|
HC NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
OP
|
$551.65
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$496.49
|
| 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 |
$535.10
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$454.84
|
| Rate for Payer: BCN Commercial |
$454.84
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$441.32
|
| Rate for Payer: Cash Price |
$441.32
|
| Rate for Payer: Cofinity Commercial |
$518.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$535.10
|
| Rate for Payer: Healthscope Whirlpool |
$551.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$496.49
|
| 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 |
$468.90
|
| Rate for Payer: Nomi Health Commercial |
$452.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$413.74
|
| 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 |
$249.38
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$199.50
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.45
|
| 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 NEG PRESSURE WND TX DME GT 50 SQ CM
|
Facility
|
IP
|
$551.65
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.74 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: Aetna Commercial |
$496.49
|
| Rate for Payer: ASR ASR |
$535.10
|
| Rate for Payer: BCBS Trust/PPO |
$453.01
|
| Rate for Payer: BCN Commercial |
$453.01
|
| Rate for Payer: Cash Price |
$441.32
|
| Rate for Payer: Cofinity Commercial |
$518.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.32
|
| Rate for Payer: Healthscope Commercial |
$535.10
|
| Rate for Payer: Healthscope Whirlpool |
$551.65
|
| Rate for Payer: Mclaren Commercial |
$496.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.90
|
| Rate for Payer: Nomi Health Commercial |
$452.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$413.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.45
|
|
|
HC NEG PRESSURE WND TX DME UP TO 50 SQ CM
|
Facility
|
IP
|
$436.89
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.67 |
| Max. Negotiated Rate |
$436.89 |
| Rate for Payer: Aetna Commercial |
$393.20
|
| Rate for Payer: ASR ASR |
$423.78
|
| Rate for Payer: BCBS Trust/PPO |
$358.77
|
| Rate for Payer: BCN Commercial |
$358.77
|
| Rate for Payer: Cash Price |
$349.51
|
| Rate for Payer: Cofinity Commercial |
$410.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.51
|
| Rate for Payer: Healthscope Commercial |
$423.78
|
| Rate for Payer: Healthscope Whirlpool |
$436.89
|
| Rate for Payer: Mclaren Commercial |
$393.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.36
|
| Rate for Payer: Nomi Health Commercial |
$358.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.46
|
|
|
HC NEG PRESSURE WND TX DME UP TO 50 SQ CM
|
Facility
|
OP
|
$436.89
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
76100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$436.89 |
| Rate for Payer: Aetna Commercial |
$393.20
|
| 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 |
$423.78
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$360.22
|
| Rate for Payer: BCN Commercial |
$360.22
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$349.51
|
| Rate for Payer: Cash Price |
$349.51
|
| Rate for Payer: Cofinity Commercial |
$410.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$423.78
|
| Rate for Payer: Healthscope Whirlpool |
$436.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$393.20
|
| 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 |
$371.36
|
| Rate for Payer: Nomi Health Commercial |
$358.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.67
|
| 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 |
$151.32
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$121.05
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.46
|
| 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 NEG PRES TRAC PAD
|
Facility
|
OP
|
$75.29
|
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$75.29 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Aetna Medicare |
$27.86
|
| Rate for Payer: ASR ASR |
$73.03
|
| Rate for Payer: BCBS Complete |
$30.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.08
|
| Rate for Payer: BCN Commercial |
$62.08
|
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Cofinity Commercial |
$70.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.23
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.29
|
| Rate for Payer: Mclaren Commercial |
$67.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.00
|
| Rate for Payer: Nomi Health Commercial |
