|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
OP
|
$530.60
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$530.60 |
| Rate for Payer: Aetna Commercial |
$477.54
|
| Rate for Payer: Aetna Commercial |
$716.32
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$772.03
|
| Rate for Payer: ASR ASR |
$514.68
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$656.23
|
| Rate for Payer: BCBS Trust/PPO |
$437.48
|
| Rate for Payer: BCN Commercial |
$437.48
|
| Rate for Payer: BCN Commercial |
$656.23
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cofinity Commercial |
$498.76
|
| Rate for Payer: Cofinity Commercial |
$748.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$514.68
|
| Rate for Payer: Healthscope Commercial |
$772.03
|
| Rate for Payer: Healthscope Whirlpool |
$795.91
|
| Rate for Payer: Healthscope Whirlpool |
$530.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$716.32
|
| Rate for Payer: Mclaren Commercial |
$477.54
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.01
|
| Rate for Payer: Nomi Health Commercial |
$435.09
|
| Rate for Payer: Nomi Health Commercial |
$652.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.95
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$464.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$697.38
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$371.95
|
| Rate for Payer: Priority Health Narrow Network |
$557.93
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE
|
Facility
|
IP
|
$530.60
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
76100376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.95 |
| Max. Negotiated Rate |
$530.60 |
| Rate for Payer: Aetna Commercial |
$477.54
|
| Rate for Payer: Aetna Commercial |
$716.32
|
| Rate for Payer: ASR ASR |
$514.68
|
| Rate for Payer: ASR ASR |
$772.03
|
| Rate for Payer: BCBS Trust/PPO |
$435.73
|
| Rate for Payer: BCBS Trust/PPO |
$653.60
|
| Rate for Payer: BCN Commercial |
$435.73
|
| Rate for Payer: BCN Commercial |
$653.60
|
| Rate for Payer: Cash Price |
$636.73
|
| Rate for Payer: Cash Price |
$424.48
|
| Rate for Payer: Cofinity Commercial |
$748.16
|
| Rate for Payer: Cofinity Commercial |
$498.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.73
|
| Rate for Payer: Healthscope Commercial |
$514.68
|
| Rate for Payer: Healthscope Commercial |
$772.03
|
| Rate for Payer: Healthscope Whirlpool |
$795.91
|
| Rate for Payer: Healthscope Whirlpool |
$530.60
|
| Rate for Payer: Mclaren Commercial |
$716.32
|
| Rate for Payer: Mclaren Commercial |
$477.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.01
|
| Rate for Payer: Nomi Health Commercial |
$652.65
|
| Rate for Payer: Nomi Health Commercial |
$435.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$700.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.93
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$868.17
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.13 |
| Max. Negotiated Rate |
$868.17 |
| Rate for Payer: Aetna Commercial |
$781.35
|
| Rate for Payer: ASR ASR |
$842.12
|
| Rate for Payer: BCBS Trust/PPO |
$712.94
|
| Rate for Payer: BCN Commercial |
$712.94
|
| Rate for Payer: Cash Price |
$694.54
|
| Rate for Payer: Cofinity Commercial |
$816.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.54
|
| Rate for Payer: Healthscope Commercial |
$842.12
|
| Rate for Payer: Healthscope Whirlpool |
$868.17
|
| Rate for Payer: Mclaren Commercial |
$781.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.94
|
| Rate for Payer: Nomi Health Commercial |
$711.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$763.99
|
|
|
HC DEBRIDEMENT MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$868.17
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.22 |
| Max. Negotiated Rate |
$868.17 |
| Rate for Payer: Aetna Commercial |
$781.35
|
| Rate for Payer: Aetna Medicare |
$321.22
|
| Rate for Payer: ASR ASR |
$842.12
|
| Rate for Payer: BCBS Complete |
$347.27
|
| Rate for Payer: BCBS Trust/PPO |
$715.81
|
| Rate for Payer: BCN Commercial |
$715.81
|
| Rate for Payer: Cash Price |
$694.54
|
| Rate for Payer: Cofinity Commercial |
$816.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.54
|
| Rate for Payer: Healthscope Commercial |
$842.12
|
| Rate for Payer: Healthscope Whirlpool |
$868.17
|
| Rate for Payer: Mclaren Commercial |
$781.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$694.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.94
|
| Rate for Payer: Nomi Health Commercial |
$711.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$760.69
|
| Rate for Payer: Priority Health Narrow Network |
$608.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$763.99
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
IP
|
$96.31
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.23 |
| Max. Negotiated Rate |
$96.31 |
| Rate for Payer: Aetna Commercial |
$86.68
|
| Rate for Payer: ASR ASR |
$93.42
|
| Rate for Payer: BCBS Trust/PPO |
$79.09
|
| Rate for Payer: BCN Commercial |
$79.09
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.05
|
| Rate for Payer: Healthscope Commercial |
$93.42
|
| Rate for Payer: Healthscope Whirlpool |
$96.31
|
| Rate for Payer: Mclaren Commercial |
$86.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.75
|
|
|
HC DEBRIDEMENT OF 1-5 NAILS
|
Facility
|
OP
|
$96.31
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
76100043
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Aetna Commercial |
$86.68
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$93.42
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$79.41
|
| Rate for Payer: BCN Commercial |
$79.41
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$93.42
|
| Rate for Payer: Healthscope Whirlpool |
$96.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$86.68
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.23
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
