|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$525.44
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.03 |
| 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: 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
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$413.27
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.31 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
| Rate for Payer: BCBS Complete |
$165.31
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$289.29
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health SBD |
$260.36
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$413.27
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$289.29
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health SBD |
$260.36
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$119.67
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$222.34 |
| Rate for Payer: Aetna Commercial |
$101.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.79
|
| Rate for Payer: BCBS Complete |
$47.87
|
| Rate for Payer: BCBS Trust/PPO |
$222.34
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cofinity Commercial |
$102.92
|
| Rate for Payer: Cofinity Commercial |
$83.77
|
| Rate for Payer: Healthscope Commercial |
$107.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: PHP Commercial |
$101.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: Priority Health SBD |
$75.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.20
|
| Rate for Payer: UHC Exchange |
$86.00
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$119.67
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$107.70 |
| Rate for Payer: Aetna Commercial |
$101.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.79
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cofinity Commercial |
$83.77
|
| Rate for Payer: Cofinity Commercial |
$102.92
|
| Rate for Payer: Healthscope Commercial |
$107.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: PHP Commercial |
$101.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: Priority Health SBD |
$75.39
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$245.38
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$40.68
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health SBD |
$154.59
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$245.38
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$154.59 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Cofinity Commercial |
$171.77
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health SBD |
$154.59
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$6.80
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.42
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$5.85
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.78
|
| Rate for Payer: PHP Commercial |
$5.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health SBD |
$4.28
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
OP
|
$6.80
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$15.34 |
| Rate for Payer: Aetna Commercial |
$5.78
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.19
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.19
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$5.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.19
|
| Rate for Payer: Healthscope Commercial |
$6.12
|
| Rate for Payer: Mclaren Medicaid |
$2.84
|
| Rate for Payer: Mclaren Medicare |
$5.19
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.78
|
| Rate for Payer: PACE Medicare |
$4.93
|
| Rate for Payer: PACE SWMI |
$5.19
|
| Rate for Payer: PHP Commercial |
$5.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health SBD |
$4.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.19
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.19
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
OP
|
$1,385.01
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.00 |
| Max. Negotiated Rate |
$1,246.51 |
| Rate for Payer: Aetna Commercial |
$1,177.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.26
|
| Rate for Payer: BCBS Complete |
$554.00
|
| Rate for Payer: Cash Price |
$1,108.01
|
| Rate for Payer: Cofinity Commercial |
$1,191.11
|
| Rate for Payer: Cofinity Commercial |
$969.51
|
| Rate for Payer: Healthscope Commercial |
$1,246.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.26
|
| Rate for Payer: PHP Commercial |
$1,177.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.51
|
| Rate for Payer: Priority Health SBD |
$872.56
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
IP
|
$1,385.01
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.56 |
| Max. Negotiated Rate |
$1,246.51 |
| Rate for Payer: Aetna Commercial |
$1,177.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.26
|
| Rate for Payer: Cash Price |
$1,108.01
|
| Rate for Payer: Cofinity Commercial |
$1,191.11
|
| Rate for Payer: Cofinity Commercial |
$969.51
|
| Rate for Payer: Healthscope Commercial |
$1,246.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.26
|
| Rate for Payer: PHP Commercial |
$1,177.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.51
|
| Rate for Payer: Priority Health SBD |
$872.56
|
|
|
HC XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$299.88
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
32000325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.92 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.92
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$257.90
|
| Rate for Payer: Cofinity Commercial |
$209.92
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.90
|
| Rate for Payer: PHP Commercial |
$254.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.92
|
| Rate for Payer: Priority Health SBD |
$188.92
|
|
|
HC XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$299.88
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
32000325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$269.89 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$257.90
|
| Rate for Payer: Cofinity Commercial |
$209.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$269.89
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.90
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$254.90
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$188.92
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$29.80
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR ABDOMEN 2 VW
|
Facility
|
IP
|
$332.01
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
32000326
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.17 |
