|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$760.66 |
| Max. Negotiated Rate |
$7,746.90 |
| Rate for Payer: Aetna Commercial |
$6,972.21
|
| Rate for Payer: Aetna Medicare |
$1,390.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,738.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,738.26
|
| Rate for Payer: ASR ASR |
$7,514.49
|
| Rate for Payer: BCBS Complete |
$798.77
|
| Rate for Payer: BCBS MAPPO |
$1,390.61
|
| Rate for Payer: BCBS Trust/PPO |
$6,006.17
|
| Rate for Payer: BCN Commercial |
$6,006.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,390.61
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$7,282.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,390.61
|
| Rate for Payer: Healthscope Commercial |
$7,746.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,514.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,390.61
|
| Rate for Payer: Mclaren Commercial |
$6,972.21
|
| Rate for Payer: Mclaren Medicaid |
$760.66
|
| Rate for Payer: Mclaren Medicare |
$1,390.61
|
| Rate for Payer: Meridian Medicaid |
$798.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,460.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,584.86
|
| Rate for Payer: PACE Medicare |
$1,321.08
|
| Rate for Payer: PACE SWMI |
$1,390.61
|
| Rate for Payer: PHP Commercial |
$1,529.67
|
| Rate for Payer: PHP Medicaid |
$760.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,390.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$760.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,422.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,049.68
|
| Rate for Payer: Priority Health Medicare |
$1,390.61
|
| Rate for Payer: Priority Health Narrow Network |
$5,500.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,390.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,817.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,432.33
|
| Rate for Payer: VA VA |
$1,390.61
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,746.90
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,422.83 |
| Max. Negotiated Rate |
$7,746.90 |
| Rate for Payer: Aetna Commercial |
$6,972.21
|
| Rate for Payer: ASR ASR |
$7,514.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,006.17
|
| Rate for Payer: BCN Commercial |
$6,006.17
|
| Rate for Payer: Cash Price |
$6,197.52
|
| Rate for Payer: Cofinity Commercial |
$7,282.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,197.52
|
| Rate for Payer: Healthscope Commercial |
$7,746.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,514.49
|
| Rate for Payer: Mclaren Commercial |
$6,972.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,584.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,422.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,817.27
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$255.37
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$178.76 |
| Max. Negotiated Rate |
$255.37 |
| Rate for Payer: Aetna Commercial |
$229.83
|
| Rate for Payer: ASR ASR |
$247.71
|
| Rate for Payer: BCBS Trust/PPO |
$197.99
|
| Rate for Payer: BCN Commercial |
$197.99
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Healthscope Commercial |
$255.37
|
| Rate for Payer: Healthscope Whirlpool |
$247.71
|
| Rate for Payer: Mclaren Commercial |
$229.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.73
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$255.37
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$255.37 |
| Rate for Payer: Aetna Commercial |
$229.83
|
| Rate for Payer: ASR ASR |
$247.71
|
| Rate for Payer: BCBS Complete |
$102.15
|
| Rate for Payer: BCBS Trust/PPO |
$197.99
|
| Rate for Payer: BCN Commercial |
$197.99
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.30
|
| Rate for Payer: Healthscope Commercial |
$255.37
|
| Rate for Payer: Healthscope Whirlpool |
$247.71
|
| Rate for Payer: Mclaren Commercial |
$229.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.39
|
| Rate for Payer: Priority Health Narrow Network |
$181.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.73
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$307.30 |
| Max. Negotiated Rate |
$439.00 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: ASR ASR |
$425.83
|
| Rate for Payer: BCBS Trust/PPO |
$340.36
|
| Rate for Payer: BCN Commercial |
$340.36
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$412.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.20
|
| Rate for Payer: Healthscope Commercial |
$439.00
|
| Rate for Payer: Healthscope Whirlpool |
$425.83
|
| Rate for Payer: Mclaren Commercial |
$395.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.32
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$439.00 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: ASR ASR |
$425.83
|
| Rate for Payer: BCBS Complete |
$175.60
|
| Rate for Payer: BCBS Trust/PPO |
$340.36
|
| Rate for Payer: BCN Commercial |
$340.36
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$412.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.20
|
| Rate for Payer: Healthscope Commercial |
$439.00
|
| Rate for Payer: Healthscope Whirlpool |
$425.83
|
| Rate for Payer: Mclaren Commercial |
$395.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$399.49
|
| Rate for Payer: Priority Health Narrow Network |
$311.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$386.32
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$236.16
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.31 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Aetna Commercial |
$212.54
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: BCBS Trust/PPO |
$183.09
|
| Rate for Payer: BCN Commercial |
$183.09
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$221.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$236.16
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.82
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$236.16
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Aetna Commercial |
$212.54
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS Trust/PPO |
$183.09
|
| Rate for Payer: BCN Commercial |
$183.09
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$221.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$236.16
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.91
