|
HC POUCH WOUND 1 X 1
|
Facility
|
IP
|
$31.06
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: ASR ASR |
$30.13
|
| Rate for Payer: BCBS Trust/PPO |
$25.51
|
| Rate for Payer: BCN Commercial |
$25.51
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cofinity Commercial |
$29.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.85
|
| Rate for Payer: Healthscope Commercial |
$30.13
|
| Rate for Payer: Healthscope Whirlpool |
$31.06
|
| Rate for Payer: Mclaren Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.40
|
| Rate for Payer: Nomi Health Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.33
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$40.60 |
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: Aetna Medicare |
$15.02
|
| Rate for Payer: ASR ASR |
$39.38
|
| Rate for Payer: BCBS Complete |
$16.24
|
| Rate for Payer: BCBS Trust/PPO |
$33.47
|
| Rate for Payer: BCN Commercial |
$33.47
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Healthscope Whirlpool |
$40.60
|
| Rate for Payer: Mclaren Commercial |
$36.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$33.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35.57
|
| Rate for Payer: Priority Health Narrow Network |
$28.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.73
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$40.60 |
| Rate for Payer: Aetna Commercial |
$36.54
|
| Rate for Payer: ASR ASR |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.34
|
| Rate for Payer: BCN Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.48
|
| Rate for Payer: Healthscope Commercial |
$39.38
|
| Rate for Payer: Healthscope Whirlpool |
$40.60
|
| Rate for Payer: Mclaren Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$33.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.73
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: ASR ASR |
$56.12
|
| Rate for Payer: BCBS Trust/PPO |
$47.51
|
| Rate for Payer: BCN Commercial |
$47.51
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$56.12
|
| Rate for Payer: Healthscope Whirlpool |
$57.86
|
| Rate for Payer: Mclaren Commercial |
$52.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Nomi Health Commercial |
$47.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.92
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$57.86
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: ASR ASR |
$56.12
|
| Rate for Payer: BCBS Complete |
$23.14
|
| Rate for Payer: BCBS Trust/PPO |
$47.71
|
| Rate for Payer: BCN Commercial |
$47.71
|
| Rate for Payer: Cash Price |
$46.29
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.29
|
| Rate for Payer: Healthscope Commercial |
$56.12
|
| Rate for Payer: Healthscope Whirlpool |
$57.86
|
| Rate for Payer: Mclaren Commercial |
$52.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.18
|
| Rate for Payer: Nomi Health Commercial |
$47.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50.70
|
| Rate for Payer: Priority Health Narrow Network |
$40.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.92
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$94.19
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: ASR ASR |
$101.51
|
| Rate for Payer: BCBS Complete |
$41.86
|
| Rate for Payer: BCBS Trust/PPO |
$86.28
|
| Rate for Payer: BCN Commercial |
$86.28
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Commercial |
$98.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$101.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.65
|
| Rate for Payer: Mclaren Commercial |
$94.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Nomi Health Commercial |
$85.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.69
|
| Rate for Payer: Priority Health Narrow Network |
$73.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.09
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$104.65
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.49 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$94.19
|
| Rate for Payer: ASR ASR |
$101.51
|
| Rate for Payer: BCBS Trust/PPO |
$85.94
|
| Rate for Payer: BCN Commercial |
$85.94
|
| Rate for Payer: Cash Price |
$83.72
|
| Rate for Payer: Cofinity Commercial |
$98.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.72
|
| Rate for Payer: Healthscope Commercial |
$101.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.65
|
| Rate for Payer: Mclaren Commercial |
$94.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.95
|
| Rate for Payer: Nomi Health Commercial |
$85.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.09
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: ASR ASR |
$19.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.74
|
| Rate for Payer: BCN Commercial |
$16.74
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$20.39
|
| Rate for Payer: Mclaren Commercial |
$18.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Nomi Health Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.94
