|
HC WHITE HICKORY IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WHITE HICKORY IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC WHITE PINE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WHITE PINE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
IP
|
$874.70
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$551.06 |
| Max. Negotiated Rate |
$787.23 |
| Rate for Payer: Aetna Commercial |
$743.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.56
|
| Rate for Payer: Cash Price |
$699.76
|
| Rate for Payer: Cofinity Commercial |
$612.29
|
| Rate for Payer: Cofinity Commercial |
$752.24
|
| Rate for Payer: Healthscope Commercial |
$787.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.50
|
| Rate for Payer: PHP Commercial |
$743.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.29
|
| Rate for Payer: Priority Health SBD |
$551.06
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
OP
|
$874.70
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$103.75 |
| Max. Negotiated Rate |
$787.23 |
| Rate for Payer: Aetna Commercial |
$743.50
|
| Rate for Payer: Aetna Medicare |
$197.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.09
|
| Rate for Payer: BCBS Complete |
$108.95
|
| Rate for Payer: BCBS MAPPO |
$189.67
|
| Rate for Payer: BCBS Trust/PPO |
$661.37
|
| Rate for Payer: BCN Medicare Advantage |
$189.67
|
| Rate for Payer: Cash Price |
$699.76
|
| Rate for Payer: Cash Price |
$699.76
|
| Rate for Payer: Cofinity Commercial |
$752.24
|
| Rate for Payer: Cofinity Commercial |
$612.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.67
|
| Rate for Payer: Healthscope Commercial |
$787.23
|
| Rate for Payer: Mclaren Medicaid |
$103.75
|
| Rate for Payer: Mclaren Medicare |
$189.67
|
| Rate for Payer: Meridian Medicaid |
$108.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.50
|
| Rate for Payer: PACE Medicare |
$180.19
|
| Rate for Payer: PACE SWMI |
$189.67
|
| Rate for Payer: PHP Commercial |
$743.50
|
| Rate for Payer: PHP Medicare Advantage |
$189.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.51
|
| Rate for Payer: Priority Health Medicare |
$189.67
|
| Rate for Payer: Priority Health Narrow Network |
$546.01
|
| Rate for Payer: Priority Health SBD |
$551.06
|
| Rate for Payer: Railroad Medicare Medicare |
$189.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.67
|
| Rate for Payer: UHC Medicare Advantage |
$195.36
|
| Rate for Payer: VA VA |
$189.67
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
IP
|
$499.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.60 |
| Max. Negotiated Rate |
$449.42 |
| Rate for Payer: Aetna Commercial |
$424.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.58
|
| Rate for Payer: Cash Price |
$399.49
|
| Rate for Payer: Cofinity Commercial |
$349.55
|
| Rate for Payer: Cofinity Commercial |
$429.45
|
| Rate for Payer: Healthscope Commercial |
$449.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.46
|
| Rate for Payer: PHP Commercial |
$424.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.55
|
| Rate for Payer: Priority Health SBD |
$314.60
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
OP
|
$499.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.74 |
| Max. Negotiated Rate |
$449.42 |
| Rate for Payer: Aetna Commercial |
$424.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.58
|
| Rate for Payer: BCBS Complete |
$199.74
|
| Rate for Payer: Cash Price |
$399.49
|
| Rate for Payer: Cofinity Commercial |
$429.45
|
| Rate for Payer: Cofinity Commercial |
$349.55
|
| Rate for Payer: Healthscope Commercial |
$449.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.46
|
| Rate for Payer: PHP Commercial |
$424.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.55
|
| Rate for Payer: Priority Health SBD |
$314.60
|
|
|
HC WILLOW IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WILLOW IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
IP
|
$305.91
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$192.72 |
| Max. Negotiated Rate |
$275.32 |
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cash Price |
$244.73
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Cofinity Commercial |
$262.37
|
| Rate for Payer: Cofinity Commercial |
$214.14
|
| Rate for Payer: Cofinity Commercial |
$263.08
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Healthscope Commercial |
$275.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.60
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.14
|
| Rate for Payer: Priority Health SBD |
$192.72
|
| Rate for Payer: Priority Health SBD |
$236.14
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Commercial |
$260.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.63
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: BCBS Complete |
$122.36
|
| Rate for Payer: BCBS Trust/PPO |
$206.48
|
| Rate for Payer: BCBS Trust/PPO |
$206.48
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cash Price |
$244.73
|
| Rate for Payer: Cash Price |
$244.73
|
| Rate for Payer: Cofinity Commercial |
$263.08
|
| Rate for Payer: Cofinity Commercial |
$214.14
|
| Rate for Payer: Cofinity Commercial |
$262.37
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Healthscope Commercial |
$275.32
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.02
|
| Rate for Payer: PHP Commercial |
$260.02
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.37
|
| Rate for Payer: Priority Health SBD |
$236.14
|
| Rate for Payer: Priority Health SBD |
$192.72
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,880.55 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,035.48
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$5,422.83
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,584.86
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,422.83
|
