|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: Priority Health SBD |
$248.18
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$2.49
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$7.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.76
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.14
|
| Rate for Payer: UHC Core |
$7.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.76
|
| Rate for Payer: UHC Exchange |
$7.14
|
| Rate for Payer: UHC Medicaid |
$2.49
|
| Rate for Payer: UHCCP Medicaid |
$2.49
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health SBD |
$13.63
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.17
|
| Rate for Payer: BCN Commercial |
$14.17
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.82
|
| Rate for Payer: UHC Core |
$10.82
|
| Rate for Payer: UHC Exchange |
$10.82
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$37.66
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.91
|
| Rate for Payer: BCBS Complete |
$2.60
|
| Rate for Payer: BCBS MAPPO |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$5.05
|
| Rate for Payer: BCN Commercial |
$5.05
|
| Rate for Payer: BCN Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Advantage |
$26.36
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Mclaren Medicare |
$4.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.97
|
| Rate for Payer: Meridian Medicaid |
$4.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Nomi Health Commercial |
$7.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: PACE Medicare |
$4.49
|
| Rate for Payer: PACE SWMI |
$4.73
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: PHP Medicare Advantage |
$4.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.73
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health SBD |
$23.73
|
| Rate for Payer: Priority Health Tiered Network |
$3.78
|
| Rate for Payer: Railroad Medicare Medicare |
$4.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.10
|
| Rate for Payer: UHC Core |
$7.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.73
|
| Rate for Payer: UHC Exchange |
$7.10
|
| Rate for Payer: UHC Medicaid |
$2.47
|
| Rate for Payer: UHCCP Medicaid |
$2.47
|
| Rate for Payer: VA VA |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$37.66
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Advantage |
$26.36
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: Priority Health SBD |
$23.73
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.40
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.76
|
| Rate for Payer: UHC Core |
$5.42
|
| Rate for Payer: UHC Exchange |
$4.09
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
IP
|
$10.40
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health SBD |
$6.55
|
|
|
HC POUCH 2-PIECE
|
Facility
|
IP
|
$17.63
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.46
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Advantage |
$12.34
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$15.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.22
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: Priority Health SBD |
$11.11
|
|
|
HC POUCH 2-PIECE
|
Facility
|
OP
|
$17.63
|
|
| Hospital Charge Code |
27000137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.46
|
| Rate for Payer: BCBS Complete |
$7.05
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cofinity Advantage |
$12.34
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.10
|
| Rate for Payer: Healthscope Commercial |
$15.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.22
|
| Rate for Payer: PHP Commercial |
$14.99
|
| Rate for Payer: Priority Health SBD |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.46
|
| Rate for Payer: UHC Core |
$9.19
|
| Rate for Payer: UHC Exchange |
$6.93
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
OP
|
$115.13
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$103.62 |
| Rate for Payer: Aetna Commercial |
$97.86
|
| Rate for Payer: Aetna Medicare |
$57.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.83
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Advantage |
$80.59
|
| Rate for Payer: Cofinity Commercial |
$99.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$103.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.35
|
| Rate for Payer: PHP Commercial |
$97.86
|
| Rate for Payer: Priority Health SBD |
$72.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.83
|
| Rate for Payer: UHC Core |
$59.98
|
| Rate for Payer: UHC Exchange |
$45.25
|
|
|
HC POUCH WOUND 11 X 5
|
Facility
|
IP
|
$115.13
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$103.62 |
| Rate for Payer: Aetna Commercial |
$97.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.83
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cofinity Advantage |
$80.59
|
| Rate for Payer: Cofinity Commercial |
$99.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$103.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.35
|
| Rate for Payer: PHP Commercial |
$97.86
|
| Rate for Payer: Priority Health SBD |
$72.53
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$31.06
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.19
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cofinity Advantage |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.85
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.40
|
| Rate for Payer: Priority Health SBD |
$19.57
|
|
|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$31.06
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$55.84 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Aetna Medicare |
$15.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.19
|
| Rate for Payer: BCBS Complete |
$12.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cofinity Advantage |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.85
|
| Rate for Payer: Healthscope Commercial |
$27.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.40
|
| Rate for Payer: Priority Health SBD |
$19.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.19
|
| Rate for Payer: UHC Core |
$16.18
|
| Rate for Payer: UHC Exchange |
$12.21
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.58 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.39
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Advantage |
$28.42
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.45
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: Priority Health SBD |
$25.58
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$55.84 |
| Rate for Payer: Aetna Commercial |
$34.51
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.39
|
| Rate for Payer: BCBS Complete |
$16.24
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Advantage |
$28.42
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$36.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.45
|
| Rate for Payer: PHP Commercial |
$34.51
|
| Rate for Payer: Priority Health SBD |
$25.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Core |
$21.15
|
| Rate for Payer: UHC Exchange |
$15.96
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$55.84 |
| Rate for Payer: Aetna Commercial |
$49.18
|
| Rate for Payer: Aetna Medicare |
$28.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.61
|
| Rate for Payer: BCBS Complete |
$23.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Advantage |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$52.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: Priority Health SBD |
$36.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.61
|
| Rate for Payer: UHC Core |
$30.15
|
| Rate for Payer: UHC Exchange |
$22.74
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$52.07 |
| Rate for Payer: Aetna Commercial |
$49.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.61
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Advantage |
$40.50
|
| Rate for Payer: Cofinity Commercial |
$49.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$52.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: Priority Health SBD |
$36.45
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.02
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Advantage |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: PHP Commercial |
$88.95
|
| Rate for Payer: Priority Health SBD |
$65.93
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.13 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Aetna Commercial |
$88.95
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.02
|
| Rate for Payer: BCBS Complete |
$41.86
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Advantage |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$94.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: PHP Commercial |
$88.95
|
| Rate for Payer: Priority Health SBD |
$65.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.02
|
| Rate for Payer: UHC Core |
$54.52
|
| Rate for Payer: UHC Exchange |
$41.13
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Advantage |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Advantage |
$14.27
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: PHP Commercial |
$17.33
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$10.62
|
| Rate for Payer: UHC Exchange |
$8.01
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.02
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Advantage |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$22.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$23.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: PHP Commercial |
$22.26
|
| Rate for Payer: Priority Health SBD |
$16.50
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.02
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Advantage |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$22.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$23.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: PHP Commercial |
$22.26
|
| Rate for Payer: Priority Health SBD |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.02
|
| Rate for Payer: UHC Core |
$13.64
|
| Rate for Payer: UHC Exchange |
$10.29
|
|