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$20.39
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Aetna Commercial |
$18.35
|
| Rate for Payer: Aetna Medicare |
$7.54
|
| Rate for Payer: ASR ASR |
$19.78
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.81
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$19.78
|
| Rate for Payer: Healthscope Whirlpool |
$20.39
|
| Rate for Payer: Mclaren Commercial |
$18.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.33
|
| Rate for Payer: Nomi Health Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.87
|
| Rate for Payer: Priority Health Narrow Network |
$14.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.94
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$9.69
|
| Rate for Payer: ASR ASR |
$25.40
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$21.59
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Healthscope Whirlpool |
$26.19
|
| Rate for Payer: Mclaren Commercial |
$23.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.05
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$26.19
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: ASR ASR |
$25.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.95
|
| Rate for Payer: Healthscope Commercial |
$25.40
|
| Rate for Payer: Healthscope Whirlpool |
$26.19
|
| Rate for Payer: Mclaren Commercial |
$23.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.26
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.05
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$563.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.59 |
| Max. Negotiated Rate |
$563.75 |
| Rate for Payer: Aetna Commercial |
$507.38
|
| Rate for Payer: Aetna Medicare |
$208.59
|
| Rate for Payer: ASR ASR |
$546.84
|
| Rate for Payer: BCBS Complete |
$225.50
|
| Rate for Payer: BCBS Trust/PPO |
$464.81
|
| Rate for Payer: BCN Commercial |
$464.81
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cofinity Commercial |
$529.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.00
|
| Rate for Payer: Healthscope Commercial |
$546.84
|
| Rate for Payer: Healthscope Whirlpool |
$563.75
|
| Rate for Payer: Mclaren Commercial |
$507.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.19
|
| Rate for Payer: Nomi Health Commercial |
$462.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$493.96
|
| Rate for Payer: Priority Health Narrow Network |
$395.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.10
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$563.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.81 |
| Max. Negotiated Rate |
$563.75 |
| Rate for Payer: Aetna Commercial |
$507.38
|
| Rate for Payer: ASR ASR |
$546.84
|
| Rate for Payer: BCBS Trust/PPO |
$462.95
|
| Rate for Payer: BCN Commercial |
$462.95
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cofinity Commercial |
$529.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.00
|
| Rate for Payer: Healthscope Commercial |
$546.84
|
| Rate for Payer: Healthscope Whirlpool |
$563.75
|
| Rate for Payer: Mclaren Commercial |
$507.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.19
|
| Rate for Payer: Nomi Health Commercial |
$462.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$496.10
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: ASR ASR |
$38.30
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$37.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$38.30
|
| Rate for Payer: Healthscope Whirlpool |
$39.48
|
| Rate for Payer: Mclaren Commercial |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Nomi Health Commercial |
$32.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.74
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: ASR ASR |
$38.30
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: BCBS Trust/PPO |
$32.55
|
| Rate for Payer: BCN Commercial |
$32.55
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$37.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$38.30
|
| Rate for Payer: Healthscope Whirlpool |
$39.48
|
| Rate for Payer: Mclaren Commercial |
$35.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Nomi Health Commercial |
$32.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.59
|
| Rate for Payer: Priority Health Narrow Network |
$27.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.74
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$548.74
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.56 |
| Max. Negotiated Rate |
$548.74 |
| Rate for Payer: Aetna Commercial |
$493.87
|
| Rate for Payer: ASR ASR |
$532.28
|
| Rate for Payer: BCBS Trust/PPO |
$450.63
|
| Rate for Payer: BCN Commercial |
$450.63
|
| Rate for Payer: Cash Price |
$438.99
|
| Rate for Payer: Cofinity Commercial |
$515.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.99
|
| Rate for Payer: Healthscope Commercial |
$532.28
|
| Rate for Payer: Healthscope Whirlpool |
$548.74
|
| Rate for Payer: Mclaren Commercial |
$493.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.43