OP
|
$116.75
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$116.75 |
| Rate for Payer: Aetna Commercial |
$105.08
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$113.25
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$96.26
|
| Rate for Payer: BCN Commercial |
$96.26
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cofinity Commercial |
$109.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$113.25
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$105.08
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.24
|
| Rate for Payer: Nomi Health Commercial |
$95.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.56
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.30
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$81.84
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC DEBRIDEMENT OF 6 OR MORE NAILS
|
Facility
|
IP
|
$116.75
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
76100044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.56 |
| Max. Negotiated Rate |
$116.75 |
| Rate for Payer: Aetna Commercial |
$105.08
|
| Rate for Payer: ASR ASR |
$113.25
|
| Rate for Payer: BCBS Trust/PPO |
$95.88
|
| Rate for Payer: BCN Commercial |
$95.88
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cofinity Commercial |
$109.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.40
|
| Rate for Payer: Healthscope Commercial |
$113.25
|
| Rate for Payer: Healthscope Whirlpool |
$116.75
|
| Rate for Payer: Mclaren Commercial |
$105.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.24
|
| Rate for Payer: Nomi Health Commercial |
$95.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.74
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,135.66
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.76 |
| Max. Negotiated Rate |
$1,141.44 |
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$1,101.59
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$936.35
|
| Rate for Payer: BCN Commercial |
$936.35
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cofinity Commercial |
$1,067.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$1,101.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$1,022.09
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.31
|
| Rate for Payer: Nomi Health Commercial |
$931.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.75
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.20
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$381.76
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$999.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,141.44
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC DEBRIDE MUSCLE FASCIA FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$1,135.66
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
76100026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.75 |
| Max. Negotiated Rate |
$1,135.66 |
| Rate for Payer: Aetna Commercial |
$1,022.09
|
| Rate for Payer: ASR ASR |
$1,101.59
|
| Rate for Payer: BCBS Trust/PPO |
$932.60
|
| Rate for Payer: BCN Commercial |
$932.60
|
| Rate for Payer: Cash Price |
$908.53
|
| Rate for Payer: Cofinity Commercial |
$1,067.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.53
|
| Rate for Payer: Healthscope Commercial |
$1,101.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.66
|
| Rate for Payer: Mclaren Commercial |
$1,022.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.31
|
| Rate for Payer: Nomi Health Commercial |
$931.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$851.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$999.38
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$1,924.74
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,443.56 |
| Max. Negotiated Rate |
$1,924.74 |
| Rate for Payer: Aetna Commercial |
$1,732.27
|
| Rate for Payer: ASR ASR |
$1,867.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,580.60
|
| Rate for Payer: BCN Commercial |
$1,580.60
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cofinity Commercial |
$1,809.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.79
|
| Rate for Payer: Healthscope Commercial |
$1,867.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,924.74
|
| Rate for Payer: Mclaren Commercial |
$1,732.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.03
|
| Rate for Payer: Nomi Health Commercial |
$1,578.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,693.77
|
|
|
HC DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$1,924.74
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
76100390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$1,924.74 |
| Rate for Payer: Aetna Commercial |
$1,732.27
|
| Rate for Payer: Aetna Medicare |
$705.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: ASR ASR |
$1,867.00
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.95
|
| Rate for Payer: BCN Commercial |
$1,586.95
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cash Price |
$1,539.79
|
| Rate for Payer: Cofinity Commercial |
$1,809.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,539.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$1,867.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,924.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$705.59
|
| Rate for Payer: Mclaren Commercial |
$1,732.27
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$387.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.03
|
| Rate for Payer: Nomi Health Commercial |
$1,578.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,443.56
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$776.15
|
| Rate for Payer: PHP Medicaid |
$378.20
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$848.60
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Narrow Network |
$678.88
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,693.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Exchange |
