|
HC WILLOW IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
IP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$236.14 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.63
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Advantage |
$262.37
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.12
|
| Rate for Payer: PHP Commercial |
$318.60
|
| 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 |
$711.50 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Medicare |
$187.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.63
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: BCBS Trust/PPO |
$281.14
|
| Rate for Payer: BCN Commercial |
$281.14
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Advantage |
$262.37
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Healthscope Commercial |
$337.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.12
|
| Rate for Payer: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health SBD |
$236.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.50
|
| Rate for Payer: UHC Core |
$711.50
|
| Rate for Payer: UHC Exchange |
$711.50
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,901.84
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,978.16 |
| Max. Negotiated Rate |
$7,111.66 |
| Rate for Payer: Aetna Commercial |
$6,716.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,136.20
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cofinity Advantage |
$5,531.29
|
| Rate for Payer: Cofinity Commercial |
$6,795.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,321.47
|
| Rate for Payer: Healthscope Commercial |
$7,111.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,716.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,926.38
|
| Rate for Payer: PHP Commercial |
$6,716.56
|
| Rate for Payer: Priority Health SBD |
$4,978.16
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,901.84
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$7,111.66 |
| Rate for Payer: Aetna Commercial |
$6,716.56
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,136.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cofinity Advantage |
$5,531.29
|
| Rate for Payer: Cofinity Commercial |
$6,795.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,321.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$7,111.66
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,716.56
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,926.38
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$6,716.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$4,978.16
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,136.20
|
| Rate for Payer: UHC Core |
$4,116.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$3,105.42
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$265.69
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$239.12 |
| Rate for Payer: Aetna Commercial |
$225.84
|
| Rate for Payer: Aetna Medicare |
$132.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.70
|
| Rate for Payer: BCBS Complete |
$106.28
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cofinity Advantage |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$228.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$239.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.84
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.27
|
| Rate for Payer: PHP Commercial |
$225.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$167.38
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.70
|
| Rate for Payer: UHC Core |
$138.42
|
| Rate for Payer: UHC Exchange |
$104.42
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$265.69
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$167.38 |
| Max. Negotiated Rate |
$239.12 |
| Rate for Payer: Aetna Commercial |
$225.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.70
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cofinity Advantage |
$185.98
|
| Rate for Payer: Cofinity Commercial |
$228.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$239.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.27
|
| Rate for Payer: PHP Commercial |
$225.84
|
| Rate for Payer: Priority Health SBD |
$167.38
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$456.74
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$287.75 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna Commercial |
$388.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.88
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cofinity Advantage |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.39
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: PHP Commercial |
$388.23
|
| Rate for Payer: Priority Health SBD |
$287.75
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$456.74
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.47 |
| Max. Negotiated Rate |
$411.07 |
| Rate for Payer: Aetna Commercial |
$388.23
|
| Rate for Payer: Aetna Medicare |
$228.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.88
|
| Rate for Payer: BCBS Complete |
$182.70
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cofinity Advantage |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$392.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.39
|
| Rate for Payer: Healthscope Commercial |
$411.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.23
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: PHP Commercial |
$388.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$134.34
|
| Rate for Payer: Priority Health SBD |
$287.75
|
| Rate for Payer: Priority Health Tiered Network |
$107.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.88
|
| Rate for Payer: UHC Core |
$237.96
|
| Rate for Payer: UHC Exchange |
$179.50
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$245.70
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.71
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Advantage |
$171.99
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health SBD |
$154.79
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$245.70
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.56 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: Aetna Medicare |
$122.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.71
|
| Rate for Payer: BCBS Complete |
$98.28
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Advantage |
$171.99
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health SBD |
$154.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.71
|
| Rate for Payer: UHC Core |
$128.01
|
| Rate for Payer: UHC Exchange |
$96.56
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,191.64
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$750.73 |
| Max. Negotiated Rate |
$1,072.48 |
| Rate for Payer: Aetna Commercial |
$1,012.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.57
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cofinity Advantage |
$834.15
|
| Rate for Payer: Cofinity Commercial |
$1,024.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.31
|
| Rate for Payer: Healthscope Commercial |
$1,072.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.73
|
| Rate for Payer: PHP Commercial |
$1,012.89
|
| Rate for Payer: Priority Health SBD |
$750.73
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,191.64
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$1,072.48 |
| Rate for Payer: Aetna Commercial |
$1,012.89
|
| Rate for Payer: Aetna Medicare |
$595.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.57
|
| Rate for Payer: BCBS Complete |
$476.66
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cofinity Advantage |
$834.15
|
| Rate for Payer: Cofinity Commercial |
$1,024.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.31
|
| Rate for Payer: Healthscope Commercial |
$1,072.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$953.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.73
|
| Rate for Payer: PHP Commercial |
$1,012.89
|
| Rate for Payer: Priority Health SBD |
$750.73
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$737.09
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.37 |
| Max. Negotiated Rate |
$663.38 |
