|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,924.74
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,212.59 |
| Max. Negotiated Rate |
$1,732.27 |
| Rate for Payer: Aetna Commercial |
$1,636.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.08
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cofinity Advantage |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,655.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.79
|
| Rate for Payer: Healthscope Commercial |
$1,732.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.56
|
| Rate for Payer: PHP Commercial |
$1,636.03
|
| Rate for Payer: Priority Health SBD |
$1,212.59
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,161.60
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,621.81 |
| Max. Negotiated Rate |
$3,745.44 |
| Rate for Payer: Aetna Commercial |
$3,537.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,705.04
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Advantage |
$2,913.12
|
| Rate for Payer: Cofinity Commercial |
$3,578.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Healthscope Commercial |
$3,745.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PHP Commercial |
$3,537.36
|
| Rate for Payer: Priority Health SBD |
$2,621.81
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,161.60
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,180.96 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$3,537.36
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,705.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.96
|
| Rate for Payer: BCN Commercial |
$1,180.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Advantage |
$2,913.12
|
| Rate for Payer: Cofinity Commercial |
$3,578.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$3,745.44
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$3,537.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$2,621.81
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.04
|
| Rate for Payer: UHC Core |
$2,168.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Exchange |
$1,635.51
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$519.25
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.75 |
| Max. Negotiated Rate |
$467.32 |
| Rate for Payer: Aetna Commercial |
$441.36
|
| Rate for Payer: Aetna Medicare |
$259.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.51
|
| Rate for Payer: BCBS Complete |
$207.70
|
| Rate for Payer: BCBS Trust/PPO |
$107.75
|
| Rate for Payer: BCN Commercial |
$107.75
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cofinity Advantage |
$363.48
|
| Rate for Payer: Cofinity Commercial |
$446.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$467.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.44
|
| Rate for Payer: PHP Commercial |
$441.36
|
| Rate for Payer: Priority Health SBD |
$327.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.51
|
| Rate for Payer: UHC Core |
$270.53
|
| Rate for Payer: UHC Exchange |
$204.07
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$519.25
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.13 |
| Max. Negotiated Rate |
$467.32 |
| Rate for Payer: Aetna Commercial |
$441.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.51
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cofinity Advantage |
$363.48
|
| Rate for Payer: Cofinity Commercial |
$446.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$467.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.44
|
| Rate for Payer: PHP Commercial |
$441.36
|
| Rate for Payer: Priority Health SBD |
$327.13
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$657.98
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$559.28
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$236.23
|
| Rate for Payer: BCN Commercial |
$236.23
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cofinity Advantage |
$460.59
|
| Rate for Payer: Cofinity Commercial |
$565.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$592.18
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.28
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.49
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$559.28
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$414.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.69
|
| Rate for Payer: UHC Core |
$342.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$258.59
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$657.98
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.53 |
| Max. Negotiated Rate |
$592.18 |
| Rate for Payer: Aetna Commercial |
$559.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.69
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cofinity Advantage |
$460.59
|
| Rate for Payer: Cofinity Commercial |
$565.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.38
|
| Rate for Payer: Healthscope Commercial |
$592.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.49
|
| Rate for Payer: PHP Commercial |
$559.28
|
| Rate for Payer: Priority Health SBD |
$414.53
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$38.31
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$32.56
|
| Rate for Payer: Aetna Medicare |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.90
|
| Rate for Payer: BCBS Complete |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.20
|
| Rate for Payer: BCN Commercial |
$14.20
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cofinity Advantage |
$26.82
|
| Rate for Payer: Cofinity Commercial |
$32.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.65
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: PHP Commercial |
$32.56
|
| Rate for Payer: Priority Health SBD |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.14