$61.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.97
|
| Rate for Payer: Priority Health Narrow Network |
$52.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.26
|
|
|
HC NEG PRES TRAC PAD
|
Facility
|
IP
|
$75.29
|
|
| Hospital Charge Code |
27000158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$75.29 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: ASR ASR |
$73.03
|
| Rate for Payer: BCBS Trust/PPO |
$61.83
|
| Rate for Payer: BCN Commercial |
$61.83
|
| Rate for Payer: Cash Price |
$60.23
|
| Rate for Payer: Cofinity Commercial |
$70.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.23
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.29
|
| Rate for Payer: Mclaren Commercial |
$67.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.00
|
| Rate for Payer: Nomi Health Commercial |
$61.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.26
|
|
|
HC NEG PRES VF CASSETTE
|
Facility
|
IP
|
$217.13
|
|
| Hospital Charge Code |
27200230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$217.13 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: ASR ASR |
$210.62
|
| Rate for Payer: BCBS Trust/PPO |
$178.31
|
| Rate for Payer: BCN Commercial |
$178.31
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Commercial |
$204.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Healthscope Commercial |
$210.62
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Mclaren Commercial |
$195.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.56
|
| Rate for Payer: Nomi Health Commercial |
$178.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.07
|
|
|
HC NEG PRES VF CASSETTE
|
Facility
|
OP
|
$217.13
|
|
| Hospital Charge Code |
27200230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$217.13 |
| Rate for Payer: Aetna Commercial |
$195.42
|
| Rate for Payer: Aetna Medicare |
$80.34
|
| Rate for Payer: ASR ASR |
$210.62
|
| Rate for Payer: BCBS Complete |
$86.85
|
| Rate for Payer: BCBS Trust/PPO |
$179.02
|
| Rate for Payer: BCN Commercial |
$179.02
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Commercial |
$204.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Healthscope Commercial |
$210.62
|
| Rate for Payer: Healthscope Whirlpool |
$217.13
|
| Rate for Payer: Mclaren Commercial |
$195.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.56
|
| Rate for Payer: Nomi Health Commercial |
$178.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.25
|
| Rate for Payer: Priority Health Narrow Network |
$152.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.07
|
|
|
HC NEG PRES VF DRSG MED
|
Facility
|
IP
|
$454.00
|
|
| Hospital Charge Code |
27200228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.50 |
| Max. Negotiated Rate |
$454.00 |
| Rate for Payer: Aetna Commercial |
$408.60
|
| Rate for Payer: ASR ASR |
$440.38
|
| Rate for Payer: BCBS Trust/PPO |
$372.82
|
| Rate for Payer: BCN Commercial |
$372.82
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cofinity Commercial |
$426.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.20
|
| Rate for Payer: Healthscope Commercial |
$440.38
|
| Rate for Payer: Healthscope Whirlpool |
$454.00
|
| Rate for Payer: Mclaren Commercial |
$408.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.90
|
| Rate for Payer: Nomi Health Commercial |
$372.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$399.52
|
|
|
HC NEG PRES VF DRSG MED
|
Facility
|
OP
|
$454.00
|
|
| Hospital Charge Code |
27200228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.98 |
| Max. Negotiated Rate |
$454.00 |
| Rate for Payer: Aetna Commercial |
$408.60
|
| Rate for Payer: Aetna Medicare |
$167.98
|
| Rate for Payer: ASR ASR |
$440.38
|
| Rate for Payer: BCBS Complete |
$181.60
|
| Rate for Payer: BCBS Trust/PPO |
$374.32
|
| Rate for Payer: BCN Commercial |
$374.32
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cofinity Commercial |
$426.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.20
|
| Rate for Payer: Healthscope Commercial |
$440.38
|
| Rate for Payer: Healthscope Whirlpool |
$454.00
|
| Rate for Payer: Mclaren Commercial |
$408.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.90
|
| Rate for Payer: Nomi Health Commercial |
$372.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$397.79
|
| Rate for Payer: Priority Health Narrow Network |
$318.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$399.52
|
|
|
HC NEG PRES VF DRSG SMA
|
Facility
|
OP
|
$386.89
|
|
| Hospital Charge Code |