| Rate for Payer: Priority Health SBD |
$4,880.55
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,035.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Cofinity Commercial |
$5,422.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,584.86
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,422.83
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$4,880.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$255.37
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$229.83 |
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.99
|
| Rate for Payer: BCBS Complete |
$102.15
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$178.76
|
| Rate for Payer: Cofinity Commercial |
$219.62
|
| Rate for Payer: Healthscope Commercial |
$229.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.76
|
| Rate for Payer: Priority Health SBD |
$160.88
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$255.37
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$160.88 |
| Max. Negotiated Rate |
$229.83 |
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.99
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$178.76
|
| Rate for Payer: Cofinity Commercial |
$219.62
|
| Rate for Payer: Healthscope Commercial |
$229.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.76
|
| Rate for Payer: Priority Health SBD |
$160.88
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Aetna Commercial |
$373.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.35
|
| Rate for Payer: BCBS Complete |
$175.60
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Cofinity Commercial |
$377.54
|
| Rate for Payer: Healthscope Commercial |
$395.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.15
|
| Rate for Payer: PHP Commercial |
$373.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health SBD |
$276.57
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$276.57 |
| Max. Negotiated Rate |
$395.10 |
| Rate for Payer: Aetna Commercial |
$373.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.35
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Cofinity Commercial |
$377.54
|
| Rate for Payer: Healthscope Commercial |
$395.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.15
|
| Rate for Payer: PHP Commercial |
$373.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health SBD |
$276.57
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$236.16
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: Priority Health SBD |
$148.78
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$236.16
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: Priority Health SBD |
$148.78
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,145.36
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$458.14 |
| Max. Negotiated Rate |
$1,030.82 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.48
|
| Rate for Payer: BCBS Complete |
$458.14
|
| Rate for Payer: Cash Price |
$916.29
|
| Rate for Payer: Cofinity Commercial |
$801.75
|
| Rate for Payer: Cofinity Commercial |
$985.01
|
| Rate for Payer: Healthscope Commercial |
$1,030.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$973.56
|
| Rate for Payer: PHP Commercial |
$973.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.75
|
| Rate for Payer: Priority Health SBD |
$721.58
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,145.36
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$721.58 |
| Max. Negotiated Rate |
$1,030.82 |
| Rate for Payer: Aetna Commercial |
$973.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.48
|
| Rate for Payer: Cash Price |
$916.29
|
| Rate for Payer: Cofinity Commercial |
$801.75
|
| Rate for Payer: Cofinity Commercial |
$985.01
|
| Rate for Payer: Healthscope Commercial |
$1,030.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$973.56
|
| Rate for Payer: PHP Commercial |
$973.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.75
|
| Rate for Payer: Priority Health SBD |
$721.58
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$708.47
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.39 |
| Max. Negotiated Rate |
$637.62 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.51
|
| Rate for Payer: BCBS Complete |
$283.39
|
| Rate for Payer: Cash Price |
$566.78
|
| Rate for Payer: Cofinity Commercial |
$495.93
|
| Rate for Payer: Cofinity Commercial |
$609.28
|
| Rate for Payer: Healthscope Commercial |
$637.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.20
|
| Rate for Payer: PHP Commercial |
$602.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health SBD |
$446.34
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$708.47
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.34 |
| Max. Negotiated Rate |
$637.62 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.51
|
| Rate for Payer: Cash Price |
$566.78
|
| Rate for Payer: Cofinity Commercial |
$495.93
|
| Rate for Payer: Cofinity Commercial |
$609.28
|
| Rate for Payer: Healthscope Commercial |
$637.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.20
|
| Rate for Payer: PHP Commercial |
$602.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health SBD |
$446.34
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$525.44
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.18 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Aetna Commercial |
$446.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.54
|
| Rate for Payer: BCBS Complete |
$210.18
|
| Rate for Payer: Cash Price |
$420.35
|
| Rate for Payer: Cofinity Commercial |
$367.81
|
| Rate for Payer: Cofinity Commercial |
$451.88
|
| Rate for Payer: Healthscope Commercial |
$472.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.62
|
| Rate for Payer: PHP Commercial |
$446.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.81
|
| Rate for Payer: Priority Health SBD |
$331.03
|
|
