|
HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,111.52
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
91047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,330.26 |
| Max. Negotiated Rate |
$1,900.37 |
| Rate for Payer: Aetna Commercial |
$1,794.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,372.49
|
| Rate for Payer: Cash Price |
$1,689.22
|
| Rate for Payer: Cofinity Commercial |
$1,478.06
|
| Rate for Payer: Cofinity Commercial |
$1,815.91
|
| Rate for Payer: Healthscope Commercial |
$1,900.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,794.79
|
| Rate for Payer: PHP Commercial |
$1,794.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,478.06
|
| Rate for Payer: Priority Health SBD |
$1,330.26
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP
|
Facility
|
IP
|
$153.75
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
118174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.86 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna Commercial |
$130.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.94
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cofinity Commercial |
$107.62
|
| Rate for Payer: Cofinity Commercial |
$132.22
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.69
|
| Rate for Payer: PHP Commercial |
$130.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.62
|
| Rate for Payer: Priority Health SBD |
$96.86
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$35,266.15
|
|
|
Service Code
|
MS-DRG 421
|
| Min. Negotiated Rate |
$12,164.67 |
| Max. Negotiated Rate |
$35,266.15 |
| Rate for Payer: Aetna Medicare |
$13,317.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,006.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,006.15
|
| Rate for Payer: BCBS MAPPO |
$12,804.92
|
| Rate for Payer: BCBS Trust/PPO |
$35,266.15
|
| Rate for Payer: BCN Medicare Advantage |
$12,804.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,804.92
|
| Rate for Payer: Mclaren Medicare |
$12,804.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,445.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,725.66
|
| Rate for Payer: PACE Medicare |
$12,164.67
|
| Rate for Payer: PACE SWMI |
$12,804.92
|
| Rate for Payer: PHP Medicare Advantage |
$12,804.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,532.62
|
| Rate for Payer: Priority Health Medicare |
$12,804.92
|
| Rate for Payer: Priority Health Narrow Network |
$19,626.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12,804.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,078.24
|
| Rate for Payer: UHC Core |
$16,001.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,804.92
|
| Rate for Payer: UHC Exchange |
$17,138.74
|
| Rate for Payer: UHC Medicare Advantage |
$13,189.07
|
| Rate for Payer: VA VA |
$12,804.92
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$73,496.77
|
|
|
Service Code
|
MS-DRG 420
|
| Min. Negotiated Rate |
$22,367.01 |
| Max. Negotiated Rate |
$73,496.77 |
| Rate for Payer: Aetna Medicare |
$24,485.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,430.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,430.28
|
| Rate for Payer: BCBS MAPPO |
$23,544.22
|
| Rate for Payer: BCBS Trust/PPO |
$73,496.77
|
| Rate for Payer: BCN Medicare Advantage |
$23,544.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,544.22
|
| Rate for Payer: Mclaren Medicare |
$23,544.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,721.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,075.85
|
| Rate for Payer: PACE Medicare |
$22,367.01
|
| Rate for Payer: PACE SWMI |
$23,544.22
|
| Rate for Payer: PHP Medicare Advantage |
$23,544.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,931.22
|
| Rate for Payer: Priority Health Medicare |
$23,544.22
|
| Rate for Payer: Priority Health Narrow Network |
$36,744.98
|
| Rate for Payer: Railroad Medicare Medicare |
$23,544.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,825.00
|
| Rate for Payer: UHC Core |
$29,959.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,544.22
|
| Rate for Payer: UHC Exchange |
$32,088.02
|
| Rate for Payer: UHC Medicare Advantage |
$24,250.55
|
| Rate for Payer: VA VA |
$23,544.22
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,106.65
|
|
|
Service Code
|
MS-DRG 422
|
| Min. Negotiated Rate |
$10,121.74 |
| Max. Negotiated Rate |
$29,106.65 |
| Rate for Payer: Aetna Medicare |
$11,080.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,318.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,318.08
|
| Rate for Payer: BCBS MAPPO |
$10,654.46
|
| Rate for Payer: BCBS Trust/PPO |
$29,106.65
|
| Rate for Payer: BCN Medicare Advantage |
$10,654.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,654.46
|
| Rate for Payer: Mclaren Medicare |
$10,654.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,187.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,252.63
|
| Rate for Payer: PACE Medicare |
$10,121.74
|
| Rate for Payer: PACE SWMI |
$10,654.46
|
| Rate for Payer: PHP Medicare Advantage |
$10,654.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,247.74
|
| Rate for Payer: Priority Health Medicare |
$10,654.46
|
| Rate for Payer: Priority Health Narrow Network |
$16,198.19
|
| Rate for Payer: Railroad Medicare Medicare |
$10,654.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,523.39
|
| Rate for Payer: UHC Core |
$13,206.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,654.46
|
| Rate for Payer: UHC Exchange |
$14,145.28
|
| Rate for Payer: UHC Medicare Advantage |
$10,974.09
|
| Rate for Payer: VA VA |