|
| Rate for Payer: Priority Health Narrow Network |
$167.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.82
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,145.36
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$458.14 |
| Max. Negotiated Rate |
$1,145.36 |
| Rate for Payer: Aetna Commercial |
$1,030.82
|
| Rate for Payer: ASR ASR |
$1,111.00
|
| Rate for Payer: BCBS Complete |
$458.14
|
| Rate for Payer: BCBS Trust/PPO |
$888.00
|
| Rate for Payer: BCN Commercial |
$888.00
|
| Rate for Payer: Cash Price |
$916.29
|
| Rate for Payer: Cofinity Commercial |
$1,076.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.29
|
| Rate for Payer: Healthscope Commercial |
$1,145.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.00
|
| Rate for Payer: Mclaren Commercial |
$1,030.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$973.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,042.28
|
| Rate for Payer: Priority Health Narrow Network |
$813.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.92
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,145.36
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.75 |
| Max. Negotiated Rate |
$1,145.36 |
| Rate for Payer: Aetna Commercial |
$1,030.82
|
| Rate for Payer: ASR ASR |
$1,111.00
|
| Rate for Payer: BCBS Trust/PPO |
$888.00
|
| Rate for Payer: BCN Commercial |
$888.00
|
| Rate for Payer: Cash Price |
$916.29
|
| Rate for Payer: Cofinity Commercial |
$1,076.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.29
|
| Rate for Payer: Healthscope Commercial |
$1,145.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.00
|
| Rate for Payer: Mclaren Commercial |
$1,030.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$973.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.92
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$708.47
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.39 |
| Max. Negotiated Rate |
$708.47 |
| Rate for Payer: Aetna Commercial |
$637.62
|
| Rate for Payer: ASR ASR |
$687.22
|
| Rate for Payer: BCBS Complete |
$283.39
|
| Rate for Payer: BCBS Trust/PPO |
$549.28
|
| Rate for Payer: BCN Commercial |
$549.28
|
| Rate for Payer: Cash Price |
$566.78
|
| Rate for Payer: Cofinity Commercial |
$665.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.78
|
| Rate for Payer: Healthscope Commercial |
$708.47
|
| Rate for Payer: Healthscope Whirlpool |
$687.22
|
| Rate for Payer: Mclaren Commercial |
$637.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.71
|
| Rate for Payer: Priority Health Narrow Network |
$503.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$623.45
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$708.47
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$495.93 |
| Max. Negotiated Rate |
$708.47 |
| Rate for Payer: Aetna Commercial |
$637.62
|
| Rate for Payer: ASR ASR |
$687.22
|
| Rate for Payer: BCBS Trust/PPO |
$549.28
|
| Rate for Payer: BCN Commercial |
$549.28
|
| Rate for Payer: Cash Price |
$566.78
|
| Rate for Payer: Cofinity Commercial |
$665.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.78
|
| Rate for Payer: Healthscope Commercial |
$708.47
|
| Rate for Payer: Healthscope Whirlpool |
$687.22
|
| Rate for Payer: Mclaren Commercial |
$637.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$602.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$623.45
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$525.44
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.18 |
| Max. Negotiated Rate |
$525.44 |
| Rate for Payer: Aetna Commercial |
$472.90
|
| Rate for Payer: ASR ASR |
$509.68
|
| Rate for Payer: BCBS Complete |
$210.18
|
| Rate for Payer: BCBS Trust/PPO |
$407.37
|
| Rate for Payer: BCN Commercial |
$407.37
|
| Rate for Payer: Cash Price |
$420.35
|
| Rate for Payer: Cofinity Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.35
|
| Rate for Payer: Healthscope Commercial |
$525.44
|
| Rate for Payer: Healthscope Whirlpool |
$509.68
|
| Rate for Payer: Mclaren Commercial |
$472.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$478.15
|
| Rate for Payer: Priority Health Narrow Network |
$373.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.39
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$525.44
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.81 |
| Max. Negotiated Rate |
$525.44 |
| Rate for Payer: Aetna Commercial |
$472.90
|
| Rate for Payer: ASR ASR |
$509.68
|
| Rate for Payer: BCBS Trust/PPO |
$407.37
|
| Rate for Payer: BCN Commercial |
$407.37
|
| Rate for Payer: Cash Price |
$420.35
|
| Rate for Payer: Cofinity Commercial |
$493.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.35
|
| Rate for Payer: Healthscope Commercial |
$525.44
|
| Rate for Payer: Healthscope Whirlpool |
$509.68
|
| Rate for Payer: Mclaren Commercial |
$472.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$462.39
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$413.27
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.31 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: ASR ASR |
$400.87
|
| Rate for Payer: BCBS Complete |
$165.31
|
| Rate for Payer: BCBS Trust/PPO |
$320.41
|
| Rate for Payer: BCN Commercial |
$320.41
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$388.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$413.27
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Mclaren Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.08
|
| Rate for Payer: Priority Health Narrow Network |
$293.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.68
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$413.27
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.29 |
| Max. Negotiated Rate |
$413.27 |
| Rate for Payer: Aetna Commercial |
$371.94
|
| Rate for Payer: ASR ASR |
$400.87
|
| Rate for Payer: BCBS Trust/PPO |
$320.41
|
| Rate for Payer: BCN Commercial |
$320.41
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$388.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$413.27
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Mclaren Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.68
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$119.67
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.77 |
| Max. Negotiated Rate |
$119.67 |