$1,093.66
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP DNSP |
$705.59
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
OP
|
$4,161.60
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$4,486.12 |
| Rate for Payer: Aetna Commercial |
$3,745.44
|
| Rate for Payer: Aetna Medicare |
$2,894.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: ASR ASR |
$4,036.75
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,431.24
|
| Rate for Payer: BCN Commercial |
$3,431.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Commercial |
$3,911.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$4,036.75
|
| Rate for Payer: Healthscope Whirlpool |
$4,161.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,894.27
|
| Rate for Payer: Mclaren Commercial |
$3,745.44
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$1,589.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Nomi Health Commercial |
$3,412.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$3,183.70
|
| Rate for Payer: PHP Medicaid |
$1,551.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,646.39
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Narrow Network |
$2,917.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,662.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Exchange |
$4,486.12
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP DNSP |
$2,894.27
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
HC DEBRIDE SKIN BONE AT FX SITE
|
Facility
|
IP
|
$4,161.60
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,121.20 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,745.44
|
| Rate for Payer: ASR ASR |
$4,036.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,417.51
|
| Rate for Payer: BCN Commercial |
$3,417.51
|
| Rate for Payer: Cash Price |
$3,329.28
|
| Rate for Payer: Cofinity Commercial |
$3,911.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,329.28
|
| Rate for Payer: Healthscope Commercial |
$4,036.75
|
| Rate for Payer: Healthscope Whirlpool |
$4,161.60
|
| Rate for Payer: Mclaren Commercial |
$3,745.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,537.36
|
| Rate for Payer: Nomi Health Commercial |
$3,412.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,121.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,662.21
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
IP
|
$519.25
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.44 |
| Max. Negotiated Rate |
$519.25 |
| Rate for Payer: Aetna Commercial |
$467.32
|
| Rate for Payer: ASR ASR |
$503.67
|
| Rate for Payer: BCBS Trust/PPO |
$426.41
|
| Rate for Payer: BCN Commercial |
$426.41
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cofinity Commercial |
$488.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$503.67
|
| Rate for Payer: Healthscope Whirlpool |
$519.25
|
| Rate for Payer: Mclaren Commercial |
$467.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.36
|
| Rate for Payer: Nomi Health Commercial |
$425.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.94
|
|
|
HC DEBRIDE SQ TISSUE EACH ADDL 20SQ CM
|
Facility
|
OP
|
$519.25
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
36100405
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.12 |
| Max. Negotiated Rate |
$519.25 |
| Rate for Payer: Aetna Commercial |
$467.32
|
| Rate for Payer: Aetna Medicare |
$192.12
|
| Rate for Payer: ASR ASR |
$503.67
|
| Rate for Payer: BCBS Complete |
$207.70
|
| Rate for Payer: BCBS Trust/PPO |
$428.12
|
| Rate for Payer: BCN Commercial |
$428.12
|
| Rate for Payer: Cash Price |
$415.40
|
| Rate for Payer: Cofinity Commercial |
$488.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$503.67
|
| Rate for Payer: Healthscope Whirlpool |
$519.25
|
| Rate for Payer: Mclaren Commercial |
$467.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.36
|
| Rate for Payer: Nomi Health Commercial |
$425.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$454.97
|
| Rate for Payer: Priority Health Narrow Network |
$363.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.94
|
|
|
HC DEBRIDE SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$657.98
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$657.98 |
| Rate for Payer: Aetna Commercial |
$592.18
|
| 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 |
$638.24
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$542.50
|
| Rate for Payer: BCN Commercial |
$542.50
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cofinity Commercial |
$618.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$638.24
|
| Rate for Payer: Healthscope Whirlpool |
$657.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$592.18
|
| 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 |
$559.28
|
| Rate for Payer: Nomi Health Commercial |
$539.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.49
|
| 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 |
$477.20
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$381.76
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.02
|
| 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 SQ TISSUE FIRST 20 SQ CM OR LESS
|
Facility
|
IP
|
$657.98
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
76100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.49 |
| Max. Negotiated Rate |
$657.98 |
| Rate for Payer: Aetna Commercial |
$592.18
|
| Rate for Payer: ASR ASR |
$638.24
|
| Rate for Payer: BCBS Trust/PPO |
$540.33
|
| Rate for Payer: BCN Commercial |
$540.33
|
| Rate for Payer: Cash Price |
$526.38
|
| Rate for Payer: Cofinity Commercial |
$618.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.38
|
| Rate for Payer: Healthscope Commercial |
$638.24
|
| Rate for Payer: Healthscope Whirlpool |
$657.98
|
| Rate for Payer: Mclaren Commercial |
$592.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.28
|
| Rate for Payer: Nomi Health Commercial |
$539.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.02
