|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$778.23
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$778.23 |
| Rate for Payer: Aetna Commercial |
$700.41
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$754.88
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$641.65
|
| Rate for Payer: BCN Commercial |
$641.65
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$622.58
|
| Rate for Payer: Cash Price |
$622.58
|
| Rate for Payer: Cofinity Commercial |
$731.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$754.88
|
| Rate for Payer: Healthscope Whirlpool |
$778.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$700.41
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.50
|
| Rate for Payer: Nomi Health Commercial |
$638.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.67
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.09
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$110.47
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$778.23
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$583.67 |
| Max. Negotiated Rate |
$778.23 |
| Rate for Payer: Aetna Commercial |
$700.41
|
| Rate for Payer: ASR ASR |
$754.88
|
| Rate for Payer: BCBS Trust/PPO |
$639.08
|
| Rate for Payer: BCN Commercial |
$639.08
|
| Rate for Payer: Cash Price |
$622.58
|
| Rate for Payer: Cofinity Commercial |
$731.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.58
|
| Rate for Payer: Healthscope Commercial |
$754.88
|
| Rate for Payer: Healthscope Whirlpool |
$778.23
|
| Rate for Payer: Mclaren Commercial |
$700.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.50
|
| Rate for Payer: Nomi Health Commercial |
$638.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$684.84
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$787.95
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$787.95 |
| Rate for Payer: Aetna Commercial |
$709.15
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$764.31
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$649.66
|
| Rate for Payer: BCN Commercial |
$649.66
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cofinity Commercial |
$740.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$764.31
|
| Rate for Payer: Healthscope Whirlpool |
$787.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$709.15
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.76
|
| Rate for Payer: Nomi Health Commercial |
$646.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.96
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.09
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$110.47
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$787.95
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$590.96 |
| Max. Negotiated Rate |
$787.95 |
| Rate for Payer: Aetna Commercial |
$709.15
|
| Rate for Payer: ASR ASR |
$764.31
|
| Rate for Payer: BCBS Trust/PPO |
$647.06
|
| Rate for Payer: BCN Commercial |
$647.06
|
| Rate for Payer: Cash Price |
$630.36
|
| Rate for Payer: Cofinity Commercial |
$740.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.36
|
| Rate for Payer: Healthscope Commercial |
$764.31
|
| Rate for Payer: Healthscope Whirlpool |
$787.95
|
| Rate for Payer: Mclaren Commercial |
$709.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.76
|
| Rate for Payer: Nomi Health Commercial |
$646.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$590.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$693.40
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$486.40
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Aetna Commercial |
$437.76
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$471.81
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$401.04
|
| Rate for Payer: BCN Commercial |
$401.04
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cofinity Commercial |
$457.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$471.81
|
| Rate for Payer: Healthscope Whirlpool |
$486.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$437.76
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.44
|
| Rate for Payer: Nomi Health Commercial |
$398.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.80
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.09
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$110.47
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$428.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$486.40
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$364.80 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Aetna Commercial |
$437.76
|
| Rate for Payer: ASR ASR |
$471.81
|
| Rate for Payer: BCBS Trust/PPO |
$399.43
|
| Rate for Payer: BCN Commercial |
$399.43
|
| Rate for Payer: Cash Price |
$389.12
|
| Rate for Payer: Cofinity Commercial |
$457.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.12
|
| Rate for Payer: Healthscope Commercial |
$471.81
|
| Rate for Payer: Healthscope Whirlpool |
$486.40
|
| Rate for Payer: Mclaren Commercial |
$437.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.44
|
| Rate for Payer: Nomi Health Commercial |
$398.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$428.03
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
IP
|
$343.19
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.39 |
| Max. Negotiated Rate |
$343.19 |
| Rate for Payer: Aetna Commercial |
$308.87
|
| Rate for Payer: ASR ASR |
$332.89
|
| Rate for Payer: BCBS Trust/PPO |
$281.83
|
| Rate for Payer: BCN Commercial |
$281.83
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cofinity Commercial |
$322.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.55
|
| Rate for Payer: Healthscope Commercial |
$332.89
|
| Rate for Payer: Healthscope Whirlpool |
$343.19
|
| Rate for Payer: Mclaren Commercial |
$308.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.71
|
| Rate for Payer: Nomi Health Commercial |
