial |
$10.67
|
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: ASR ASR |
$10.21
|
| Rate for Payer: ASR ASR |
$22.57
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR ASR |
$11.50
|
| Rate for Payer: BCBS Trust/PPO |
$13.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$9.20
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: BCN Commercial |
$8.16
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: BCN Commercial |
$9.20
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$11.86
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Healthscope Whirlpool |
$11.50
|
| Rate for Payer: Healthscope Whirlpool |
$10.21
|
| Rate for Payer: Healthscope Whirlpool |
$22.57
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Mclaren Commercial |
$10.67
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$20.94
|
| Rate for Payer: Mclaren Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.48
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$20,813.64
|
|
|
Service Code
|
MS-DRG 513
|
| Min. Negotiated Rate |
$14,634.73 |
| Max. Negotiated Rate |
$20,813.64 |
| Rate for Payer: Aetna Medicare |
$15,404.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,256.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,256.22
|
| Rate for Payer: BCBS MAPPO |
$15,404.98
|
| Rate for Payer: BCN Medicare Advantage |
$15,404.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,404.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,404.98
|
| Rate for Payer: Mclaren Medicare |
$15,404.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,175.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,715.73
|
| Rate for Payer: PACE Medicare |
$14,634.73
|
| Rate for Payer: PACE SWMI |
$15,404.98
|
| Rate for Payer: PHP Commercial |
$16,945.48
|
| Rate for Payer: PHP Medicare Advantage |
$15,404.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,813.64
|
| Rate for Payer: Priority Health Medicare |
$15,404.98
|
| Rate for Payer: Priority Health Narrow Network |
$16,650.91
|
| Rate for Payer: Railroad Medicare Medicare |
$15,404.98
|
| Rate for Payer: UHC Medicare Advantage |
$15,867.13
|
| Rate for Payer: VA VA |
$15,404.98
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,372.86
|
|
|
Service Code
|
MS-DRG 514
|
| Min. Negotiated Rate |
$9,973.76 |
| Max. Negotiated Rate |
$13,372.86 |
| Rate for Payer: Aetna Medicare |
$10,498.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,123.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,123.36
|
| Rate for Payer: BCBS MAPPO |
$10,498.69
|
| Rate for Payer: BCN Medicare Advantage |
$10,498.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,498.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,498.69
|
| Rate for Payer: Mclaren Medicare |
$10,498.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,023.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,073.49
|
| Rate for Payer: PACE Medicare |
$9,973.76
|
| Rate for Payer: PACE SWMI |
$10,498.69
|
| Rate for Payer: PHP Commercial |
$11,548.56
|
| Rate for Payer: PHP Medicare Advantage |
$10,498.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,372.86
|
| Rate for Payer: Priority Health Medicare |
$10,498.69
|
| Rate for Payer: Priority Health Narrow Network |
$10,698.29
|
| Rate for Payer: Railroad Medicare Medicare |
$10,498.69
|
| Rate for Payer: UHC Medicare Advantage |
$10,813.65
|
| Rate for Payer: VA VA |
$10,498.69
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$24,159.74
|
|
|
Service Code
|
MS-DRG 906
|
| Min. Negotiated Rate |
$16,730.74 |
| Max. Negotiated Rate |
$24,159.74 |
| Rate for Payer: Aetna Medicare |
$17,611.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,014.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,014.14
|
| Rate for Payer: BCBS MAPPO |
$17,611.31
|
| Rate for Payer: BCN Medicare Advantage |
$17,611.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,611.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,611.31
|
| Rate for Payer: Mclaren Medicare |
$17,611.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,491.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,253.01
|
| Rate for Payer: PACE Medicare |
$16,730.74
|
| Rate for Payer: PACE SWMI |
$17,611.31
|
| Rate for Payer: PHP Commercial |
$19,372.44
|
| Rate for Payer: PHP Medicare Advantage |
$17,611.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,159.74
|
| Rate for Payer: Priority Health Medicare |
$17,611.31
|
| Rate for Payer: Priority Health Narrow Network |
$19,327.79
|
| Rate for Payer: Railroad Medicare Medicare |
$17,611.31
|
| Rate for Payer: UHC Medicare Advantage |
$18,139.65
|
| Rate for Payer: VA VA |
$17,611.31
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$64.26
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$57.83
|
| Rate for Payer: ASR ASR |
$62.33
|
| Rate for Payer: BCBS Trust/PPO |
$49.82
|
| Rate for Payer: BCN Commercial |
$49.82
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Healthscope Whirlpool |
$62.33
|
| Rate for Payer: Mclaren Commercial |