| Rate for Payer: Aetna Commercial |
$626.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.11
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cofinity Advantage |
$515.96
|
| Rate for Payer: Cofinity Commercial |
$633.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.67
|
| Rate for Payer: Healthscope Commercial |
$663.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.82
|
| Rate for Payer: PHP Commercial |
$626.53
|
| Rate for Payer: Priority Health SBD |
$464.37
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$737.09
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$663.38 |
| Rate for Payer: Aetna Commercial |
$626.53
|
| Rate for Payer: Aetna Medicare |
$368.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.11
|
| Rate for Payer: BCBS Complete |
$294.84
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cofinity Advantage |
$515.96
|
| Rate for Payer: Cofinity Commercial |
$633.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.67
|
| Rate for Payer: Healthscope Commercial |
$663.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$589.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.82
|
| Rate for Payer: PHP Commercial |
$626.53
|
| Rate for Payer: Priority Health SBD |
$464.37
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$546.67
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$464.67
|
| Rate for Payer: Aetna Medicare |
$273.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.34
|
| Rate for Payer: BCBS Complete |
$218.67
|
| Rate for Payer: Cash Price |
$437.34
|
| Rate for Payer: Cash Price |
$437.34
|
| Rate for Payer: Cofinity Advantage |
$382.67
|
| Rate for Payer: Cofinity Commercial |
$470.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.34
|
| Rate for Payer: Healthscope Commercial |
$492.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$437.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.00
|
| Rate for Payer: PHP Commercial |
$464.67
|
| Rate for Payer: Priority Health SBD |
$344.40
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$546.67
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$464.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.34
|
| Rate for Payer: Cash Price |
$437.34
|
| Rate for Payer: Cofinity Advantage |
$382.67
|
| Rate for Payer: Cofinity Commercial |
$470.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.34
|
| Rate for Payer: Healthscope Commercial |
$492.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.00
|
| Rate for Payer: PHP Commercial |
$464.67
|
| Rate for Payer: Priority Health SBD |
$344.40
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$429.97
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.88 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.48
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Advantage |
$300.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health SBD |
$270.88
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$429.97
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$386.97 |
| Rate for Payer: Aetna Commercial |
$365.47
|
| Rate for Payer: Aetna Medicare |
$214.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.48
|
| Rate for Payer: BCBS Complete |
$171.99
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cash Price |
$343.98
|
| Rate for Payer: Cofinity Advantage |
$300.98
|
| Rate for Payer: Cofinity Commercial |
$369.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.98
|
| Rate for Payer: Healthscope Commercial |
$386.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.48
|
| Rate for Payer: PHP Commercial |
$365.47
|
| Rate for Payer: Priority Health SBD |
$270.88
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$124.50
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.44 |
| Max. Negotiated Rate |
$112.05 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cofinity Advantage |
$87.15
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.38
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: Priority Health SBD |
$78.44
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$124.50
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$223.46 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: BCBS Complete |
$49.80
|
| Rate for Payer: BCBS Trust/PPO |
$223.46
|
| Rate for Payer: BCN Commercial |
$223.46
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cofinity Advantage |
$87.15
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.38
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.00
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health Tiered Network |
$65.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.92
|
| Rate for Payer: UHC Core |
$64.86
|
| Rate for Payer: UHC Exchange |
$48.93
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$255.30
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$505.38 |
| Rate for Payer: Aetna Commercial |
$217.00
|
| Rate for Payer: Aetna Medicare |
$127.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.94
|
| Rate for Payer: BCBS Complete |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$55.39
|
| Rate for Payer: BCN Commercial |
$55.39
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cofinity Advantage |
$178.71
|
| Rate for Payer: Cofinity Commercial |
$219.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.24
|
| Rate for Payer: Healthscope Commercial |
$229.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.47
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: Priority Health SBD |
$160.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.38
|
| Rate for Payer: UHC Core |
$505.38
|
| Rate for Payer: UHC Exchange |
$505.38
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$255.30
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$160.84 |
| Max. Negotiated Rate |
$229.77 |
| Rate for Payer: Aetna Commercial |
$217.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.94
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cofinity Advantage |
$178.71
|
| Rate for Payer: Cofinity Commercial |
$219.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.24
|
| Rate for Payer: Healthscope Commercial |
$229.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.47
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: Priority Health SBD |
$160.84
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.60
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cofinity Advantage |
$4.96
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.66
|
| Rate for Payer: Healthscope Commercial |
$6.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.31
|
| Rate for Payer: PHP Commercial |
$6.02
|
| Rate for Payer: Priority Health SBD |
$4.46
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
OP
|
$7.08
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.61
|
| Rate for Payer: BCBS Complete |
$2.91
|
| Rate for Payer: BCBS MAPPO |
$5.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.17
|
| Rate for Payer: BCN Commercial |
$13.17
|
| Rate for Payer: BCN Medicare Advantage |
$5.29
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cofinity Advantage |
$4.96
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.29
|
| Rate for Payer: Healthscope Commercial |
$6.37
|
| Rate for Payer: Mclaren Medicaid |
$2.77
|
| Rate for Payer: Mclaren Medicare |
$5.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.55
|
| Rate for Payer: Meridian Medicaid |
$5.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.02
|
| Rate for Payer: Nomi Health Commercial |
$15.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.31
|
| Rate for Payer: PACE Medicare |
$5.03
|
| Rate for Payer: PACE SWMI |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.56
|
| Rate for Payer: Priority Health Medicare |
$5.29
|
| Rate for Payer: Priority Health SBD |
$4.46
|
| Rate for Payer: Priority Health Tiered Network |
$14.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.78
|
| Rate for Payer: UHC Core |
$5.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.29
|
| Rate for Payer: UHC Exchange |
$5.78
|
| Rate for Payer: UHC Medicaid |
$2.77
|
| Rate for Payer: UHCCP Medicaid |
$2.77
|
| Rate for Payer: VA VA |
$5.29
|
|
