|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$535.95
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.65 |
| Max. Negotiated Rate |
$482.36 |
| Rate for Payer: Aetna Commercial |
$455.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.37
|
| 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
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$421.54
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.57 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.00
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health SBD |
$265.57
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$421.54
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.62 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna Medicare |
$210.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.00
|
| Rate for Payer: BCBS Complete |
$168.62
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health SBD |
$265.57
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$122.06
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.90 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$103.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.34
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$104.97
|
| Rate for Payer: Cofinity Commercial |
$85.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.65
|
| Rate for Payer: Healthscope Commercial |
$109.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.75
|
| Rate for Payer: PHP Commercial |
$103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.34
|
| Rate for Payer: Priority Health SBD |
$76.90
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$122.06
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Commercial |
$103.75
|
| Rate for Payer: Aetna Medicare |
$61.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.34
|
| Rate for Payer: BCBS Complete |
$48.82
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$104.97
|
| Rate for Payer: Cofinity Commercial |
$85.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.65
|
| Rate for Payer: Healthscope Commercial |
$109.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.75
|
| Rate for Payer: PHP Commercial |
$103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.34
|
| Rate for Payer: Priority Health SBD |
$76.90
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$250.29
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$157.68 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.69
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$157.68
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$250.29
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.69
|
| Rate for Payer: BCBS Complete |
$100.12
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$157.68
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$6.94
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna Commercial |
$5.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.51
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$5.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.55
|
| Rate for Payer: Healthscope Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.90
|
| Rate for Payer: PHP Commercial |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.51
|
| Rate for Payer: Priority Health SBD |
$4.37
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
OP
|
$6.94
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$15.68 |
| Rate for Payer: Aetna Commercial |
$5.90
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$5.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$6.25
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.90
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$5.90
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.51
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health SBD |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$3.14
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
OP
|
$1,412.71
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.08 |
| Max. Negotiated Rate |
$1,271.44 |
| Rate for Payer: Aetna Commercial |
$1,200.80
|
| Rate for Payer: Aetna Medicare |
$706.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.26
|
| Rate for Payer: BCBS Complete |
$565.08
|
| Rate for Payer: Cash Price |
$1,130.17
|
| Rate for Payer: Cofinity Commercial |
$1,214.93
|
| Rate for Payer: Cofinity Commercial |
$988.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.17
|
| Rate for Payer: Healthscope Commercial |
$1,271.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.80
|
| Rate for Payer: PHP Commercial |
$1,200.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.26
|
| Rate for Payer: Priority Health SBD |
$890.01
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
IP
|
$1,412.71
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$890.01 |
| Max. Negotiated Rate |
$1,271.44 |
| Rate for Payer: Aetna Commercial |
$1,200.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.26
|
| Rate for Payer: Cash Price |
$1,130.17
|
| Rate for Payer: Cofinity Commercial |
$1,214.93
|
| Rate for Payer: Cofinity Commercial |
$988.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$988.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.17
|
| Rate for Payer: Healthscope Commercial |
$1,271.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.80
|
| Rate for Payer: PHP Commercial |
$1,200.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.26
|
| Rate for Payer: Priority Health SBD |
$890.01
|
|
|
HC XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$305.88
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
32000325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.70 |
| Max. Negotiated Rate |
$275.29 |
| Rate for Payer: Aetna Commercial |
$260.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.82
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$214.12
|
| Rate for Payer: Cofinity Commercial |
$263.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: PHP Commercial |
$260.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.82
|
| Rate for Payer: Priority Health SBD |
$192.70
|
|
|
HC XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$305.88
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
32000325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$275.29 |
| Rate for Payer: Aetna Commercial |
$260.00
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$263.06
|
| Rate for Payer: Cofinity Commercial |
$214.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$275.29
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.00
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$260.00
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.82
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$192.70
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$226.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$226.35
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ABDOMEN 2 VW
|
Facility
|
OP
|
$338.65
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
32000326
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$304.79 |
| Rate for Payer: Aetna Commercial |
$287.85
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$270.92
|
| Rate for Payer: Cash Price |