$10,654.46
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$28,711.39
|
|
|
Service Code
|
MS-DRG 354
|
| Min. Negotiated Rate |
$12,220.77 |
| Max. Negotiated Rate |
$28,711.39 |
| Rate for Payer: Aetna Medicare |
$13,378.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,079.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,079.96
|
| Rate for Payer: BCBS MAPPO |
$12,863.97
|
| Rate for Payer: BCBS Trust/PPO |
$28,711.39
|
| Rate for Payer: BCN Medicare Advantage |
$12,863.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,863.97
|
| Rate for Payer: Mclaren Medicare |
$12,863.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,507.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,793.57
|
| Rate for Payer: PACE Medicare |
$12,220.77
|
| Rate for Payer: PACE SWMI |
$12,863.97
|
| Rate for Payer: PHP Medicare Advantage |
$12,863.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,650.29
|
| Rate for Payer: Priority Health Medicare |
$12,863.97
|
| Rate for Payer: Priority Health Narrow Network |
$19,720.23
|
| Rate for Payer: Railroad Medicare Medicare |
$12,863.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,203.32
|
| Rate for Payer: UHC Core |
$16,078.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,863.97
|
| Rate for Payer: UHC Exchange |
$17,220.95
|
| Rate for Payer: UHC Medicare Advantage |
$13,249.89
|
| Rate for Payer: VA VA |
$12,863.97
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$55,253.24
|
|
|
Service Code
|
MS-DRG 353
|
| Min. Negotiated Rate |
$20,475.28 |
| Max. Negotiated Rate |
$55,253.24 |
| Rate for Payer: Aetna Medicare |
$22,415.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,941.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,941.16
|
| Rate for Payer: BCBS MAPPO |
$21,552.93
|
| Rate for Payer: BCBS Trust/PPO |
$55,253.24
|
| Rate for Payer: BCN Medicare Advantage |
$21,552.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,552.93
|
| Rate for Payer: Mclaren Medicare |
$21,552.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,630.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,785.87
|
| Rate for Payer: PACE Medicare |
$20,475.28
|
| Rate for Payer: PACE SWMI |
$21,552.93
|
| Rate for Payer: PHP Medicare Advantage |
$21,552.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,963.47
|
| Rate for Payer: Priority Health Medicare |
$21,552.93
|
| Rate for Payer: Priority Health Narrow Network |
$33,570.78
|
| Rate for Payer: Railroad Medicare Medicare |
$21,552.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,607.27
|
| Rate for Payer: UHC Core |
$27,371.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,552.93
|
| Rate for Payer: UHC Exchange |
$29,316.11
|
| Rate for Payer: UHC Medicare Advantage |
$22,199.52
|
| Rate for Payer: VA VA |
$21,552.93
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$24,240.54
|
|
|
Service Code
|
MS-DRG 355
|
| Min. Negotiated Rate |
$9,790.60 |
| Max. Negotiated Rate |
$24,240.54 |
| Rate for Payer: Aetna Medicare |
$10,718.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,882.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,882.36
|
| Rate for Payer: BCBS MAPPO |
$10,305.89
|
| Rate for Payer: BCBS Trust/PPO |
$24,240.54
|
| Rate for Payer: BCN Medicare Advantage |
$10,305.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,305.89
|
| Rate for Payer: Mclaren Medicare |
$10,305.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,821.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,851.77
|
| Rate for Payer: PACE Medicare |
$9,790.60
|
| Rate for Payer: PACE SWMI |
$10,305.89
|
| Rate for Payer: PHP Medicare Advantage |
$10,305.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,553.20
|
| Rate for Payer: Priority Health Medicare |
$10,305.89
|
| Rate for Payer: Priority Health Narrow Network |
$15,642.56
|
| Rate for Payer: Railroad Medicare Medicare |
$10,305.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,785.10
|
| Rate for Payer: UHC Core |
$12,753.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,305.89
|
| Rate for Payer: UHC Exchange |
$13,660.07
|
| Rate for Payer: UHC Medicare Advantage |
$10,615.07
|
| Rate for Payer: VA VA |
$10,305.89
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
OP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.73
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Exchange |
$6.71
|
|
|
HH CATHETER LEG STRAP BARD
|
Facility
|
IP
|
$12.47
|
|
|
Service Code
|
HCPCS A4334
|
| Hospital Charge Code |
27000598
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.73
|
| Rate for Payer: Priority Health SBD |
$7.86
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
IP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health SBD |
$17.11
|
|
|
HH DRSG MEPILEX AG FOAM 4X4 EA
|
Facility
|
OP
|
$27.16
|
|
|
Service Code
|
HCPCS A6209
|
| Hospital Charge Code |
62300044
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$28.88 |
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: BCBS Trust/PPO |
$28.88
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health SBD |
$17.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Exchange |
$10.20
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
IP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.36
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health SBD |
$6.16
|
|
|
HH DRSG MEPILEX BORDER 4X4 EA
|
Facility
|
OP
|
$9.78
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300017
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$37.51 |
| Rate for Payer: Aetna Commercial |
