|
HC D & C
|
Facility
|
IP
|
$2,082.24
|
|
| Hospital Charge Code |
45000037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,561.68 |
| Max. Negotiated Rate |
$2,082.24 |
| Rate for Payer: Aetna Commercial |
$1,874.02
|
| Rate for Payer: ASR ASR |
$2,019.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.94
|
| Rate for Payer: BCN Commercial |
$1,709.94
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Commercial |
$1,957.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Healthscope Commercial |
$2,019.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.24
|
| Rate for Payer: Mclaren Commercial |
$1,874.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Nomi Health Commercial |
$1,707.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,832.37
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
IP
|
$1,072.43
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$804.32 |
| Max. Negotiated Rate |
$1,072.43 |
| Rate for Payer: Aetna Commercial |
$965.19
|
| Rate for Payer: ASR ASR |
$1,040.26
|
| Rate for Payer: BCBS Trust/PPO |
$880.68
|
| Rate for Payer: BCN Commercial |
$880.68
|
| Rate for Payer: Cash Price |
$857.94
|
| Rate for Payer: Cofinity Commercial |
$1,008.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.94
|
| Rate for Payer: Healthscope Commercial |
$1,040.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,072.43
|
| Rate for Payer: Mclaren Commercial |
$965.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.57
|
| Rate for Payer: Nomi Health Commercial |
$879.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$943.74
|
|
|
HC D&C (OB SURGERY)
|
Facility
|
OP
|
$1,072.43
|
|
| Hospital Charge Code |
36000026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.80 |
| Max. Negotiated Rate |
$1,072.43 |
| Rate for Payer: Aetna Commercial |
$965.19
|
| Rate for Payer: Aetna Medicare |
$396.80
|
| Rate for Payer: ASR ASR |
$1,040.26
|
| Rate for Payer: BCBS Complete |
$428.97
|
| Rate for Payer: BCBS Trust/PPO |
$884.22
|
| Rate for Payer: BCN Commercial |
$884.22
|
| Rate for Payer: Cash Price |
$857.94
|
| Rate for Payer: Cofinity Commercial |
$1,008.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.94
|
| Rate for Payer: Healthscope Commercial |
$1,040.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,072.43
|
| Rate for Payer: Mclaren Commercial |
$965.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$857.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$911.57
|
| Rate for Payer: Nomi Health Commercial |
$879.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$939.66
|
| Rate for Payer: Priority Health Narrow Network |
$751.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$943.74
|
|
|
HC D & C POSTPARTUM
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,078.33 |
| Max. Negotiated Rate |
$8,104.44 |
| Rate for Payer: Aetna Commercial |
$7,294.00
|
| Rate for Payer: ASR ASR |
$7,861.31
|
| Rate for Payer: BCBS Trust/PPO |
$6,655.37
|
| Rate for Payer: BCN Commercial |
$6,655.37
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Commercial |
$7,618.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,861.31
|
| Rate for Payer: Healthscope Whirlpool |
$8,104.44
|
| Rate for Payer: Mclaren Commercial |
$7,294.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$6,645.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,131.91
|
|
|
HC D & C POSTPARTUM
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
76100341
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$8,104.44 |
| Rate for Payer: Aetna Commercial |
$7,294.00
|
| Rate for Payer: Aetna Medicare |
$3,225.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: ASR ASR |
$7,861.31
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,682.11
|
| Rate for Payer: BCN Commercial |
$6,682.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Commercial |
$7,618.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$7,861.31
|
| Rate for Payer: Healthscope Whirlpool |
$8,104.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,225.49
|
| Rate for Payer: Mclaren Commercial |
$7,294.00
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$1,771.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$6,645.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,548.04
|
| Rate for Payer: PHP Medicaid |
$1,728.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,101.11
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Narrow Network |
$5,681.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,131.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$4,999.51
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP DNSP |
$3,225.49
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DDAVP CMPT1
|
Facility
|
OP
|
$39.26
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Mclaren Medicaid |
$22.94
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.40
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$27.52
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicaid |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.00
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC DDAVP CMPT1
|
Facility
|
IP
|
$39.26
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.45 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$32.24
|
| Rate for Payer: BCN Commercial |
$32.24
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