|
| Rate for Payer: UHC Core |
$12.14
|
| Rate for Payer: UHC Exchange |
$12.14
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$38.31
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$34.48 |
| Rate for Payer: Aetna Commercial |
$32.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.90
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cofinity Advantage |
$26.82
|
| Rate for Payer: Cofinity Commercial |
$32.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.65
|
| Rate for Payer: Healthscope Commercial |
$34.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: PHP Commercial |
$32.56
|
| Rate for Payer: Priority Health SBD |
$24.14
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$492.82
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.48 |
| Max. Negotiated Rate |
$443.54 |
| Rate for Payer: Aetna Commercial |
$418.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.33
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cofinity Advantage |
$344.97
|
| Rate for Payer: Cofinity Commercial |
$423.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.26
|
| Rate for Payer: Healthscope Commercial |
$443.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.62
|
| Rate for Payer: PHP Commercial |
$418.90
|
| Rate for Payer: Priority Health SBD |
$310.48
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$492.82
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$418.90
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$274.25
|
| Rate for Payer: BCN Commercial |
$274.25
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cofinity Advantage |
$344.97
|
| Rate for Payer: Cofinity Commercial |
$423.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$443.54
|
| Rate for Payer: Mclaren Medicaid |
$172.13
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$345.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.90
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.62
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$418.90
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,064.33
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health SBD |
$310.48
|
| Rate for Payer: Priority Health Tiered Network |
$851.46
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.33
|
| Rate for Payer: UHC Core |
$256.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$193.68
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$146.25
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.14 |
| Max. Negotiated Rate |
$131.62 |
| Rate for Payer: Aetna Commercial |
$124.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.06
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cofinity Advantage |
$102.38
|
| Rate for Payer: Cofinity Commercial |
$125.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.00
|
| Rate for Payer: Healthscope Commercial |
$131.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.69
|
| Rate for Payer: PHP Commercial |
$124.31
|
| Rate for Payer: Priority Health SBD |
$92.14
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$146.25
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$131.62 |
| Rate for Payer: Aetna Commercial |
$124.31
|
| Rate for Payer: Aetna Medicare |
$73.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.06
|
| Rate for Payer: BCBS Complete |
$58.50
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cofinity Advantage |
$102.38
|
| Rate for Payer: Cofinity Commercial |
$125.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.00
|
| Rate for Payer: Healthscope Commercial |
$131.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.69
|
| Rate for Payer: PHP Commercial |
$124.31
|
| Rate for Payer: Priority Health SBD |
$92.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.06
|
| Rate for Payer: UHC Core |
$76.20
|
| Rate for Payer: UHC Exchange |
$57.48
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$839.72
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$529.02 |
| Max. Negotiated Rate |
$755.75 |
| Rate for Payer: Aetna Commercial |
$713.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.82
|
| Rate for Payer: Cash Price |
$671.78
|
| Rate for Payer: Cofinity Advantage |
$587.80
|
| Rate for Payer: Cofinity Commercial |
$722.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.78
|
| Rate for Payer: Healthscope Commercial |
$755.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.79
|
| Rate for Payer: PHP Commercial |
$713.76
|
| Rate for Payer: Priority Health SBD |
$529.02
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$839.72
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$330.01 |
| Max. Negotiated Rate |
$755.75 |
| Rate for Payer: Aetna Commercial |
$713.76
|
| Rate for Payer: Aetna Medicare |
$419.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.82
|
| Rate for Payer: BCBS Complete |
$335.89
|
| Rate for Payer: Cash Price |
$671.78
|
| Rate for Payer: Cofinity Advantage |
$587.80
|
| Rate for Payer: Cofinity Commercial |
$722.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.78
|
| Rate for Payer: Healthscope Commercial |
$755.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$671.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.79
|
| Rate for Payer: PHP Commercial |
$713.76
|
| Rate for Payer: Priority Health SBD |
$529.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.82
|
| Rate for Payer: UHC Core |
$437.49
|
| Rate for Payer: UHC Exchange |
$330.01
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,679.41
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,058.03 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.62
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Advantage |
$1,175.59
