|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,113.39
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$946.38
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cash Price |
$890.71
|
| Rate for Payer: Cofinity Commercial |
$957.52
|
| Rate for Payer: Cofinity Commercial |
$779.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$779.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$890.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$1,002.05
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.38
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$946.38
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.70
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$701.44
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$1,603.95
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,622.82
|
| Rate for Payer: Cofinity Commercial |
$1,320.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,320.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,698.30
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.95
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$1,603.95
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.55
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$1,188.81
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,887.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,188.81 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Aetna Commercial |
$1,603.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.55
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,320.90
|
| Rate for Payer: Cofinity Commercial |
$1,622.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,320.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.60
|
| Rate for Payer: Healthscope Commercial |
$1,698.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.95
|
| Rate for Payer: PHP Commercial |
$1,603.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.55
|
| Rate for Payer: Priority Health SBD |
$1,188.81
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,080.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Cofinity Commercial |
$2,856.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,856.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$2,570.40
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,080.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$3,468.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.00
|
| Rate for Payer: Cash Price |
$3,264.00
|
| Rate for Payer: Cofinity Commercial |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$3,508.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,856.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,264.00
|
| Rate for Payer: Healthscope Commercial |
$3,672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,468.00
|
| Rate for Payer: PHP Commercial |
$3,468.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,652.00
|
| Rate for Payer: Priority Health SBD |
$2,570.40
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$509.07
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.63 |
| Max. Negotiated Rate |
$458.16 |
| Rate for Payer: Aetna Commercial |
$432.71
|
| Rate for Payer: Aetna Medicare |
$254.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.90
|
| Rate for Payer: BCBS Complete |
$203.63
|
| Rate for Payer: Cash Price |
$407.26
|
| Rate for Payer: Cofinity Commercial |
$356.35
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.26
|
| Rate for Payer: Healthscope Commercial |
$458.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.71
|
| Rate for Payer: PHP Commercial |
$432.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.90
|
| Rate for Payer: Priority Health SBD |
$320.71
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$509.07
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.71 |
| Max. Negotiated Rate |
$458.16 |
| Rate for Payer: Aetna Commercial |
$432.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.90
|
| Rate for Payer: Cash Price |
$407.26
|
| Rate for Payer: Cofinity Commercial |
$356.35
|
| Rate for Payer: Cofinity Commercial |
$437.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.26
|
| Rate for Payer: Healthscope Commercial |
$458.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.71
|
| Rate for Payer: PHP Commercial |
$432.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.90
|
| Rate for Payer: Priority Health SBD |
$320.71
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$645.08
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.40 |
| Max. Negotiated Rate |
$580.57 |
| Rate for Payer: Aetna Commercial |
$548.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.30
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cofinity Commercial |
$451.56
|
| Rate for Payer: Cofinity Commercial |
$554.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$451.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.06
|
| Rate for Payer: Healthscope Commercial |
$580.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.32
|
| Rate for Payer: PHP Commercial |
$548.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.30
|
| Rate for Payer: Priority Health SBD |
$406.40
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$645.08
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$548.32
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cash Price |
$516.06
|
| Rate for Payer: Cofinity Commercial |
$554.77
|
| Rate for Payer: Cofinity Commercial |
$451.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$451.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$580.57
|
| 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 |
$548.32
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$548.32
|
| 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 |
$419.30
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$406.40
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.41
|
| Rate for Payer: BCBS Complete |
$15.02
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health SBD |
$23.66
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$37.56
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.41
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$32.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.05
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.93
|
| Rate for Payer: PHP Commercial |
$31.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.41
|
| Rate for Payer: Priority Health SBD |
$23.66
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Cofinity Commercial |
$338.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health SBD |
$304.39
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$483.16
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$434.84 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.05
|
| Rate for Payer: Cash Price |
$386.53
|
| Rate for Payer: Cofinity Commercial |
$338.21
|
| Rate for Payer: Cofinity Commercial |
$415.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$338.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.53
|
| Rate for Payer: Healthscope Commercial |
$434.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.69
|
| Rate for Payer: PHP Commercial |
$410.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.05
|
| Rate for Payer: Priority Health SBD |
$304.39
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.35 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.20
|
| Rate for Payer: BCBS Complete |
$57.35
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health SBD |
$90.33
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$143.38
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna Commercial |
$121.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.20
|
| Rate for Payer: Cash Price |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$123.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.70
|
| Rate for Payer: Healthscope Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.87
|
| Rate for Payer: PHP Commercial |
$121.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.20
|
| Rate for Payer: Priority Health SBD |
$90.33
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
OP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$329.30 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna Medicare |
$411.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.11
|
| Rate for Payer: BCBS Complete |
$329.30
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$576.27
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$576.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health SBD |
$518.65
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$823.25
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$518.65 |
| Max. Negotiated Rate |
$740.92 |
| Rate for Payer: Aetna Commercial |
$699.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.11
|
| Rate for Payer: Cash Price |
$658.60
|
| Rate for Payer: Cofinity Commercial |
$576.27
|
| Rate for Payer: Cofinity Commercial |
$708.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$576.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.60
|
| Rate for Payer: Healthscope Commercial |
$740.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.76
|
| Rate for Payer: PHP Commercial |
$699.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.11
|
| Rate for Payer: Priority Health SBD |
$518.65
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
IP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,037.28 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
|
|
HC DECONTAMINATION NON AMBULATORY
|
Facility
|
OP
|
$1,646.48
|
|
| Hospital Charge Code |
27000126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$658.59 |
| Max. Negotiated Rate |
$1,481.83 |
| Rate for Payer: Aetna Commercial |
$1,399.51
|
| Rate for Payer: Aetna Medicare |
$823.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.21
|
| Rate for Payer: BCBS Complete |
$658.59
|
| Rate for Payer: Cash Price |
$1,317.18
|
| Rate for Payer: Cofinity Commercial |
$1,152.54
|
| Rate for Payer: Cofinity Commercial |
$1,415.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,152.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,317.18
|
| Rate for Payer: Healthscope Commercial |
$1,481.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,399.51
|
| Rate for Payer: PHP Commercial |
$1,399.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.21
|
| Rate for Payer: Priority Health SBD |
$1,037.28
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEFINITY CONTRAST 1ST ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.54 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna Medicare |
$148.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEFINITY CONTRAST 2ND ML
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
63600003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.54 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna Commercial |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.47
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.69
|
| Rate for Payer: PHP Commercial |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.47
|
| Rate for Payer: Priority Health SBD |
$186.54
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.93
|
|
|
HC DEGARELIX INJECTION PER 1MG
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
63600146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$12.53 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.56
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Mclaren Medicaid |
$2.39
|
| Rate for Payer: Mclaren Medicare |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Meridian Medicaid |
$2.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.30
|
| Rate for Payer: PACE Medicare |
$4.23
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.45
|
| Rate for Payer: UHC Medicare Advantage |
$4.45
|
| Rate for Payer: UHCCP Medicaid |
$2.51
|
| Rate for Payer: VA VA |
$4.45
|
|