$8.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.36
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.51
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Cofinity Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.85
|
| Rate for Payer: Priority Health SBD |
$6.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Exchange |
$13.25
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
IP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.78
|
|
|
HH DRSG MEPILEX BORDER 6X6 EA
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
HCPCS A6212
|
| Hospital Charge Code |
62300067
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$37.51 |
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$37.51
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Exchange |
$13.25
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$52.30 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS Trust/PPO |
$52.30
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health SBD |
$14.16
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.61
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$15.73
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.10
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.73
|
| Rate for Payer: Priority Health SBD |
$14.16
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$823.40
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$1,076.20 |
| Rate for Payer: Aetna Commercial |
$699.89
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$366.58
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cofinity Commercial |
$708.12
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$741.06
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.89
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$699.89
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$860.96
|
| Rate for Payer: Priority Health SBD |
$518.74
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$823.40
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.74 |
| Max. Negotiated Rate |
$741.06 |
| Rate for Payer: Aetna Commercial |
$699.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.21
|
| Rate for Payer: Cash Price |
$658.72
|
| Rate for Payer: Cofinity Commercial |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$708.12
|
| Rate for Payer: Healthscope Commercial |
$741.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.89
|
| Rate for Payer: PHP Commercial |
$699.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.38
|
| Rate for Payer: Priority Health SBD |
$518.74
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$686.17
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.29 |
| Max. Negotiated Rate |
$617.55 |
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.01
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cofinity Commercial |
$480.32
|
| Rate for Payer: Cofinity Commercial |
$590.11
|
| Rate for Payer: Healthscope Commercial |
$617.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.24
|
| Rate for Payer: PHP Commercial |
$583.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.32
|
| Rate for Payer: Priority Health SBD |
$432.29
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$686.17
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$617.55 |
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$367.91
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cofinity Commercial |
$480.32
|
| Rate for Payer: Cofinity Commercial |
$590.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$617.55
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.24
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$583.24
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.32
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health SBD |
$432.29
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$24.23
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health SBD |
$3.93
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.06
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Cofinity Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health SBD |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.66
|
| Rate for Payer: UHC Exchange |
$6.38
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$39,996.12
|
|
|
Service Code
|
MS-DRG 481
|
| Min. Negotiated Rate |
$14,663.94 |
| Max. Negotiated Rate |
$39,996.12 |
| Rate for Payer: Aetna Medicare |
$16,053.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,294.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,294.66
|
| Rate for Payer: BCBS MAPPO |
$15,435.73
|
| Rate for Payer: BCBS Trust/PPO |
$39,996.12
|
| Rate for Payer: BCN Medicare Advantage |
$15,435.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,435.73
|
| Rate for Payer: Mclaren Medicare |
$15,435.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,207.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,751.09
|
| Rate for Payer: PACE Medicare |
$14,663.94
|
| Rate for Payer: PACE SWMI |
$15,435.73
|
| Rate for Payer: PHP Medicare Advantage |
$15,435.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,774.65
|
| Rate for Payer: Priority Health Medicare |
$15,435.73
|
| Rate for Payer: Priority Health Narrow Network |
$23,819.72
|
| Rate for Payer: Railroad Medicare Medicare |
$15,435.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,650.52
|
| Rate for Payer: UHC Core |
$19,421.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,435.73
|
| Rate for Payer: UHC Exchange |
$20,800.87
|
| Rate for Payer: UHC Medicare Advantage |
$15,898.80
|
| Rate for Payer: VA VA |
$15,435.73
|
|