$281.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.01
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
OP
|
$343.19
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$343.19 |
| Rate for Payer: Aetna Commercial |
$308.87
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$332.89
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$282.96
|
| Rate for Payer: BCN Commercial |
$282.96
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cash Price |
$274.55
|
| Rate for Payer: Cofinity Commercial |
$322.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$332.89
|
| Rate for Payer: Healthscope Whirlpool |
$343.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$308.87
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.71
|
| Rate for Payer: Nomi Health Commercial |
$281.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.39
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.09
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$110.47
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$283.54
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$283.54 |
| Rate for Payer: Aetna Commercial |
$255.19
|
| Rate for Payer: ASR ASR |
$275.03
|
| Rate for Payer: BCBS Trust/PPO |
$232.84
|
| Rate for Payer: BCN Commercial |
$232.84
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cofinity Commercial |
$266.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.83
|
| Rate for Payer: Healthscope Commercial |
$275.03
|
| Rate for Payer: Healthscope Whirlpool |
$283.54
|
| Rate for Payer: Mclaren Commercial |
$255.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$232.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.52
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$283.54
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$283.54 |
| Rate for Payer: Aetna Commercial |
$255.19
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$275.03
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.78
|
| Rate for Payer: BCN Commercial |
$233.78
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cofinity Commercial |
$266.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$275.03
|
| Rate for Payer: Healthscope Whirlpool |
$283.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$255.19
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$232.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.66
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$138.09
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$110.47
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
IP
|
$2,507.96
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,880.97 |
| Max. Negotiated Rate |
$2,507.96 |
| Rate for Payer: Aetna Commercial |
$2,257.16
|
| Rate for Payer: ASR ASR |
$2,432.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.54
|
| Rate for Payer: BCN Commercial |
$2,059.54
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cofinity Commercial |
$2,357.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.37
|
| Rate for Payer: Healthscope Commercial |
$2,432.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,507.96
|
| Rate for Payer: Mclaren Commercial |
$2,257.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.77
|
| Rate for Payer: Nomi Health Commercial |
$2,056.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.00
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
OP
|
$2,507.96
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,186.58 |
| Rate for Payer: Aetna Commercial |
$2,257.16
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$2,432.72
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,067.81
|
| Rate for Payer: BCN Commercial |
$2,067.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cofinity Commercial |
$2,357.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,432.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,507.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$2,257.16
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.77
|
| Rate for Payer: Nomi Health Commercial |
$2,056.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.97
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,197.47
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,758.08
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,207.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
OP
|
$3,283.73
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,283.73 |
| Rate for Payer: Aetna Commercial |
$2,955.36
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$3,185.22
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,707.44
|
| Rate for Payer: BCN Commercial |
$2,707.44
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cofinity Commercial |
$3,086.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$3,185.22
|
| Rate for Payer: Healthscope Whirlpool |
$3,283.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$2,955.36
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.17
|
| Rate for Payer: Nomi Health Commercial |
$2,692.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,462.80
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,877.20
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,301.89
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,889.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
IP
|
$3,283.73
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,462.80 |
| Max. Negotiated Rate |
$3,283.73 |
| Rate for Payer: Aetna Commercial |
$2,955.36
|
| Rate for Payer: ASR ASR |
$3,185.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,696.60
|
| Rate for Payer: BCN Commercial |
$2,696.60
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cofinity Commercial |
$3,086.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.98
|
| Rate for Payer: Healthscope Commercial |
$3,185.22
|
| Rate for Payer: Healthscope Whirlpool |
$3,283.73
|