$270.92
|
| Rate for Payer: Cofinity Commercial |
$291.24
|
| Rate for Payer: Cofinity Commercial |
$237.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$304.79
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.85
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$287.85
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$213.35
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$250.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$250.60
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR ABDOMEN 2 VW
|
Facility
|
IP
|
$338.65
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
32000326
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.35 |
| Max. Negotiated Rate |
$304.79 |
| Rate for Payer: Aetna Commercial |
$287.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.12
|
| Rate for Payer: Cash Price |
$270.92
|
| Rate for Payer: Cofinity Commercial |
$237.06
|
| Rate for Payer: Cofinity Commercial |
$291.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.92
|
| Rate for Payer: Healthscope Commercial |
$304.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.85
|
| Rate for Payer: PHP Commercial |
$287.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health SBD |
$213.35
|
|
|
HC XR ABDOMEN 3 OR MORE VIEWS
|
Facility
|
IP
|
$371.42
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
32000327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.99 |
| Max. Negotiated Rate |
$334.28 |
| Rate for Payer: Aetna Commercial |
$315.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.42
|
| Rate for Payer: Cash Price |
$297.14
|
| Rate for Payer: Cofinity Commercial |
$259.99
|
| Rate for Payer: Cofinity Commercial |
$319.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.14
|
| Rate for Payer: Healthscope Commercial |
$334.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.71
|
| Rate for Payer: PHP Commercial |
$315.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.42
|
| Rate for Payer: Priority Health SBD |
$233.99
|
|
|
HC XR ABDOMEN 3 OR MORE VIEWS
|
Facility
|
OP
|
$371.42
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
32000327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$334.28 |
| Rate for Payer: Aetna Commercial |
$315.71
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$297.14
|
| Rate for Payer: Cash Price |
$297.14
|
| Rate for Payer: Cofinity Commercial |
$319.42
|
| Rate for Payer: Cofinity Commercial |
$259.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$334.28
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.71
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$315.71
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.42
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$233.99
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$274.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$274.85
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR ABDOMEN ACUTE
|
Facility
|
OP
|
$490.40
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$441.36 |
| Rate for Payer: Aetna Commercial |
$416.84
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cofinity Commercial |
$421.74
|
| Rate for Payer: Cofinity Commercial |
$343.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$441.36
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.84
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$416.84
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.76
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$308.95
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$362.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$362.90
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR ABDOMEN ACUTE
|
Facility
|
IP
|
$490.40
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.95 |
| Max. Negotiated Rate |
$441.36 |
| Rate for Payer: Aetna Commercial |
$416.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.76
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cofinity Commercial |
$343.28
|
| Rate for Payer: Cofinity Commercial |
$421.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.32
|
| Rate for Payer: Healthscope Commercial |
$441.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.84
|
| Rate for Payer: PHP Commercial |
$416.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.76
|
| Rate for Payer: Priority Health SBD |
$308.95
|
|
|
HC XR AC JOINTS
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
32000068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.15 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health SBD |
$225.15
|
|
|
HC XR AC JOINTS
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
32000068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$321.64 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$307.35
|
| Rate for Payer: Cofinity Commercial |
$250.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.77
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$264.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$264.46
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ANKLE 1 VW
|
Facility
|
IP
|
$243.21
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.22 |
| Max. Negotiated Rate |
$218.89 |
| Rate for Payer: Aetna Commercial |
$206.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.09
|
| Rate for Payer: Cash Price |
$194.57
|
| Rate for Payer: Cofinity Commercial |
$170.25
|
| Rate for Payer: Cofinity Commercial |
$209.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.57
|
| Rate for Payer: Healthscope Commercial |
$218.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.73
|
| Rate for Payer: PHP Commercial |
$206.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.09
|
| Rate for Payer: Priority Health SBD |
$153.22
|
|
|
HC XR ANKLE 1 VW
|
Facility
|
OP
|
$243.21
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Commercial |
$206.73
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$194.57
|
| Rate for Payer: Cash Price |
$194.57
|
| Rate for Payer: Cofinity Commercial |
$209.16
|
| Rate for Payer: Cofinity Commercial |
$170.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$218.89
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.73
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$206.73
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.09
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$179.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$179.98
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$255.46
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Cofinity Commercial |
$178.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$160.94
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$189.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$189.04
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR ANKLE 2 VIEWS
|
Facility
|
IP
|
$255.46
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
32000117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.94 |
| Max. Negotiated Rate |
$229.91 |
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.05
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$178.82
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: Priority Health SBD |
$160.94
|
|