|
| Rate for Payer: Nomi Health Commercial |
$449.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.89
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$548.74
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.03 |
| Max. Negotiated Rate |
$548.74 |
| Rate for Payer: Aetna Commercial |
$493.87
|
| Rate for Payer: Aetna Medicare |
$203.03
|
| Rate for Payer: ASR ASR |
$532.28
|
| Rate for Payer: BCBS Complete |
$219.50
|
| Rate for Payer: BCBS Trust/PPO |
$452.44
|
| Rate for Payer: BCN Commercial |
$452.44
|
| Rate for Payer: Cash Price |
$438.99
|
| Rate for Payer: Cofinity Commercial |
$515.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.99
|
| Rate for Payer: Healthscope Commercial |
$532.28
|
| Rate for Payer: Healthscope Whirlpool |
$548.74
|
| Rate for Payer: Mclaren Commercial |
$493.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$438.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.43
|
| Rate for Payer: Nomi Health Commercial |
$449.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$480.81
|
| Rate for Payer: Priority Health Narrow Network |
$384.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$482.89
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$12,110.55
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,082.91 |
| Max. Negotiated Rate |
$12,110.55 |
| Rate for Payer: Aetna Commercial |
$10,899.50
|
| Rate for Payer: ASR ASR |
$11,747.23
|
| Rate for Payer: BCBS Trust/PPO |
$9,945.18
|
| Rate for Payer: BCN Commercial |
$9,945.18
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cofinity Commercial |
$11,383.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,688.44
|
| Rate for Payer: Healthscope Commercial |
$11,747.23
|
| Rate for Payer: Healthscope Whirlpool |
$12,110.55
|
| Rate for Payer: Mclaren Commercial |
$10,899.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,293.97
|
| Rate for Payer: Nomi Health Commercial |
$9,930.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,082.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,657.28
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$12,110.55
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,446.74 |
| Max. Negotiated Rate |
$16,142.34 |
| Rate for Payer: Aetna Commercial |
$10,899.50
|
| Rate for Payer: Aetna Medicare |
$10,414.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: ASR ASR |
$11,747.23
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$9,985.15
|
| Rate for Payer: BCN Commercial |
$9,985.15
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cash Price |
$9,688.44
|
| Rate for Payer: Cofinity Commercial |
$11,383.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,688.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$11,747.23
|
| Rate for Payer: Healthscope Whirlpool |
$12,110.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,414.41
|
| Rate for Payer: Mclaren Commercial |
$10,899.50
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$5,719.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,293.97
|
| Rate for Payer: Nomi Health Commercial |
$9,930.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,082.91
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$11,455.85
|
| Rate for Payer: PHP Medicaid |
$5,582.12
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,611.26
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health Narrow Network |
$8,489.50
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,657.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Exchange |
$16,142.34
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP DNSP |
$10,414.41
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: VA VA |
$10,414.41
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
OP
|
$13,713.41
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,446.74 |
| Max. Negotiated Rate |
$16,142.34 |
| Rate for Payer: Aetna Commercial |
$12,342.07
|
| Rate for Payer: Aetna Medicare |
$10,414.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,018.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,018.01
|
| Rate for Payer: ASR ASR |
$13,302.01
|
| Rate for Payer: BCBS Complete |
$5,719.59
|
| Rate for Payer: BCBS MAPPO |
$10,414.41
|
| Rate for Payer: BCBS Trust/PPO |
$11,306.71
|
| Rate for Payer: BCN Commercial |
$11,306.71
|
| Rate for Payer: BCN Medicare Advantage |
$10,414.41
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cofinity Commercial |
$12,890.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,970.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,414.41
|
| Rate for Payer: Healthscope Commercial |
$13,302.01
|
| Rate for Payer: Healthscope Whirlpool |
$13,713.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,414.41
|
| Rate for Payer: Mclaren Commercial |
$12,342.07
|
| Rate for Payer: Mclaren Medicaid |
$10,414.41
|
| Rate for Payer: Mclaren Medicare |
$10,414.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,935.13
|
| Rate for Payer: Meridian Medicaid |