| Rate for Payer: Mclaren Commercial |
$2,955.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.17
|
| Rate for Payer: Nomi Health Commercial |
$2,692.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,462.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,889.68
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$47.11
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: ASR ASR |
$50.77
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.15
|
| Rate for Payer: BCN Commercial |
$43.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$50.77
|
| Rate for Payer: Healthscope Whirlpool |
$52.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.27
|
| Rate for Payer: Mclaren Commercial |
$47.11
|
| Rate for Payer: Mclaren Medicaid |
$4.27
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$4.70
|
| Rate for Payer: PHP Medicaid |
$2.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$36.31
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$29.05
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$47.11
|
| Rate for Payer: ASR ASR |
$50.77
|
| Rate for Payer: BCBS Trust/PPO |
$42.98
|
| Rate for Payer: BCN Commercial |
$42.98
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$50.77
|
| Rate for Payer: Healthscope Whirlpool |
$52.34
|
| Rate for Payer: Mclaren Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.06
|
|
|
HC GRANULOCYTES
|
Facility
|
OP
|
$1,964.28
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$726.78 |
| Max. Negotiated Rate |
$1,964.28 |
| Rate for Payer: Aetna Commercial |
$1,767.85
|
| Rate for Payer: Aetna Medicare |
$726.78
|
| Rate for Payer: ASR ASR |
$1,905.35
|
| Rate for Payer: BCBS Complete |
$785.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.55
|
| Rate for Payer: BCN Commercial |
$1,619.55
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cofinity Commercial |
$1,846.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.42
|
| Rate for Payer: Healthscope Commercial |
$1,905.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,964.28
|
| Rate for Payer: Mclaren Commercial |
$1,767.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,571.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.64
|
| Rate for Payer: Nomi Health Commercial |
$1,610.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,721.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,376.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.57
|
|
|
HC GRANULOCYTES
|
Facility
|
IP
|
$1,964.28
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,473.21 |
| Max. Negotiated Rate |
$1,964.28 |
| Rate for Payer: Aetna Commercial |
$1,767.85
|
| Rate for Payer: ASR ASR |
$1,905.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,613.07
|
| Rate for Payer: BCN Commercial |
$1,613.07
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cofinity Commercial |
$1,846.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.42
|
| Rate for Payer: Healthscope Commercial |
$1,905.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,964.28
|
| Rate for Payer: Mclaren Commercial |
$1,767.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.64
|
| Rate for Payer: Nomi Health Commercial |
$1,610.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,728.57
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: BCBS Trust/PPO |
$16.42
|
| Rate for Payer: BCN Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Healthscope Whirlpool |
$20.00
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.49
|
| Rate for Payer: BCN Commercial |
$16.49
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Healthscope Whirlpool |
$20.00
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow Network |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
IP
|
$1,472.60
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,104.45 |
| Max. Negotiated Rate |
$1,472.60 |
| Rate for Payer: Aetna Commercial |
$1,325.34
|
| Rate for Payer: ASR ASR |
$1,428.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.30
|
| Rate for Payer: BCN Commercial |
$1,209.30
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cofinity Commercial |
$1,384.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.08
|
| Rate for Payer: Healthscope Commercial |
$1,428.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,472.60
|
| Rate for Payer: Mclaren Commercial |
$1,325.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,251.71
|
| Rate for Payer: Nomi Health Commercial |
$1,207.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,295.89
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
OP
|
$1,472.60
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,472.60 |
| Rate for Payer: Aetna Commercial |
$1,325.34
|
| Rate for Payer: Aetna Medicare |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: ASR ASR |
$1,428.42
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,214.16
|
| Rate for Payer: BCN Commercial |
$1,214.16
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cofinity Commercial |
$1,384.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,428.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,472.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$237.74
|
| Rate for Payer: Mclaren Commercial |
$1,325.34
|
| Rate for Payer: Mclaren Medicaid |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$130.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,251.71
|
| Rate for Payer: Nomi Health Commercial |
$1,207.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.45
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$261.51
|
| Rate for Payer: PHP Medicaid |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,290.29
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,032.29
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,295.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP DNSP |
$237.74
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
