|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$22.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$11.20
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: Meridian Medicaid |
$22.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.41
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health Tiered Network |
$17.13
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.12
|
| Rate for Payer: UHC Core |
$32.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.41
|
| Rate for Payer: UHC Exchange |
$32.12
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$32.09
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: Priority Health SBD |
$32.09
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$193.58
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$174.22 |
| Rate for Payer: Aetna Commercial |
$164.54
|
| Rate for Payer: Aetna Medicare |
$96.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.83
|
| Rate for Payer: BCBS Complete |
$77.43
|
| Rate for Payer: Cash Price |
$154.86
|
| Rate for Payer: Cofinity Advantage |
$135.51
|
| Rate for Payer: Cofinity Commercial |
$166.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.86
|
| Rate for Payer: Healthscope Commercial |
$174.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.19
|
| Rate for Payer: PHP Commercial |
$164.54
|
| Rate for Payer: Priority Health SBD |
$121.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.83
|
| Rate for Payer: UHC Core |
$100.86
|
| Rate for Payer: UHC Exchange |
$76.08
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$193.58
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$121.96 |
| Max. Negotiated Rate |
$174.22 |
| Rate for Payer: Aetna Commercial |
$164.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.83
|
| Rate for Payer: Cash Price |
$154.86
|
| Rate for Payer: Cofinity Advantage |
$135.51
|
| Rate for Payer: Cofinity Commercial |
$166.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.86
|
| Rate for Payer: Healthscope Commercial |
$174.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.19
|
| Rate for Payer: PHP Commercial |
$164.54
|
| Rate for Payer: Priority Health SBD |
$121.96
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,209.35
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.27 |
| Max. Negotiated Rate |
$1,088.41 |
| Rate for Payer: Aetna Commercial |
$1,027.95
|
| Rate for Payer: Aetna Medicare |
$604.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.08
|
| Rate for Payer: BCBS Complete |
$483.74
|
| Rate for Payer: Cash Price |
$967.48
|
| Rate for Payer: Cofinity Advantage |
$846.54
|
| Rate for Payer: Cofinity Commercial |
$1,040.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.48
|
| Rate for Payer: Healthscope Commercial |
$1,088.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$967.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.01
|
| Rate for Payer: PHP Commercial |
$1,027.95
|
| Rate for Payer: Priority Health SBD |
$761.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.08
|
| Rate for Payer: UHC Core |
$630.07
|
| Rate for Payer: UHC Exchange |
$475.27
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,209.35
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.89 |
| Max. Negotiated Rate |
$1,088.41 |
| Rate for Payer: Aetna Commercial |
$1,027.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.08
|
| Rate for Payer: Cash Price |
$967.48
|
| Rate for Payer: Cofinity Advantage |
$846.54
|
| Rate for Payer: Cofinity Commercial |
$1,040.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.48
|
| Rate for Payer: Healthscope Commercial |
$1,088.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.01
|
| Rate for Payer: PHP Commercial |
$1,027.95
|
| Rate for Payer: Priority Health SBD |
$761.89
|
|
|
HC INTERFACE CABLE LEVEL 7
|
Facility
|
IP
|
$1,985.00
|
|
| Hospital Charge Code |
27000721
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,250.55 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$1,687.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,290.25
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Advantage |
$1,389.50
|
| Rate for Payer: Cofinity Commercial |
$1,707.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.00
|
| Rate for Payer: Healthscope Commercial |
$1,786.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,488.75
|
| Rate for Payer: PHP Commercial |
$1,687.25
|
| Rate for Payer: Priority Health SBD |
$1,250.55
|
|
|
HC INTERFACE CABLE LEVEL 7
|
Facility
|
OP
|
$1,985.00
|
|
| Hospital Charge Code |
27000721
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$780.11 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$1,687.25
|
| Rate for Payer: Aetna Medicare |
$992.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,290.25
|
| Rate for Payer: BCBS Complete |
$794.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cofinity Advantage |
$1,389.50
|
| Rate for Payer: Cofinity Commercial |
$1,707.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.00
|
| Rate for Payer: Healthscope Commercial |
$1,786.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,588.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,488.75
|
| Rate for Payer: PHP Commercial |
$1,687.25
|
| Rate for Payer: Priority Health SBD |
$1,250.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,290.25
|
| Rate for Payer: UHC Core |
$1,034.18
|
| Rate for Payer: UHC Exchange |
$780.11
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$134.21
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.55 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Aetna Commercial |
$114.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Advantage |
