|
HC WHITE HICKORY IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC WHITE HICKORY IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WHITE PINE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WHITE PINE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
IP
|
$892.19
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$562.08 |
| Max. Negotiated Rate |
$802.97 |
| Rate for Payer: Aetna Commercial |
$758.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.92
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cofinity Commercial |
$624.53
|
| Rate for Payer: Cofinity Commercial |
$767.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$624.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.75
|
| Rate for Payer: Healthscope Commercial |
$802.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.36
|
| Rate for Payer: PHP Commercial |
$758.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.92
|
| Rate for Payer: Priority Health SBD |
$562.08
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
OP
|
$892.19
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$117.68 |
| Max. Negotiated Rate |
$802.97 |
| Rate for Payer: Aetna Commercial |
$758.36
|
| Rate for Payer: Aetna Medicare |
$228.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.45
|
| Rate for Payer: BCBS Complete |
$123.57
|
| Rate for Payer: BCBS MAPPO |
$219.56
|
| Rate for Payer: BCN Medicare Advantage |
$219.56
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cofinity Commercial |
$767.28
|
| Rate for Payer: Cofinity Commercial |
$624.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$624.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.56
|
| Rate for Payer: Healthscope Commercial |
$802.97
|
| Rate for Payer: Mclaren Medicaid |
$117.68
|
| Rate for Payer: Mclaren Medicare |
$219.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.54
|
| Rate for Payer: Meridian Medicaid |
$123.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.36
|
| Rate for Payer: PACE Medicare |
$208.58
|
| Rate for Payer: PACE SWMI |
$219.56
|
| Rate for Payer: PHP Commercial |
$758.36
|
| Rate for Payer: PHP Medicare Advantage |
$219.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.92
|
| Rate for Payer: Priority Health Medicare |
$219.56
|
| Rate for Payer: Priority Health SBD |
$562.08
|
| Rate for Payer: Railroad Medicare Medicare |
$219.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$618.04
|
| Rate for Payer: UHC Core |
$660.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.56
|
| Rate for Payer: UHC Exchange |
$660.22
|
| Rate for Payer: UHC Medicare Advantage |
$219.56
|
| Rate for Payer: UHCCP Medicaid |
$123.61
|
| Rate for Payer: VA VA |
$219.56
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
IP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.89 |
| Max. Negotiated Rate |
$458.42 |
| Rate for Payer: Aetna Commercial |
$432.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.08
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$356.55
|
| Rate for Payer: Cofinity Commercial |
$438.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Healthscope Commercial |
$458.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: PHP Commercial |
$432.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: Priority Health SBD |
$320.89
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
OP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.74 |
| Max. Negotiated Rate |
$458.42 |
| Rate for Payer: Aetna Commercial |
$432.95
|
| Rate for Payer: Aetna Medicare |
$254.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.08
|
| Rate for Payer: BCBS Complete |
$203.74
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$356.55
|
| Rate for Payer: Cofinity Commercial |
$438.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Healthscope Commercial |
$458.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: PHP Commercial |
$432.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: Priority Health SBD |
$320.89
|
|
|
HC WILLOW IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WILLOW IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
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 Commercial |
$262.37
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.37
|
| 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: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: Priority Health SBD |
$236.14
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$337.34 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Medicare |
$187.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.63
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$262.37
|
| Rate for Payer: Cofinity Commercial |
$322.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.37
|
| 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: PHP Commercial |
$318.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: Priority Health SBD |
$236.14
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna Medicare |
$1,479.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,035.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Cofinity Commercial |
$5,422.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,422.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health SBD |
$4,880.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,004.28
|
| Rate for Payer: UHC Core |
$5,732.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$5,732.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$800.88
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,880.55 |
| Max. Negotiated Rate |
$6,972.21 |
| Rate for Payer: Aetna Commercial |
$6,584.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,035.48
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$5,422.83
|
| Rate for Payer: Cofinity Commercial |
$6,662.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,422.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Healthscope Commercial |
$6,972.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: PHP Commercial |
$6,584.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health SBD |
$4,880.55
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna Commercial |
$221.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.31
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Healthscope Commercial |
$234.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: PHP Commercial |
$221.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health SBD |
$164.10
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna Commercial |
$221.41
|
| Rate for Payer: Aetna Medicare |
$130.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.31