|
|
HC DDAVP CMPT2
|
Facility
|
IP
|
$39.26
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.45 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$32.24
|
| Rate for Payer: BCN Commercial |
$32.24
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
|
|
HC DDAVP CMPT2
|
Facility
|
OP
|
$39.26
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$217.90 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Mclaren Medicaid |
$22.94
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.90
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$174.32
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicaid |
$12.00
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.00
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
OP
|
$39.26
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.40
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$27.52
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC DDAVP FACTOR VIII RISTOCETIN V
|
Facility
|
IP
|
$39.26
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500021
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.45 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$32.24
|
| Rate for Payer: BCN Commercial |
$32.24
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
OP
|
$127.13
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$127.13 |
| Rate for Payer: Aetna Commercial |
$114.42
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$123.32
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$104.82
|
| Rate for Payer: BCN Commercial |
$104.82
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cofinity Commercial |
$119.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$123.32
|
| Rate for Payer: Healthscope Whirlpool |
$127.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$114.42
|
| Rate for Payer: Mclaren Medicaid |
$10.18
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.06
|
| Rate for Payer: Nomi Health Commercial |
$104.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.35
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$111.39
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$89.12
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicaid |
$5.32
|
| Rate for Payer: UHCCP DNSP |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC D-DIMER QUANTITATIVE
|
Facility
|
IP
|
$127.13
|
|
|
Service Code
|
CPT 85380
|
| Hospital Charge Code |
30500081
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$127.13 |
| Rate for Payer: Aetna Commercial |
$114.42
|
| Rate for Payer: ASR ASR |
$123.32
|
| Rate for Payer: BCBS Trust/PPO |
$104.40
|
| Rate for Payer: BCN Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cofinity Commercial |
$119.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.70
|
| Rate for Payer: Healthscope Commercial |
$123.32
|
| Rate for Payer: Healthscope Whirlpool |
$127.13
|
| Rate for Payer: Mclaren Commercial |
$114.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.06
|
| Rate for Payer: Nomi Health Commercial |
$104.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.87
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,253.05
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$2,550.77 |
| Rate for Payer: Aetna Commercial |
$2,027.74
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$2,185.46
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,857.64
|
| Rate for Payer: BCN Commercial |
$1,857.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cofinity Commercial |
$2,117.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,802.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$2,185.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,253.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$2,027.74
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.09
|
| Rate for Payer: Nomi Health Commercial |
$1,847.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,689.79
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,974.12
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,579.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,982.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Exchange |
$2,550.77
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC DEBRIDE BONE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$2,253.05
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
45000070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,689.79 |
| Max. Negotiated Rate |
$2,253.05 |
| Rate for Payer: Aetna Commercial |
$2,027.74
|
| Rate for Payer: ASR ASR |
$2,185.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.20
|
| Rate for Payer: BCN Commercial |
$1,850.20
|
| Rate for Payer: Cash Price |
$1,802.44
|
| Rate for Payer: Cofinity Commercial |
$2,117.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,802.44
|
| Rate for Payer: Healthscope Commercial |
$2,185.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,253.05
|
| Rate for Payer: Mclaren Commercial |
$2,027.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,915.09
|
| Rate for Payer: Nomi Health Commercial |
$1,847.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,689.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,982.68
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
OP
|
$545.88
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$491.29