$93.95
|
| Rate for Payer: Cofinity Commercial |
$115.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Healthscope Commercial |
$120.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: Priority Health SBD |
$84.55
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$134.21
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Aetna Commercial |
$114.08
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Advantage |
$93.95
|
| Rate for Payer: Cofinity Commercial |
$115.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$120.79
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$84.55
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,994.01
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,146.23 |
| Max. Negotiated Rate |
$4,494.61 |
| Rate for Payer: Aetna Commercial |
$4,244.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,246.11
|
| Rate for Payer: Cash Price |
$3,995.21
|
| Rate for Payer: Cofinity Advantage |
$3,495.81
|
| Rate for Payer: Cofinity Commercial |
$4,294.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.21
|
| Rate for Payer: Healthscope Commercial |
$4,494.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.51
|
| Rate for Payer: PHP Commercial |
$4,244.91
|
| Rate for Payer: Priority Health SBD |
$3,146.23
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$3,024.95
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,905.72 |
| Max. Negotiated Rate |
$2,722.45 |
| Rate for Payer: Aetna Commercial |
$2,571.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,966.22
|
| Rate for Payer: Cash Price |
$2,419.96
|
| Rate for Payer: Cofinity Advantage |
$2,117.47
|
| Rate for Payer: Cofinity Commercial |
$2,601.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,419.96
|
| Rate for Payer: Healthscope Commercial |
$2,722.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,571.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,268.71
|
| Rate for Payer: PHP Commercial |
$2,571.21
|
| Rate for Payer: Priority Health SBD |
$1,905.72
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$547.59
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.98 |
| Max. Negotiated Rate |
$492.83 |
| Rate for Payer: Aetna Commercial |
$465.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.93
|
| Rate for Payer: Cash Price |
$438.07
|
| Rate for Payer: Cofinity Advantage |
$383.31
|
| Rate for Payer: Cofinity Commercial |
$470.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.07
|
| Rate for Payer: Healthscope Commercial |
$492.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.69
|
| Rate for Payer: PHP Commercial |
$465.45
|
| Rate for Payer: Priority Health SBD |
$344.98
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$547.59
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$465.45
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.93
|
| 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 |
$328.94
|
| Rate for Payer: BCN Commercial |
$328.94
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$438.07
|
| Rate for Payer: Cash Price |
$438.07
|
| Rate for Payer: Cash Price |
$438.07
|
| Rate for Payer: Cofinity Advantage |
$383.31
|
| Rate for Payer: Cofinity Commercial |
$470.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$492.83
|
| 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 |
$465.45
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.69
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$465.45
|
| 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 |
$344.98
|
| 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) |
$355.93
|
| Rate for Payer: UHC Core |
$285.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$215.20
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INTERMEDIATE REPAIR WOUND N/H/F/XTRNL GENT 7.6 TO 12.5 CM
|
Facility
|
OP
|
$1,886.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.35 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$1,603.10
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$156.35
|
| Rate for Payer: BCN Commercial |
$156.35
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cofinity Advantage |
$1,320.20
|
| Rate for Payer: Cofinity Commercial |
$1,621.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,508.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$1,697.40
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.10
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.50
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$1,603.10
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,188.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,225.90
|
| Rate for Payer: UHC Core |
$982.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$741.20
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC INTERMEDIATE REPAIR WOUND N/H/F/XTRNL GENT 7.6 TO 12.5 CM
|
Facility
|
IP
|
$1,886.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,188.18 |
| Max. Negotiated Rate |
$1,697.40 |
| Rate for Payer: Aetna Commercial |
$1,603.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.90
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cofinity Advantage |
$1,320.20
|
| Rate for Payer: Cofinity Commercial |
$1,621.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,508.80
|
| Rate for Payer: Healthscope Commercial |
$1,697.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.50
|
| Rate for Payer: PHP Commercial |
$1,603.10
|
| Rate for Payer: Priority Health SBD |
$1,188.18
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,926.16
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$756.98 |
| Max. Negotiated Rate |
$1,733.54 |
| Rate for Payer: Aetna Commercial |
$1,637.24
|