|
| Rate for Payer: BCBS Complete |
$104.19
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$224.01
|
| Rate for Payer: Cofinity Commercial |
$182.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Healthscope Commercial |
$234.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$221.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health SBD |
$164.10
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Exchange |
$192.76
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$447.78
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna Commercial |
$380.61
|
| Rate for Payer: Aetna Medicare |
$223.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.06
|
| Rate for Payer: BCBS Complete |
$179.11
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cofinity Commercial |
$385.09
|
| Rate for Payer: Cofinity Commercial |
$313.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.22
|
| Rate for Payer: Healthscope Commercial |
$403.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.61
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$380.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.06
|
| Rate for Payer: Priority Health SBD |
$282.10
|
| Rate for Payer: UHC Core |
$331.36
|
| Rate for Payer: UHC Exchange |
$331.36
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$447.78
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna Commercial |
$380.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.06
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cofinity Commercial |
$313.45
|
| Rate for Payer: Cofinity Commercial |
$385.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.22
|
| Rate for Payer: Healthscope Commercial |
$403.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.61
|
| Rate for Payer: PHP Commercial |
$380.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.06
|
| Rate for Payer: Priority Health SBD |
$282.10
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$240.88
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.75 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna Commercial |
$204.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.57
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: PHP Commercial |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health SBD |
$151.75
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$240.88
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$216.79 |
| Rate for Payer: Aetna Commercial |
$204.75
|
| Rate for Payer: Aetna Medicare |
$120.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.57
|
| Rate for Payer: BCBS Complete |
$96.35
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$207.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: PHP Commercial |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health SBD |
$151.75
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,168.27
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$467.31 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Aetna Commercial |
$993.03
|
| Rate for Payer: Aetna Medicare |
$584.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.38
|
| Rate for Payer: BCBS Complete |
$467.31
|
| Rate for Payer: Cash Price |
$934.62
|
| Rate for Payer: Cofinity Commercial |
$1,004.71
|
| Rate for Payer: Cofinity Commercial |
$817.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$817.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.62
|
| Rate for Payer: Healthscope Commercial |
$1,051.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.03
|
| Rate for Payer: PHP Commercial |
$993.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.38
|
| Rate for Payer: Priority Health SBD |
$736.01
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,168.27
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$736.01 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Aetna Commercial |
$993.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.38
|
| Rate for Payer: Cash Price |
$934.62
|
| Rate for Payer: Cofinity Commercial |
$1,004.71
|
| Rate for Payer: Cofinity Commercial |
$817.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$817.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.62
|
| Rate for Payer: Healthscope Commercial |
$1,051.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.03
|
| Rate for Payer: PHP Commercial |
$993.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.38
|
| Rate for Payer: Priority Health SBD |
$736.01
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$722.64
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.06 |
| Max. Negotiated Rate |
$650.38 |
| Rate for Payer: Aetna Commercial |
$614.24
|
| Rate for Payer: Aetna Medicare |
$361.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.72
|
| Rate for Payer: BCBS Complete |
$289.06
|
| Rate for Payer: Cash Price |
$578.11
|
| Rate for Payer: Cofinity Commercial |
$505.85
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.11
|
| Rate for Payer: Healthscope Commercial |
$650.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.24
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.72
|
| Rate for Payer: Priority Health SBD |
$455.26
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$722.64
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.26 |
| Max. Negotiated Rate |
$650.38 |
| Rate for Payer: Aetna Commercial |
$614.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.72
|
| Rate for Payer: Cash Price |
$578.11
|
| Rate for Payer: Cofinity Commercial |
$505.85
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.11
|
| Rate for Payer: Healthscope Commercial |
$650.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.24
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.72
|
| Rate for Payer: Priority Health SBD |
$455.26
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$535.95
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.38 |
| Max. Negotiated Rate |
$482.36 |
| Rate for Payer: Aetna Commercial |
$455.56
|
| Rate for Payer: Aetna Medicare |
$267.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.37
|
| Rate for Payer: BCBS Complete |
$214.38
|
| Rate for Payer: Cash Price |
$428.76
|
| Rate for Payer: Cofinity Commercial |
$375.17
|
| Rate for Payer: Cofinity Commercial |
$460.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$375.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.76
|
| Rate for Payer: Healthscope Commercial |
$482.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.56
|
| Rate for Payer: PHP Commercial |
$455.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.37
|
| Rate for Payer: Priority Health SBD |
$337.65
|
|