$5,719.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,976.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,455.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,656.40
|
| Rate for Payer: Nomi Health Commercial |
$11,245.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,285.06
|
| Rate for Payer: PACE Medicare |
$9,893.69
|
| Rate for Payer: PACE SWMI |
$10,414.41
|
| Rate for Payer: PHP Commercial |
$11,455.85
|
| Rate for Payer: PHP Medicaid |
$5,582.12
|
| Rate for Payer: PHP Medicare Advantage |
$10,414.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,446.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,015.69
|
| Rate for Payer: Priority Health Medicare |
$10,414.41
|
| Rate for Payer: Priority Health Narrow Network |
$9,613.10
|
| Rate for Payer: Railroad Medicare Medicare |
$10,414.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,067.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,414.41
|
| Rate for Payer: UHC Exchange |
$16,142.34
|
| Rate for Payer: UHC Medicaid |
$5,446.74
|
| Rate for Payer: UHCCP DNSP |
$10,414.41
|
| Rate for Payer: UHCCP Medicaid |
$5,446.74
|
| Rate for Payer: VA VA |
$10,414.41
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$13,713.41
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,285.06 |
| Max. Negotiated Rate |
$13,713.41 |
| Rate for Payer: Aetna Commercial |
$12,342.07
|
| Rate for Payer: ASR ASR |
$13,302.01
|
| Rate for Payer: BCBS Trust/PPO |
$11,261.45
|
| Rate for Payer: BCN Commercial |
$11,261.45
|
| Rate for Payer: Cash Price |
$10,970.73
|
| Rate for Payer: Cofinity Commercial |
$12,890.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,970.73
|
| Rate for Payer: Healthscope Commercial |
$13,302.01
|
| Rate for Payer: Healthscope Whirlpool |
$13,713.41
|
| Rate for Payer: Mclaren Commercial |
$12,342.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,656.40
|
| Rate for Payer: Nomi Health Commercial |
$11,245.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,285.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,067.80
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.39
|
| Rate for Payer: BCN Commercial |
$131.39
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Medicare |
$59.20
|
| Rate for Payer: ASR ASR |
$155.20
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.92
|
| Rate for Payer: BCN Commercial |
$131.92
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$150.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$155.20
|
| Rate for Payer: Healthscope Whirlpool |
$160.00
|
| Rate for Payer: Mclaren Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.05
|
| Rate for Payer: Priority Health Narrow Network |
$54.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$335.53 |
| Max. Negotiated Rate |
$447.37 |
| Rate for Payer: Aetna Commercial |
$402.63
|
| Rate for Payer: ASR ASR |
$433.95
|
| Rate for Payer: BCBS Trust/PPO |
$367.38
|
| Rate for Payer: BCN Commercial |
$367.38
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Commercial |
$420.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Healthscope Commercial |
$433.95
|
| Rate for Payer: Healthscope Whirlpool |
$447.37
|
| Rate for Payer: Mclaren Commercial |
$402.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Nomi Health Commercial |
$366.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.69
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
OP
|
$447.37
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$447.37 |
| Rate for Payer: Aetna Commercial |
$402.63
|
| Rate for Payer: Aetna Medicare |
$51.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.84
|
| Rate for Payer: ASR ASR |
$433.95
|
| Rate for Payer: BCBS Complete |
$28.05
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$368.86
|
| Rate for Payer: BCN Commercial |
$368.86
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Commercial |
$420.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$433.95
|
| Rate for Payer: Healthscope Whirlpool |
$447.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.07
|
| Rate for Payer: Mclaren Commercial |
$402.63
|
| Rate for Payer: Mclaren Medicaid |
$51.07
|
| Rate for Payer: Mclaren Medicare |
$51.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Meridian Medicaid |
$28.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Nomi Health Commercial |
$366.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PACE Medicare |
$48.52
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: PHP Medicaid |
$27.37
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.76
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health Narrow Network |
$54.21
|
| Rate for Payer: Railroad Medicare Medicare |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.07
|
| Rate for Payer: UHC Exchange |
$79.16
|
| Rate for Payer: UHC Medicaid |
$26.71
|
| Rate for Payer: UHCCP DNSP |
$51.07
|
| Rate for Payer: UHCCP Medicaid |
$26.71
|
| Rate for Payer: VA VA |
$51.07
|
|