27200227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.15 |
| Max. Negotiated Rate |
$386.89 |
| Rate for Payer: Aetna Commercial |
$348.20
|
| Rate for Payer: Aetna Medicare |
$143.15
|
| Rate for Payer: ASR ASR |
$375.28
|
| Rate for Payer: BCBS Complete |
$154.76
|
| Rate for Payer: BCBS Trust/PPO |
$318.99
|
| Rate for Payer: BCN Commercial |
$318.99
|
| Rate for Payer: Cash Price |
$309.51
|
| Rate for Payer: Cofinity Commercial |
$363.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.51
|
| Rate for Payer: Healthscope Commercial |
$375.28
|
| Rate for Payer: Healthscope Whirlpool |
$386.89
|
| Rate for Payer: Mclaren Commercial |
$348.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.86
|
| Rate for Payer: Nomi Health Commercial |
$317.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$338.99
|
| Rate for Payer: Priority Health Narrow Network |
$271.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.46
|
|
|
HC NEG PRES VF DRSG SMA
|
Facility
|
IP
|
$386.89
|
|
| Hospital Charge Code |
27200227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.17 |
| Max. Negotiated Rate |
$386.89 |
| Rate for Payer: Aetna Commercial |
$348.20
|
| Rate for Payer: ASR ASR |
$375.28
|
| Rate for Payer: BCBS Trust/PPO |
$317.71
|
| Rate for Payer: BCN Commercial |
$317.71
|
| Rate for Payer: Cash Price |
$309.51
|
| Rate for Payer: Cofinity Commercial |
$363.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.51
|
| Rate for Payer: Healthscope Commercial |
$375.28
|
| Rate for Payer: Healthscope Whirlpool |
$386.89
|
| Rate for Payer: Mclaren Commercial |
$348.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.86
|
| Rate for Payer: Nomi Health Commercial |
$317.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.46
|
|
|
HC NEG PRES VF DUO TRAC PAD
|
Facility
|
IP
|
$296.09
|
|
| Hospital Charge Code |
27200231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.07 |
| Max. Negotiated Rate |
$296.09 |
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: ASR ASR |
$287.21
|
| Rate for Payer: BCBS Trust/PPO |
$243.15
|
| Rate for Payer: BCN Commercial |
$243.15
|
| Rate for Payer: Cash Price |
$236.87
|
| Rate for Payer: Cofinity Commercial |
$278.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.87
|
| Rate for Payer: Healthscope Commercial |
$287.21
|
| Rate for Payer: Healthscope Whirlpool |
$296.09
|
| Rate for Payer: Mclaren Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: Nomi Health Commercial |
$242.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.56
|
|
|
HC NEG PRES VF DUO TRAC PAD
|
Facility
|
OP
|
$296.09
|
|
| Hospital Charge Code |
27200231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$296.09 |
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna Medicare |
$109.55
|
| Rate for Payer: ASR ASR |
$287.21
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$244.13
|
| Rate for Payer: BCN Commercial |
$244.13
|
| Rate for Payer: Cash Price |
$236.87
|
| Rate for Payer: Cofinity Commercial |
$278.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.87
|
| Rate for Payer: Healthscope Commercial |
$287.21
|
| Rate for Payer: Healthscope Whirlpool |
$296.09
|
| Rate for Payer: Mclaren Commercial |
$266.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.68
|
| Rate for Payer: Nomi Health Commercial |
$242.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$259.43
|
| Rate for Payer: Priority Health Narrow Network |
$207.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.56
|
|
|
HC NEG PRES WHT FOAM DRSG
|
Facility
|
OP
|
$183.70
|
|
| Hospital Charge Code |
27200158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$183.70 |
| Rate for Payer: Aetna Commercial |
$165.33
|
| Rate for Payer: Aetna Medicare |
$67.97
|
| Rate for Payer: ASR ASR |
$178.19
|
| Rate for Payer: BCBS Complete |
$73.48
|
| Rate for Payer: BCBS Trust/PPO |
$151.46
|
| Rate for Payer: BCN Commercial |
$151.46
|
| Rate for Payer: Cash Price |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$172.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.96
|
| Rate for Payer: Healthscope Commercial |
$178.19
|
| Rate for Payer: Healthscope Whirlpool |
$183.70
|
| Rate for Payer: Mclaren Commercial |
$165.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.15
|
| Rate for Payer: Nomi Health Commercial |
$150.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$160.96
|
| Rate for Payer: Priority Health Narrow Network |
$128.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.66
|
|
|
HC NEG PRES WHT FOAM DRSG
|
Facility
|
IP
|
$183.70
|
|