$57.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.55
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$64.26
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$57.83
|
| Rate for Payer: Aetna Medicare |
$29.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.60
|
| Rate for Payer: ASR ASR |
$62.33
|
| Rate for Payer: BCBS Complete |
$16.82
|
| Rate for Payer: BCBS MAPPO |
$29.28
|
| Rate for Payer: BCBS Trust/PPO |
$49.82
|
| Rate for Payer: BCN Commercial |
$49.82
|
| Rate for Payer: BCN Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.28
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Healthscope Whirlpool |
$62.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.28
|
| Rate for Payer: Mclaren Commercial |
$57.83
|
| Rate for Payer: Mclaren Medicaid |
$16.02
|
| Rate for Payer: Mclaren Medicare |
$29.28
|
| Rate for Payer: Meridian Medicaid |
$16.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PACE Medicare |
$27.82
|
| Rate for Payer: PACE SWMI |
$29.28
|
| Rate for Payer: PHP Commercial |
$32.21
|
| Rate for Payer: PHP Medicaid |
$16.02
|
| Rate for Payer: PHP Medicare Advantage |
$29.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.48
|
| Rate for Payer: Priority Health Medicare |
$29.28
|
| Rate for Payer: Priority Health Narrow Network |
$45.62
|
| Rate for Payer: Railroad Medicare Medicare |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.16
|
| Rate for Payer: VA VA |
$29.28
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$6.75
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: ASR ASR |
$6.55
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$6.75
|
| Rate for Payer: Healthscope Whirlpool |
$6.55
|
| Rate for Payer: Mclaren Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.94
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$6.75
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: ASR ASR |
$6.55
|
| Rate for Payer: BCBS Complete |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$6.75
|
| Rate for Payer: Healthscope Whirlpool |
$6.55
|
| Rate for Payer: Mclaren Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.14
|
| Rate for Payer: Priority Health Narrow Network |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.94
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$272.95
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.06 |
| Max. Negotiated Rate |
$272.95 |
| Rate for Payer: Aetna Commercial |
$245.66
|
| Rate for Payer: ASR ASR |
$264.76
|
| Rate for Payer: BCBS Trust/PPO |
$211.62
|
| Rate for Payer: BCN Commercial |
$211.62
|
| Rate for Payer: Cash Price |
$218.36
|
| Rate for Payer: Cofinity Commercial |
$256.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.36
|
| Rate for Payer: Healthscope Commercial |
$272.95
|
| Rate for Payer: Healthscope Whirlpool |
$264.76
|
| Rate for Payer: Mclaren Commercial |
$245.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.20
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$272.95
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.18 |
| Max. Negotiated Rate |
$272.95 |
| Rate for Payer: Aetna Commercial |
$245.66
|
| Rate for Payer: ASR ASR |
$264.76
|
| Rate for Payer: BCBS Complete |
$109.18
|
| Rate for Payer: BCBS Trust/PPO |
$211.62
|
| Rate for Payer: BCN Commercial |
$211.62
|
| Rate for Payer: Cash Price |
$218.36
|
| Rate for Payer: Cofinity Commercial |
$256.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.36
|
| Rate for Payer: Healthscope Commercial |
$272.95
|
| Rate for Payer: Healthscope Whirlpool |
$264.76
|
| Rate for Payer: Mclaren Commercial |
$245.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.38
|
| Rate for Payer: Priority Health Narrow Network |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.20
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: BCBS Complete |
$23.99
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$56.94
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$22.85
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Medicaid |
$23.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicaid |
$22.85
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.83
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$52.14
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
| Rate for Payer: UHC Medicare Advantage |
$43.02
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$56.94
|
| Rate for Payer: BCN Commercial |
$56.94
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Healthscope Whirlpool |
$71.24
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$85.21
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna Commercial |
$76.69
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.21
|
| Rate for Payer: ASR ASR |
$82.65
|
| Rate for Payer: BCBS Complete |
$23.99
|
| Rate for Payer: BCBS MAPPO |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$66.06
|
| Rate for Payer: BCN Commercial |
$66.06
|
| Rate for Payer: BCN Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$80.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.77