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$529.50
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$450.08
|
| Rate for Payer: BCN Commercial |
$450.08
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cofinity Commercial |
$513.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$529.50
|
| Rate for Payer: Healthscope Whirlpool |
$545.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$491.29
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.00
|
| Rate for Payer: Nomi Health Commercial |
$447.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$455.16
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$364.13
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC DEBRIDE ECZEMTOUS/INFECT SKIN UP TO 10%
|
Facility
|
IP
|
$545.88
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
76100078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.41 |
| Max. Negotiated Rate |
$545.88 |
| Rate for Payer: Aetna Commercial |
$491.29
|
| Rate for Payer: ASR ASR |
$529.50
|
| Rate for Payer: BCBS Trust/PPO |
$448.28
|
| Rate for Payer: BCN Commercial |
$448.28
|
| Rate for Payer: Cash Price |
$436.70
|
| Rate for Payer: Cofinity Commercial |
$513.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.70
|
| Rate for Payer: Healthscope Commercial |
$529.50
|
| Rate for Payer: Healthscope Whirlpool |
$545.88
|
| Rate for Payer: Mclaren Commercial |
$491.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.00
|
| Rate for Payer: Nomi Health Commercial |
$447.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.37
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
IP
|
$1,369.17
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,026.88 |
| Max. Negotiated Rate |
$1,369.17 |
| Rate for Payer: Aetna Commercial |
$1,232.25
|
| Rate for Payer: Aetna Commercial |
$1,848.38
|
| Rate for Payer: ASR ASR |
$1,328.09
|
| Rate for Payer: ASR ASR |
$1,992.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,686.54
|
| Rate for Payer: BCN Commercial |
$1,124.36
|
| Rate for Payer: BCN Commercial |
$1,686.54
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cofinity Commercial |
$1,930.53
|
| Rate for Payer: Cofinity Commercial |
$1,287.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Healthscope Commercial |
$1,328.09
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,053.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,369.17
|
| Rate for Payer: Mclaren Commercial |
$1,848.38
|
| Rate for Payer: Mclaren Commercial |
$1,232.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Nomi Health Commercial |
$1,684.08
|
| Rate for Payer: Nomi Health Commercial |
$1,122.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,807.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,204.87
|
|
|
HC DEBRIDE MASTOIDECTOMY CAVITY CMPLX
|
Facility
|
OP
|
$1,369.17
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,369.17 |
| Rate for Payer: Aetna Commercial |
$1,232.25
|
| Rate for Payer: Aetna Commercial |
$1,848.38
|
| Rate for Payer: Aetna Medicare |
$537.39
|
| Rate for Payer: Aetna Medicare |
$537.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: ASR ASR |
$1,992.14
|
| Rate for Payer: ASR ASR |
$1,328.09
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.88
|
| Rate for Payer: BCN Commercial |
$1,128.88
|
| Rate for Payer: BCN Commercial |
$1,693.32
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,095.34
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cash Price |
$1,643.00
|
| Rate for Payer: Cofinity Commercial |
$1,287.02
|
| Rate for Payer: Cofinity Commercial |
$1,930.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,643.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,328.09
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,053.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,369.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.39
|
| Rate for Payer: Mclaren Commercial |
$1,848.38
|
| Rate for Payer: Mclaren Commercial |
$1,232.25
|
| Rate for Payer: Mclaren Medicaid |
$537.39
|
| Rate for Payer: Mclaren Medicaid |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$295.13
|
| Rate for Payer: Meridian Medicaid |
$295.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,745.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.79
|
| Rate for Payer: Nomi Health Commercial |
$1,122.72
|
| Rate for Payer: Nomi Health Commercial |
$1,684.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,540.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,026.88
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$591.13
|
| Rate for Payer: PHP Commercial |
$591.13
|
| Rate for Payer: PHP Medicaid |
$288.04
|
| Rate for Payer: PHP Medicaid |
$288.04
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,199.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,799.50
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Narrow Network |
$959.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,439.68
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,204.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,807.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$832.95
|
| Rate for Payer: UHC Exchange |
$832.95
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP DNSP |
$537.39
|
| Rate for Payer: UHCCP DNSP |
$537.39
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,690.34