| Hospital Charge Code |
27200158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.78 |
| Max. Negotiated Rate |
$183.70 |
| Rate for Payer: Aetna Commercial |
$165.33
|
| Rate for Payer: ASR ASR |
$178.19
|
| Rate for Payer: BCBS Trust/PPO |
$150.85
|
| Rate for Payer: BCN Commercial |
$150.85
|
| Rate for Payer: Cash Price |
$146.96
|
| Rate for Payer: Cofinity Commercial |
$172.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.96
|
| Rate for Payer: Healthscope Commercial |
$178.19
|
| Rate for Payer: Healthscope Whirlpool |
$183.70
|
| Rate for Payer: Mclaren Commercial |
$165.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.15
|
| Rate for Payer: Nomi Health Commercial |
$150.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.66
|
|
|
HC NEG PRES WND THRPY DSG EXLGE
|
Facility
|
OP
|
$388.88
|
|
| Hospital Charge Code |
27200137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.89 |
| Max. Negotiated Rate |
$388.88 |
| Rate for Payer: Aetna Commercial |
$349.99
|
| Rate for Payer: Aetna Medicare |
$143.89
|
| Rate for Payer: ASR ASR |
$377.21
|
| Rate for Payer: BCBS Complete |
$155.55
|
| Rate for Payer: BCBS Trust/PPO |
$320.63
|
| Rate for Payer: BCN Commercial |
$320.63
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cofinity Commercial |
$365.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.10
|
| Rate for Payer: Healthscope Commercial |
$377.21
|
| Rate for Payer: Healthscope Whirlpool |
$388.88
|
| Rate for Payer: Mclaren Commercial |
$349.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.55
|
| Rate for Payer: Nomi Health Commercial |
$318.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$340.74
|
| Rate for Payer: Priority Health Narrow Network |
$272.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.21
|
|
|
HC NEG PRES WND THRPY DSG EXLGE
|
Facility
|
IP
|
$388.88
|
|
| Hospital Charge Code |
27200137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.66 |
| Max. Negotiated Rate |
$388.88 |
| Rate for Payer: Aetna Commercial |
$349.99
|
| Rate for Payer: ASR ASR |
$377.21
|
| Rate for Payer: BCBS Trust/PPO |
$319.35
|
| Rate for Payer: BCN Commercial |
$319.35
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cofinity Commercial |
$365.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.10
|
| Rate for Payer: Healthscope Commercial |
$377.21
|
| Rate for Payer: Healthscope Whirlpool |
$388.88
|
| Rate for Payer: Mclaren Commercial |
$349.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.55
|
| Rate for Payer: Nomi Health Commercial |
$318.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.21
|
|
|
HC NEG PRES WND THRPY DSG SET LAR
|
Facility
|
OP
|
$206.60
|
|
| Hospital Charge Code |
27200138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$206.60 |
| Rate for Payer: Aetna Commercial |
$185.94
|
| Rate for Payer: Aetna Medicare |
$76.44
|
| Rate for Payer: ASR ASR |
$200.40
|
| Rate for Payer: BCBS Complete |
$82.64
|
| Rate for Payer: BCBS Trust/PPO |
$170.34
|
| Rate for Payer: BCN Commercial |
$170.34
|
| Rate for Payer: Cash Price |
$165.28
|
| Rate for Payer: Cofinity Commercial |
$194.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.28
|
| Rate for Payer: Healthscope Commercial |
$200.40
|
| Rate for Payer: Healthscope Whirlpool |
$206.60
|
| Rate for Payer: Mclaren Commercial |
$185.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.61
|
| Rate for Payer: Nomi Health Commercial |
$169.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$181.02
|
| Rate for Payer: Priority Health Narrow Network |
$144.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.81
|
|
|
HC NEG PRES WND THRPY DSG SET LAR
|
Facility
|
IP
|
$206.60
|
|
| Hospital Charge Code |
27200138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.95 |
| Max. Negotiated Rate |
$206.60 |
| Rate for Payer: Aetna Commercial |
$185.94
|
| Rate for Payer: ASR ASR |
$200.40
|
| Rate for Payer: BCBS Trust/PPO |
$169.66
|
| Rate for Payer: BCN Commercial |
$169.66
|
| Rate for Payer: Cash Price |
$165.28
|
| Rate for Payer: Cofinity Commercial |
$194.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.28
|
| Rate for Payer: Healthscope Commercial |
$200.40
|
| Rate for Payer: Healthscope Whirlpool |
$206.60
|
| Rate for Payer: Mclaren Commercial |
$185.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.61
|
| Rate for Payer: Nomi Health Commercial |
$169.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.81
|
|
|
HC NEG PRES WND THRPY DSG SET MED
|
Facility
|
IP
|
$148.84
|
|
| Hospital Charge Code |
