|
HC INSULIN
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
30100266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.29
|
| Rate for Payer: BCBS Complete |
$6.43
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.13
|
| Rate for Payer: Mclaren Medicare |
$11.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: Meridian Medicaid |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: PACE Medicare |
$10.86
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.43
|
| Rate for Payer: UHC Medicare Advantage |
$11.43
|
| Rate for Payer: UHCCP Medicaid |
$6.44
|
| Rate for Payer: VA VA |
$11.43
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| 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 |
$12.05
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| 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 |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.41
|
| Rate for Payer: UHC Medicare Advantage |
$21.41
|
| Rate for Payer: UHCCP Medicaid |
$12.05
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health SBD |
$43.70
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$48.61 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| 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 |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| 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 |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$31.46
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health SBD |
$31.46
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$189.78
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$75.91 |
| Max. Negotiated Rate |
$170.80 |
| Rate for Payer: Aetna Commercial |
$161.31
|
| Rate for Payer: Aetna Medicare |
$94.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.36
|
| Rate for Payer: BCBS Complete |
$75.91
|
| Rate for Payer: Cash Price |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$163.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.31
|
| Rate for Payer: PHP Commercial |
$161.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.36
|
| Rate for Payer: Priority Health SBD |
$119.56
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$189.78
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$170.80 |
| Rate for Payer: Aetna Commercial |
$161.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.36
|
| Rate for Payer: Cash Price |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$163.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.31
|
| Rate for Payer: PHP Commercial |
$161.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.36
|
| Rate for Payer: Priority Health SBD |
$119.56
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.95 |
| Max. Negotiated Rate |
$1,067.08 |
| Rate for Payer: Aetna Commercial |
$1,007.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.67
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,019.65
|
| Rate for Payer: Cofinity Commercial |
$829.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$829.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,067.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: PHP Commercial |
$1,007.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health SBD |
$746.95
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.26 |
| Max. Negotiated Rate |
$1,067.08 |
| Rate for Payer: Aetna Commercial |
$1,007.79
|
| Rate for Payer: Aetna Medicare |
$592.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.67
|
| Rate for Payer: BCBS Complete |
$474.26
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,019.65
|
| Rate for Payer: Cofinity Commercial |
$829.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$829.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,067.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: PHP Commercial |
$1,007.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health SBD |
$746.95
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$131.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Aetna Commercial |
$111.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.53
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$113.16
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Healthscope Commercial |
$118.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: PHP Commercial |
$111.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health SBD |
$82.90
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$131.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Aetna Commercial |
$111.84
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.53
|
| 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 |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Commercial |
$113.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$118.42
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| 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 |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$111.84
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$82.90
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,896.09
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,084.54 |
| Max. Negotiated Rate |
$4,406.48 |
| Rate for Payer: Aetna Commercial |
$4,161.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,182.46
|
| Rate for Payer: Cash Price |
$3,916.87
|
| Rate for Payer: Cofinity Commercial |
$3,427.26
|
| Rate for Payer: Cofinity Commercial |
$4,210.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,427.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.87
|
| Rate for Payer: Healthscope Commercial |
$4,406.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.68
|
| Rate for Payer: PHP Commercial |
$4,161.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.46
|
| Rate for Payer: Priority Health SBD |
$3,084.54
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$2,965.64
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,868.35 |
| Max. Negotiated Rate |
$2,669.08 |
| Rate for Payer: Aetna Commercial |
$2,520.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,927.67
|
| Rate for Payer: Cash Price |
$2,372.51
|
| Rate for Payer: Cofinity Commercial |
$2,075.95
|
| Rate for Payer: Cofinity Commercial |
$2,550.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,075.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,372.51
|
| Rate for Payer: Healthscope Commercial |
$2,669.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,520.79
|
| Rate for Payer: PHP Commercial |
$2,520.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,927.67
|
| Rate for Payer: Priority Health SBD |
$1,868.35
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$536.85
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$456.32
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.95
|
| 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 |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cofinity Commercial |
$461.69
|
| Rate for Payer: Cofinity Commercial |
$375.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$483.17
|
| 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 |
$456.32
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$456.32
|
| 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 |
$348.95
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$338.22
|
| 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 INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$536.85
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.22 |
| Max. Negotiated Rate |
$483.17 |
| Rate for Payer: Aetna Commercial |
$456.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.95
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cofinity Commercial |
$375.80
|
| Rate for Payer: Cofinity Commercial |
$461.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.48
|
| Rate for Payer: Healthscope Commercial |
$483.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.32
|
| Rate for Payer: PHP Commercial |
$456.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.95
|
| Rate for Payer: Priority Health SBD |
$338.22
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,888.39
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$755.36 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Aetna Commercial |
$1,605.13
|
| Rate for Payer: Aetna Medicare |
$944.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.45
|
| Rate for Payer: BCBS Complete |
$755.36
|
| Rate for Payer: Cash Price |
$1,510.71
|
| Rate for Payer: Cofinity Commercial |
$1,321.87
|
| Rate for Payer: Cofinity Commercial |
$1,624.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,321.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.71
|
| Rate for Payer: Healthscope Commercial |
$1,699.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.13
|
| Rate for Payer: PHP Commercial |
$1,605.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.45
|
| Rate for Payer: Priority Health SBD |
$1,189.69
|
| Rate for Payer: UHC Core |
$1,397.41
|
| Rate for Payer: UHC Exchange |
$1,397.41
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,888.39
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,189.69 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Aetna Commercial |
$1,605.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.45
|
| Rate for Payer: Cash Price |
$1,510.71
|
| Rate for Payer: Cofinity Commercial |
$1,321.87
|
| Rate for Payer: Cofinity Commercial |
$1,624.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,321.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.71
|
| Rate for Payer: Healthscope Commercial |
$1,699.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.13
|
| Rate for Payer: PHP Commercial |
$1,605.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.45
|
| Rate for Payer: Priority Health SBD |
$1,189.69
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health SBD |
$177.40
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| 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 |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| 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 |
$239.35
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$239.35
|
| 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 |
$183.03
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$177.40
|
| 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 INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.14 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.34
|
| 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 |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Cofinity Commercial |
$216.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$278.77
|
| 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 |
$263.29
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$263.29
|
| 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 |
$201.34
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$195.14
|
| 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 INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.14 |
| Max. Negotiated Rate |
$278.77 |
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.34
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$216.82
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$278.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: Priority Health SBD |
$195.14
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.14 |
| Max. Negotiated Rate |
$448.78 |
| Rate for Payer: Aetna Commercial |
$423.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.12
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$349.05
|
| Rate for Payer: Cofinity Commercial |
$428.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Healthscope Commercial |
$448.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: PHP Commercial |
$423.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health SBD |
$314.14
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
OP
|
$498.64
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$423.84
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.12
|
| 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 |
$398.91
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$428.83
|
| Rate for Payer: Cofinity Commercial |
$349.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$448.78
|
| 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 |
$423.84
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$423.84
|
| 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 |
$324.12
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$314.14
|
| 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 INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health SBD |
$177.40
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.03
|
| 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 |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Cofinity Commercial |
$197.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| 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 |
$239.35
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$239.35
|
| 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 |
$183.03
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$177.40
|
| 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
|
|