| Rate for Payer: Aetna Medicare |
$963.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.00
|
| Rate for Payer: BCBS Complete |
$770.46
|
| Rate for Payer: Cash Price |
$1,540.93
|
| Rate for Payer: Cofinity Advantage |
$1,348.31
|
| Rate for Payer: Cofinity Commercial |
$1,656.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.93
|
| Rate for Payer: Healthscope Commercial |
$1,733.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,540.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,444.62
|
| Rate for Payer: PHP Commercial |
$1,637.24
|
| Rate for Payer: Priority Health SBD |
$1,213.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.00
|
| Rate for Payer: UHC Core |
$1,003.53
|
| Rate for Payer: UHC Exchange |
$756.98
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,926.16
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,213.48 |
| Max. Negotiated Rate |
$1,733.54 |
| Rate for Payer: Aetna Commercial |
$1,637.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,540.93
|
| Rate for Payer: Cofinity Advantage |
$1,348.31
|
| Rate for Payer: Cofinity Commercial |
$1,656.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.93
|
| Rate for Payer: Healthscope Commercial |
$1,733.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,444.62
|
| Rate for Payer: PHP Commercial |
$1,637.24
|
| Rate for Payer: Priority Health SBD |
$1,213.48
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
OP
|
$287.22
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.69
|
| 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 |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Advantage |
$201.05
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| 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 |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$244.14
|
| 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 |
$180.95
|
| 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) |
$186.69
|
| Rate for Payer: UHC Core |
$149.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$112.88
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
IP
|
$287.22
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.95 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.69
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Advantage |
$201.05
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PHP Commercial |
$244.14
|
| Rate for Payer: Priority Health SBD |
$180.95
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
OP
|
$315.95
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.17 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$268.56
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.37
|
| 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 |
$412.19
|
| Rate for Payer: BCN Commercial |
$412.19
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cofinity Advantage |
$221.16
|
| Rate for Payer: Cofinity Commercial |
$271.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$284.36
|
| 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 |
$268.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.96
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$268.56
|
| 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 |
$199.05
|
| 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) |
$205.37
|
| Rate for Payer: UHC Core |
$164.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$124.17
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
IP
|
$315.95
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.05 |
| Max. Negotiated Rate |
$284.36 |
| Rate for Payer: Aetna Commercial |
$268.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.37
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cofinity Advantage |
$221.16
|
| Rate for Payer: Cofinity Commercial |
$271.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.76
|
| Rate for Payer: Healthscope Commercial |
$284.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.96
|
| Rate for Payer: PHP Commercial |
$268.56
|
| Rate for Payer: Priority Health SBD |
$199.05
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
OP
|
$508.61
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.88 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$432.32
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.60
|
| 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 |
$412.47
|
| Rate for Payer: BCN Commercial |
$412.47
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cofinity Advantage |
$356.03
|
| Rate for Payer: Cofinity Commercial |
$437.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$457.75
|
| 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 |
$432.32
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.46
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$432.32
|
| 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 |
$320.42
|
| 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) |
$330.60
|
| Rate for Payer: UHC Core |
$264.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$199.88
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
IP
|
$508.61
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.42 |
| Max. Negotiated Rate |
$457.75 |
| Rate for Payer: Aetna Commercial |
$432.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.60
|
| Rate for Payer: Cash Price |
$406.89
|
| Rate for Payer: Cofinity Advantage |
$356.03
|
| Rate for Payer: Cofinity Commercial |
$437.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.89
|
| Rate for Payer: Healthscope Commercial |
$457.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$381.46
|
| Rate for Payer: PHP Commercial |
$432.32
|
| Rate for Payer: Priority Health SBD |
$320.42
|
|