27200139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.63 |
| Max. Negotiated Rate |
$148.84 |
| Rate for Payer: Aetna Commercial |
$133.96
|
| Rate for Payer: ASR ASR |
$144.37
|
| Rate for Payer: BCBS Trust/PPO |
$122.23
|
| Rate for Payer: BCN Commercial |
$122.23
|
| Rate for Payer: Cash Price |
$119.07
|
| Rate for Payer: Cofinity Commercial |
$139.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.07
|
| Rate for Payer: Healthscope Commercial |
$144.37
|
| Rate for Payer: Healthscope Whirlpool |
$148.84
|
| Rate for Payer: Mclaren Commercial |
$133.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.51
|
| Rate for Payer: Nomi Health Commercial |
$122.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.98
|
|
|
HC NEG PRES WND THRPY DSG SET MED
|
Facility
|
OP
|
$148.84
|
|
| Hospital Charge Code |
27200139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$148.84 |
| Rate for Payer: Aetna Commercial |
$133.96
|
| Rate for Payer: Aetna Medicare |
$55.07
|
| Rate for Payer: ASR ASR |
$144.37
|
| Rate for Payer: BCBS Complete |
$59.54
|
| Rate for Payer: BCBS Trust/PPO |
$122.72
|
| Rate for Payer: BCN Commercial |
$122.72
|
| Rate for Payer: Cash Price |
$119.07
|
| Rate for Payer: Cofinity Commercial |
$139.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.07
|
| Rate for Payer: Healthscope Commercial |
$144.37
|
| Rate for Payer: Healthscope Whirlpool |
$148.84
|
| Rate for Payer: Mclaren Commercial |
$133.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.51
|
| Rate for Payer: Nomi Health Commercial |
$122.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$130.41
|
| Rate for Payer: Priority Health Narrow Network |
$104.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.98
|
|
|
HC NEG PRES WND THRPY DSG SET SIL
|
Facility
|
OP
|
$277.93
|
|
| Hospital Charge Code |
27200140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$277.93 |
| Rate for Payer: Aetna Commercial |
$250.14
|
| Rate for Payer: Aetna Medicare |
$102.83
|
| Rate for Payer: ASR ASR |
$269.59
|
| Rate for Payer: BCBS Complete |
$111.17
|
| Rate for Payer: BCBS Trust/PPO |
$229.15
|
| Rate for Payer: BCN Commercial |
$229.15
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cofinity Commercial |
$261.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Healthscope Commercial |
$269.59
|
| Rate for Payer: Healthscope Whirlpool |
$277.93
|
| Rate for Payer: Mclaren Commercial |
$250.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.24
|
| Rate for Payer: Nomi Health Commercial |
$227.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$243.52
|
| Rate for Payer: Priority Health Narrow Network |
$194.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.58
|
|
|
HC NEG PRES WND THRPY DSG SET SIL
|
Facility
|
IP
|
$277.93
|
|
| Hospital Charge Code |
27200140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.45 |
| Max. Negotiated Rate |
$277.93 |
| Rate for Payer: Aetna Commercial |
$250.14
|
| Rate for Payer: ASR ASR |
$269.59
|
| Rate for Payer: BCBS Trust/PPO |
$228.24
|
| Rate for Payer: BCN Commercial |
$228.24
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cofinity Commercial |
$261.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Healthscope Commercial |
$269.59
|
| Rate for Payer: Healthscope Whirlpool |
$277.93
|
| Rate for Payer: Mclaren Commercial |
$250.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.24
|
| Rate for Payer: Nomi Health Commercial |
$227.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.58
|
|
|
HC NEG PRES WND THRPY DSG SET SMA
|
Facility
|
OP
|
$118.31
|
|
| Hospital Charge Code |
27200141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.77 |
| Max. Negotiated Rate |
$118.31 |
| Rate for Payer: Aetna Commercial |
$106.48
|
| Rate for Payer: Aetna Medicare |
$43.77
|
| Rate for Payer: ASR ASR |
$114.76
|
| Rate for Payer: BCBS Complete |
$47.32
|
| Rate for Payer: BCBS Trust/PPO |
$97.55
|
| Rate for Payer: BCN Commercial |
$97.55
|
| Rate for Payer: Cash Price |
$94.65
|
| Rate for Payer: Cofinity Commercial |
$111.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.65
|
| Rate for Payer: Healthscope Commercial |
$114.76
|
| Rate for Payer: Healthscope Whirlpool |
$118.31
|
| Rate for Payer: Mclaren Commercial |
$106.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.56
|
| Rate for Payer: Nomi Health Commercial |
$97.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.66
|
| Rate for Payer: Priority Health Narrow Network |
$82.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.11
|
|