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: Priority Health SBD |
$1,058.03
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,679.41
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$660.01 |
| Max. Negotiated Rate |
$1,511.47 |
| Rate for Payer: Aetna Commercial |
$1,427.50
|
| Rate for Payer: Aetna Medicare |
$839.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.62
|
| Rate for Payer: BCBS Complete |
$671.76
|
| Rate for Payer: Cash Price |
$1,343.53
|
| Rate for Payer: Cofinity Advantage |
$1,175.59
|
| Rate for Payer: Cofinity Commercial |
$1,444.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.53
|
| Rate for Payer: Healthscope Commercial |
$1,511.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,343.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,427.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,259.56
|
| Rate for Payer: PHP Commercial |
$1,427.50
|
| Rate for Payer: Priority Health SBD |
$1,058.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,091.62
|
| Rate for Payer: UHC Core |
$874.97
|
| Rate for Payer: UHC Exchange |
$660.01
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$100.86
|
| Rate for Payer: BCN Commercial |
$100.86
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.27 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.27 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$302.02
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$271.82 |
| Rate for Payer: Aetna Commercial |
$256.72
|
| Rate for Payer: Aetna Medicare |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.31
|
| Rate for Payer: BCBS Complete |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$100.86
|
| Rate for Payer: BCN Commercial |
$100.86
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cash Price |
$241.62
|
| Rate for Payer: Cofinity Advantage |
$211.41
|
| Rate for Payer: Cofinity Commercial |
$259.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.62
|
| Rate for Payer: Healthscope Commercial |
$271.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.51
|
| Rate for Payer: PHP Commercial |
$256.72
|
| Rate for Payer: Priority Health SBD |
$190.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Exchange |
$66.35
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$14.04 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.58
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.46
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Mclaren Medicaid |
$2.33
|
| Rate for Payer: Mclaren Medicare |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.68
|
| Rate for Payer: Meridian Medicaid |
$4.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PACE Medicare |
$4.24
|
| Rate for Payer: PACE SWMI |
$4.46
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$4.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.04
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: Priority Health Tiered Network |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.34
|
| Rate for Payer: UHC Core |
$7.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.46
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicaid |
$2.33
|
| Rate for Payer: UHCCP Medicaid |
$2.33
|
| Rate for Payer: VA VA |
$4.46
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.65 |
| Max. Negotiated Rate |
$1,817.20 |
| Rate for Payer: Aetna Commercial |
$818.50
|
| Rate for Payer: Aetna Medicare |
$317.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.57
|
| Rate for Payer: BCBS Complete |
$167.65
|
| Rate for Payer: BCBS MAPPO |
$305.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,817.20
|
| Rate for Payer: BCN Commercial |
$1,817.20
|
| Rate for Payer: BCN Medicare Advantage |
$305.26
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Advantage |
$674.06
|
| Rate for Payer: Cofinity Commercial |
$828.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.26
|
| Rate for Payer: Healthscope Commercial |
$866.65
|
| Rate for Payer: Mclaren Medicaid |
$159.65
|
| Rate for Payer: Mclaren Medicare |
$305.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.52
|
| Rate for Payer: Meridian Medicaid |
$320.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$335.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Nomi Health Commercial |
$915.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: PACE Medicare |
$290.00
|
| Rate for Payer: PACE SWMI |
$305.26
|
| Rate for Payer: PHP Commercial |
$818.50
|
| Rate for Payer: PHP Medicare Advantage |
$305.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$987.21
|
| Rate for Payer: Priority Health Medicare |
$305.26
|
| Rate for Payer: Priority Health SBD |
$606.65
|
| Rate for Payer: Priority Health Tiered Network |
$789.77
|
| Rate for Payer: Railroad Medicare Medicare |
$305.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.91
|
| Rate for Payer: UHC Core |
$501.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.26
|
| Rate for Payer: UHC Exchange |
$378.44
|
| Rate for Payer: UHC Medicaid |
$159.65
|
| Rate for Payer: UHCCP Medicaid |
$159.65
|
| Rate for Payer: VA VA |
$305.26
|
|
|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
IP
|
$962.94
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$606.65 |
| Max. Negotiated Rate |
$866.65 |
| Rate for Payer: Aetna Commercial |
$818.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.91
|
| Rate for Payer: Cash Price |
$770.35
|
| Rate for Payer: Cofinity Advantage |
$674.06
|
| Rate for Payer: Cofinity Commercial |
$828.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.35
|
| Rate for Payer: Healthscope Commercial |
$866.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.21
|
| Rate for Payer: PHP Commercial |
$818.50
|
| Rate for Payer: Priority Health SBD |
$606.65
|
|