|
|
|
HC DECALCIFICATION
|
Facility
|
OP
|
$38.31
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$81.11 |
| Rate for Payer: Aetna Commercial |
$34.48
|
| Rate for Payer: Aetna Medicare |
$14.17
|
| Rate for Payer: ASR ASR |
$37.16
|
| Rate for Payer: BCBS Complete |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$31.59
|
| Rate for Payer: BCN Commercial |
$31.59
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cofinity Commercial |
$36.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.65
|
| Rate for Payer: Healthscope Commercial |
$37.16
|
| Rate for Payer: Healthscope Whirlpool |
$38.31
|
| Rate for Payer: Mclaren Commercial |
$34.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Nomi Health Commercial |
$31.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81.11
|
| Rate for Payer: Priority Health Narrow Network |
$64.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.71
|
|
|
HC DECALCIFICATION
|
Facility
|
IP
|
$38.31
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
31000051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$38.31 |
| Rate for Payer: Aetna Commercial |
$34.48
|
| Rate for Payer: ASR ASR |
$37.16
|
| Rate for Payer: BCBS Trust/PPO |
$31.46
|
| Rate for Payer: BCN Commercial |
$31.46
|
| Rate for Payer: Cash Price |
$30.65
|
| Rate for Payer: Cofinity Commercial |
$36.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.65
|
| Rate for Payer: Healthscope Commercial |
$37.16
|
| Rate for Payer: Healthscope Whirlpool |
$38.31
|
| Rate for Payer: Mclaren Commercial |
$34.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Nomi Health Commercial |
$31.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.71
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
IP
|
$492.82
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.62 |
| Max. Negotiated Rate |
$492.82 |
| Rate for Payer: Aetna Commercial |
$443.54
|
| Rate for Payer: ASR ASR |
$478.04
|
| Rate for Payer: BCBS Trust/PPO |
$404.70
|
| Rate for Payer: BCN Commercial |
$404.70
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cofinity Commercial |
$463.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.26
|
| Rate for Payer: Healthscope Commercial |
$478.04
|
| Rate for Payer: Healthscope Whirlpool |
$492.82
|
| Rate for Payer: Mclaren Commercial |
$443.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.90
|
| Rate for Payer: Nomi Health Commercial |
$404.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.68
|
|
|
HC DECLOT BY THROMBOLYTIC
|
Facility
|
OP
|
$492.82
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$510.14 |
| Rate for Payer: Aetna Commercial |
$443.54
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$478.04
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$406.33
|
| Rate for Payer: BCN Commercial |
$406.33
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cash Price |
$394.26
|
| Rate for Payer: Cofinity Commercial |
$463.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$478.04
|
| Rate for Payer: Healthscope Whirlpool |
$492.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$443.54
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.90
|
| Rate for Payer: Nomi Health Commercial |
$404.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.62
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$431.81
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$345.47
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
IP
|
$146.25
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$131.62
|
| Rate for Payer: ASR ASR |
$141.86
|
| Rate for Payer: BCBS Trust/PPO |
$120.10
|
| Rate for Payer: BCN Commercial |
$120.10
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cofinity Commercial |
$137.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.00
|
| Rate for Payer: Healthscope Commercial |
$141.86
|
| Rate for Payer: Healthscope Whirlpool |
$146.25
|
| Rate for Payer: Mclaren Commercial |
$131.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.31
|
| Rate for Payer: Nomi Health Commercial |
$119.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.70
|
|
|
HC DECONTAMINATION AMB/SELF-DIRECTED
|
Facility
|
OP
|
$146.25
|
|
| Hospital Charge Code |
27000613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$131.62
|
| Rate for Payer: Aetna Medicare |
$54.11
|
| Rate for Payer: ASR ASR |
$141.86
|
| Rate for Payer: BCBS Complete |
$58.50
|
| Rate for Payer: BCBS Trust/PPO |
$120.58
|
| Rate for Payer: BCN Commercial |
$120.58
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cofinity Commercial |
$137.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.00
|
| Rate for Payer: Healthscope Commercial |
$141.86
|
| Rate for Payer: Healthscope Whirlpool |
$146.25
|
| Rate for Payer: Mclaren Commercial |
$131.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.31
|
| Rate for Payer: Nomi Health Commercial |
$119.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$128.14
|
| Rate for Payer: Priority Health Narrow Network |
$102.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.70
|
|
|
HC DECONTAMINATION AMB W/ASSIST
|
Facility
|
IP
|
$839.72
|
|
| Hospital Charge Code |
27000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$629.79 |
| Max. Negotiated Rate |
$839.72 |
| Rate for Payer: Aetna Commercial |
$755.75
|
| Rate for Payer: ASR ASR |
$814.53
|
| Rate for Payer: BCBS Trust/PPO |
$689.58
|
| Rate for Payer: BCN Commercial |
$689.58
|
| Rate for Payer: Cash Price |
$671.78
|
| Rate for Payer: Cofinity Commercial |
$789.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.78
|
| Rate for Payer: Healthscope Commercial |
$814.53
|
| Rate for Payer: Healthscope Whirlpool |
$839.72
|
| Rate for Payer: Mclaren Commercial |
$755.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.76
|
| Rate for Payer: Nomi Health Commercial |
$688.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$738.95
|
|