| Max. Negotiated Rate |
$298.81 |
| Rate for Payer: Aetna Commercial |
$282.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.81
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Cofinity Commercial |
$285.53
|
| Rate for Payer: Healthscope Commercial |
$298.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.21
|
| Rate for Payer: PHP Commercial |
$282.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.41
|
| Rate for Payer: Priority Health SBD |
$209.17
|
|
|
HC XR ABDOMEN 2 VW
|
Facility
|
OP
|
$332.01
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
32000326
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$320.48 |
| Rate for Payer: Aetna Commercial |
$282.21
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$43.03
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Cofinity Commercial |
$285.53
|
| Rate for Payer: Cofinity Commercial |
$232.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$298.81
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.21
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$282.21
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$209.17
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR ABDOMEN 3 OR MORE VIEWS
|
Facility
|
IP
|
$364.14
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
32000327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.41 |
| Max. Negotiated Rate |
$327.73 |
| Rate for Payer: Aetna Commercial |
$309.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.69
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Cofinity Commercial |
$313.16
|
| Rate for Payer: Healthscope Commercial |
$327.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.52
|
| Rate for Payer: PHP Commercial |
$309.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.90
|
| Rate for Payer: Priority Health SBD |
$229.41
|
|
|
HC XR ABDOMEN 3 OR MORE VIEWS
|
Facility
|
OP
|
$364.14
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
32000327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$327.73 |
| Rate for Payer: Aetna Commercial |
$309.52
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$50.20
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cash Price |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$327.73
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$309.52
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$309.52
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$229.41
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$42.24
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR ABDOMEN ACUTE
|
Facility
|
OP
|
$480.78
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$432.70 |
| Rate for Payer: Aetna Commercial |
$408.66
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$57.36
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$384.62
|
| Rate for Payer: Cash Price |
$384.62
|
| Rate for Payer: Cofinity Commercial |
$336.55
|
| Rate for Payer: Cofinity Commercial |
$413.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$432.70
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.66
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$408.66
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.55
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$302.89
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$49.12
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC XR ABDOMEN ACUTE
|
Facility
|
IP
|
$480.78
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.89 |
| Max. Negotiated Rate |
$432.70 |
| Rate for Payer: Aetna Commercial |
$408.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.51
|
| Rate for Payer: Cash Price |
$384.62
|
| Rate for Payer: Cofinity Commercial |
$336.55
|
| Rate for Payer: Cofinity Commercial |
$413.47
|
| Rate for Payer: Healthscope Commercial |
$432.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.66
|
| Rate for Payer: PHP Commercial |
$408.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.55
|
| Rate for Payer: Priority Health SBD |
$302.89
|
|
|
HC XR AC JOINTS
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
32000068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.73 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
|
|
HC XR AC JOINTS
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
32000068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.54
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$28.49
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR ANKLE 1 VW
|
Facility
|
OP
|
$238.44
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$202.67
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$40.81
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$190.75
|
| Rate for Payer: Cash Price |
$190.75
|
| Rate for Payer: Cofinity Commercial |
$166.91
|
| Rate for Payer: Cofinity Commercial |
$205.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.67
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$202.67
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR ANKLE 1 VW
|
Facility
|
IP
|
$238.44
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.75
|
| Rate for Payer: Cofinity Commercial |
$166.91
|
| Rate for Payer: Cofinity Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.67
|
| Rate for Payer: PHP Commercial |
$202.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.91
|
| Rate for Payer: Priority Health SBD |
$150.22
|
|
|
HC XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$250.45
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$260.51 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$40.81
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cofinity Commercial |
$175.32
|
| Rate for Payer: Cofinity Commercial |
$215.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$225.40
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.88
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$212.88
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.51
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$208.41
|
| Rate for Payer: Priority Health SBD |
$157.78
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC XR ANKLE 2 VIEWS
|
Facility
|
IP
|
$250.45
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.79
|
| Rate for Payer: Cash Price |
$200.36
|
| Rate for Payer: Cofinity Commercial |
$175.32
|
| Rate for Payer: Cofinity Commercial |
$215.39
|
| Rate for Payer: Healthscope Commercial |
$225.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.88
|
| Rate for Payer: PHP Commercial |
$212.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.32
|
| Rate for Payer: Priority Health SBD |
$157.78
|
|