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Healthscope Whirlpool |
$82.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.77
|
| Rate for Payer: Mclaren Commercial |
$76.69
|
| Rate for Payer: Mclaren Medicaid |
$22.85
|
| Rate for Payer: Mclaren Medicare |
$41.77
|
| Rate for Payer: Meridian Medicaid |
$23.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.43
|
| Rate for Payer: PACE Medicare |
$39.68
|
| Rate for Payer: PACE SWMI |
$41.77
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicaid |
$22.85
|
| Rate for Payer: PHP Medicare Advantage |
$41.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.54
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow Network |
$60.50
|
| Rate for Payer: Railroad Medicare Medicare |
$41.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.98
|
| Rate for Payer: UHC Medicare Advantage |
$43.02
|
| Rate for Payer: VA VA |
$41.77
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$85.21
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.65 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna Commercial |
$76.69
|
| Rate for Payer: ASR ASR |
$82.65
|
| Rate for Payer: BCBS Trust/PPO |
$66.06
|
| Rate for Payer: BCN Commercial |
$66.06
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$80.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.17
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Healthscope Whirlpool |
$82.65
|
| Rate for Payer: Mclaren Commercial |
$76.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.98
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,521.71
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,521.71 |
| Rate for Payer: Aetna Commercial |
$1,369.54
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$1,476.06
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.78
|
| Rate for Payer: BCN Commercial |
$1,179.78
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,217.37
|
| Rate for Payer: Cash Price |
$1,217.37
|
| Rate for Payer: Cofinity Commercial |
$1,430.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,521.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,476.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$1,369.54
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,293.45
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,384.76
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.41
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,339.10
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,521.71
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,065.20 |
| Max. Negotiated Rate |
$1,521.71 |
| Rate for Payer: Aetna Commercial |
$1,369.54
|
| Rate for Payer: ASR ASR |
$1,476.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.78
|
| Rate for Payer: BCN Commercial |
$1,179.78
|
| Rate for Payer: Cash Price |
$1,217.37
|
| Rate for Payer: Cofinity Commercial |
$1,430.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.37
|
| Rate for Payer: Healthscope Commercial |
$1,521.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,476.06
|
| Rate for Payer: Mclaren Commercial |
$1,369.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,293.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,339.10
|
|
|
HC 2D ECHOCARDIOGRAM LIMITED STUDY
|
Facility
|
OP
|
$809.36
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
48300002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$809.36 |
| Rate for Payer: Aetna Commercial |
$728.42
|
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.26
|
| Rate for Payer: ASR ASR |
$785.08
|
| Rate for Payer: BCBS Complete |
$125.11
|
| Rate for Payer: BCBS MAPPO |
$217.81
|
| Rate for Payer: BCBS Trust/PPO |
$627.50
|
| Rate for Payer: BCN Commercial |
$627.50
|
| Rate for Payer: BCN Medicare Advantage |
$217.81
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cash Price |
$647.49
|
| Rate for Payer: Cofinity Commercial |
$760.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.81
|
| Rate for Payer: Healthscope Commercial |
$809.36
|
| Rate for Payer: Healthscope Whirlpool |
$785.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.81
|
| Rate for Payer: Mclaren Commercial |
$728.42
|
| Rate for Payer: Mclaren Medicaid |
$119.14
|
| Rate for Payer: Mclaren Medicare |
$217.81
|
| Rate for Payer: Meridian Medicaid |
$125.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.96
|
| Rate for Payer: PACE Medicare |
$206.92
|
| Rate for Payer: PACE SWMI |
$217.81
|
| Rate for Payer: PHP Commercial |
$239.59
|
| Rate for Payer: PHP Medicaid |
$119.14
|
| Rate for Payer: PHP Medicare Advantage |
$217.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$510.53
|
| Rate for Payer: Priority Health Medicare |
$217.81
|
| Rate for Payer: Priority Health Narrow Network |
$408.42
|
| Rate for Payer: Railroad Medicare Medicare |
$217.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.24
|
| Rate for Payer: UHC Medicare Advantage |
$224.34
|
| Rate for Payer: VA VA |
$217.81
|
|