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.43 |
| Max. Negotiated Rate |
$1,690.34 |
| Rate for Payer: Aetna Commercial |
$1,521.31
|
| Rate for Payer: Aetna Medicare |
$625.43
|
| Rate for Payer: ASR ASR |
$1,639.63
|
| Rate for Payer: BCBS Complete |
$676.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.69
|
| Rate for Payer: BCN Commercial |
$1,393.69
|
| Rate for Payer: Cash Price |
$1,352.27
|
| Rate for Payer: Cofinity Commercial |
$1,588.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.27
|
| Rate for Payer: Healthscope Commercial |
$1,639.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.34
|
| Rate for Payer: Mclaren Commercial |
$1,521.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,352.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,436.79
|
| Rate for Payer: Nomi Health Commercial |
$1,386.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,267.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,481.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.50
|
|
|
HC DEBRIDEMENT BONE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,690.34
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
76100034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,267.76 |
| Max. Negotiated Rate |
$1,690.34 |
| Rate for Payer: Aetna Commercial |
$1,521.31
|
| Rate for Payer: ASR ASR |
$1,639.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.11
|
| Rate for Payer: BCN Commercial |
$1,388.11
|
| Rate for Payer: Cash Price |
$1,352.27
|
| Rate for Payer: Cofinity Commercial |
$1,588.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.27
|
| Rate for Payer: Healthscope Commercial |
$1,639.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.34
|
| Rate for Payer: Mclaren Commercial |
$1,521.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,436.79
|
| Rate for Payer: Nomi Health Commercial |
$1,386.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,267.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.50
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
OP
|
$382.87
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$382.87 |
| Rate for Payer: Aetna Commercial |
$344.58
|
| Rate for Payer: Aetna Medicare |
$141.66
|
| Rate for Payer: ASR ASR |
$371.38
|
| Rate for Payer: BCBS Complete |
$153.15
|
| Rate for Payer: BCBS Trust/PPO |
$315.68
|
| Rate for Payer: BCN Commercial |
$315.68
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$359.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$371.38
|
| Rate for Payer: Healthscope Whirlpool |
$382.87
|
| Rate for Payer: Mclaren Commercial |
$344.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Nomi Health Commercial |
$313.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.84
|
| Rate for Payer: Priority Health Narrow Network |
$22.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.93
|
|
|
HC DEBRIDEMENT EA ADDL GT 20 SQ CM
|
Facility
|
IP
|
$382.87
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
42000036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.15 |
| Max. Negotiated Rate |
$382.87 |
| Rate for Payer: Aetna Commercial |
$344.58
|
| Rate for Payer: ASR ASR |
$371.38
|
| Rate for Payer: BCBS Trust/PPO |
$314.41
|
| Rate for Payer: BCN Commercial |
$314.41
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$359.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.30
|
| Rate for Payer: Healthscope Commercial |
$371.38
|
| Rate for Payer: Healthscope Whirlpool |
$382.87
|
| Rate for Payer: Mclaren Commercial |
$344.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.44
|
| Rate for Payer: Nomi Health Commercial |
$313.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$336.93
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
OP
|
$390.53
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna Commercial |
$351.48
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$378.81
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$321.99
|
| Rate for Payer: BCN Commercial |
$321.99
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cofinity Commercial |
$367.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$378.81
|
| Rate for Payer: Healthscope Whirlpool |
$390.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$351.48
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.95
|
| Rate for Payer: Nomi Health Commercial |
$320.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.90
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DEBRIDEMENT FIRST 20 SQ CM
|
Facility
|
IP
|
$390.53
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
42000035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.90 |
| Max. Negotiated Rate |
$390.53 |
| Rate for Payer: Aetna Commercial |
$351.48
|
| Rate for Payer: ASR ASR |
$378.81
|
| Rate for Payer: BCBS Trust/PPO |
$320.70
|
| Rate for Payer: BCN Commercial |
$320.70
|
| Rate for Payer: Cash Price |
$312.42
|
| Rate for Payer: Cofinity Commercial |
$367.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.42
|
| Rate for Payer: Healthscope Commercial |
$378.81
|
| Rate for Payer: Healthscope Whirlpool |
$390.53
|
| Rate for Payer: Mclaren Commercial |
$351.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.95
|
| Rate for Payer: Nomi Health Commercial |
$320.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.67
|
|