| Rate for Payer: Aetna Commercial |
$107.70
|
| Rate for Payer: ASR ASR |
$116.08
|
| Rate for Payer: BCBS Trust/PPO |
$92.78
|
| Rate for Payer: BCN Commercial |
$92.78
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.74
|
| Rate for Payer: Healthscope Commercial |
$119.67
|
| Rate for Payer: Healthscope Whirlpool |
$116.08
|
| Rate for Payer: Mclaren Commercial |
$107.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.31
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$119.67
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$119.67 |
| Rate for Payer: Aetna Commercial |
$107.70
|
| Rate for Payer: ASR ASR |
$116.08
|
| Rate for Payer: BCBS Complete |
$47.87
|
| Rate for Payer: BCBS Trust/PPO |
$92.78
|
| Rate for Payer: BCN Commercial |
$92.78
|
| Rate for Payer: Cash Price |
$95.74
|
| Rate for Payer: Cofinity Commercial |
$112.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.74
|
| Rate for Payer: Healthscope Commercial |
$119.67
|
| Rate for Payer: Healthscope Whirlpool |
$116.08
|
| Rate for Payer: Mclaren Commercial |
$107.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.90
|
| Rate for Payer: Priority Health Narrow Network |
$84.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.31
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$245.38
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$220.84
|
| Rate for Payer: ASR ASR |
$238.02
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS Trust/PPO |
$190.24
|
| Rate for Payer: BCN Commercial |
$190.24
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$230.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Healthscope Whirlpool |
$238.02
|
| Rate for Payer: Mclaren Commercial |
$220.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.30
|
| Rate for Payer: Priority Health Narrow Network |
$174.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.93
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$245.38
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$220.84
|
| Rate for Payer: ASR ASR |
$238.02
|
| Rate for Payer: BCBS Trust/PPO |
$190.24
|
| Rate for Payer: BCN Commercial |
$190.24
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$230.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Healthscope Whirlpool |
$238.02
|
| Rate for Payer: Mclaren Commercial |
$220.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.93
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
OP
|
$6.80
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: ASR ASR |
$6.60
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.19
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.19
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$6.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.19
|
| Rate for Payer: Healthscope Commercial |
$6.80
|
| Rate for Payer: Healthscope Whirlpool |
$6.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.19
|
| Rate for Payer: Mclaren Commercial |
$6.12
|
| Rate for Payer: Mclaren Medicaid |
$2.84
|
| Rate for Payer: Mclaren Medicare |
$5.19
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.78
|
| Rate for Payer: PACE Medicare |
$4.93
|
| Rate for Payer: PACE SWMI |
$5.19
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: PHP Medicaid |
$2.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.19
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow Network |
$4.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.19
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$6.80
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Aetna Commercial |
$6.12
|
| Rate for Payer: ASR ASR |
$6.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cofinity Commercial |
$6.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$6.80
|
| Rate for Payer: Healthscope Whirlpool |
$6.60
|
| Rate for Payer: Mclaren Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.98
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
OP
|
$1,385.01
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.00 |
| Max. Negotiated Rate |
$1,385.01 |
| Rate for Payer: Aetna Commercial |
$1,246.51
|
| Rate for Payer: ASR ASR |
$1,343.46
|
| Rate for Payer: BCBS Complete |
$554.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.80
|
| Rate for Payer: BCN Commercial |
$1,073.80
|
| Rate for Payer: Cash Price |
$1,108.01
|
| Rate for Payer: Cofinity Commercial |
$1,301.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.01
|
| Rate for Payer: Healthscope Commercial |
$1,385.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.46
|
| Rate for Payer: Mclaren Commercial |
$1,246.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,260.36
|
| Rate for Payer: Priority Health Narrow Network |
$983.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,218.81
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
IP
|
$1,385.01
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$969.51 |
| Max. Negotiated Rate |
$1,385.01 |
| Rate for Payer: Aetna Commercial |
$1,246.51
|
| Rate for Payer: ASR ASR |
$1,343.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.80
|
| Rate for Payer: BCN Commercial |
$1,073.80
|
| Rate for Payer: Cash Price |
$1,108.01
|
| Rate for Payer: Cofinity Commercial |
$1,301.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.01
|
| Rate for Payer: Healthscope Commercial |
$1,385.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.46
|
| Rate for Payer: Mclaren Commercial |
$1,246.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,177.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,218.81
|
|
|
HC XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$299.88
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
32000325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.92 |
| Max. Negotiated Rate |
$299.88 |
| Rate for Payer: Aetna Commercial |
$269.89
|
| Rate for Payer: ASR ASR |
$290.88
|
| Rate for Payer: BCBS Trust/PPO |
$232.50
|
| Rate for Payer: BCN Commercial |
$232.50
|
| Rate for Payer: Cash Price |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$281.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.90
|
| Rate for Payer: Healthscope Commercial |
$299.88
|
| Rate for Payer: Healthscope Whirlpool |
$290.88
|
| Rate for Payer: Mclaren Commercial |
$269.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.89
|
|
