|
HC WHITE FACED HORNET IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200107
|
|
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 WHITE FACED HORNET IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200107
|
|
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 WHITE HICKORY IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
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 WHITE HICKORY IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
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 WHITE PINE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
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 WHITE PINE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
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 WHOLE BLOOD DIRECT
|
Facility
|
OP
|
$910.03
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$910.03 |
| Rate for Payer: Aetna Commercial |
$819.03
|
| Rate for Payer: Aetna Medicare |
$185.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.44
|
| Rate for Payer: ASR ASR |
$882.73
|
| Rate for Payer: BCBS Complete |
$101.68
|
| Rate for Payer: BCBS MAPPO |
$185.15
|
| Rate for Payer: BCBS Trust/PPO |
$750.32
|
| Rate for Payer: BCN Commercial |
$750.32
|
| Rate for Payer: BCN Medicare Advantage |
$185.15
|
| Rate for Payer: Cash Price |
$728.02
|
| Rate for Payer: Cash Price |
$728.02
|
| Rate for Payer: Cofinity Commercial |
$855.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.15
|
| Rate for Payer: Healthscope Commercial |
$882.73
|
| Rate for Payer: Healthscope Whirlpool |
$910.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$185.15
|
| Rate for Payer: Mclaren Commercial |
$819.03
|
| Rate for Payer: Mclaren Medicaid |
$185.15
|
| Rate for Payer: Mclaren Medicare |
$185.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.41
|
| Rate for Payer: Meridian Medicaid |
$101.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$773.53
|
| Rate for Payer: Nomi Health Commercial |
$746.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$682.52
|
| Rate for Payer: PACE Medicare |
$175.89
|
| Rate for Payer: PACE SWMI |
$185.15
|
| Rate for Payer: PHP Commercial |
$203.66
|
| Rate for Payer: PHP Medicaid |
$99.24
|
| Rate for Payer: PHP Medicare Advantage |
$185.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$491.48
|
| Rate for Payer: Priority Health Medicare |
$185.15
|
| Rate for Payer: Priority Health Narrow Network |
$393.19
|
| Rate for Payer: Railroad Medicare Medicare |
$185.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.15
|
| Rate for Payer: UHC Exchange |
$286.98
|
| Rate for Payer: UHC Medicaid |
$96.83
|
| Rate for Payer: UHCCP DNSP |
$185.15
|
| Rate for Payer: UHCCP Medicaid |
$96.83
|
| Rate for Payer: VA VA |
$185.15
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
IP
|
$910.03
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$682.52 |
| Max. Negotiated Rate |
$910.03 |
| Rate for Payer: Aetna Commercial |
$819.03
|
| Rate for Payer: ASR ASR |
$882.73
|
| Rate for Payer: BCBS Trust/PPO |
$747.32
|
| Rate for Payer: BCN Commercial |
$747.32
|
| Rate for Payer: Cash Price |
$728.02
|
| Rate for Payer: Cofinity Commercial |
$855.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.02
|
| Rate for Payer: Healthscope Commercial |
$882.73
|
| Rate for Payer: Healthscope Whirlpool |
$910.03
|
| Rate for Payer: Mclaren Commercial |
$819.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$773.53
|
| Rate for Payer: Nomi Health Commercial |
$746.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$682.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.83
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
IP
|
$519.54
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.65 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$467.59
|
| Rate for Payer: ASR ASR |
$503.95
|
| Rate for Payer: BCBS Trust/PPO |
$426.65
|
| Rate for Payer: BCN Commercial |
$426.65
|
| Rate for Payer: Cash Price |
$415.63
|
| Rate for Payer: Cofinity Commercial |
$488.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.63
|
| Rate for Payer: Healthscope Commercial |
$503.95
|
| Rate for Payer: Healthscope Whirlpool |
$519.54
|
| Rate for Payer: Mclaren Commercial |
$467.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.61
|
| Rate for Payer: Nomi Health Commercial |
$426.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.20
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
OP
|
$519.54
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.23 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$467.59
|
| Rate for Payer: Aetna Medicare |
$192.23
|
| Rate for Payer: ASR ASR |
$503.95
|
| Rate for Payer: BCBS Complete |
$207.82
|
| Rate for Payer: BCBS Trust/PPO |
$428.36
|
| Rate for Payer: BCN Commercial |
$428.36
|
| Rate for Payer: Cash Price |
$415.63
|
| Rate for Payer: Cofinity Commercial |
$488.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.63
|
| Rate for Payer: Healthscope Commercial |
$503.95
|
| Rate for Payer: Healthscope Whirlpool |
$519.54
|
| Rate for Payer: Mclaren Commercial |
$467.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.61
|
| Rate for Payer: Nomi Health Commercial |
$426.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$455.22
|
| Rate for Payer: Priority Health Narrow Network |
$364.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$457.20
|
|
|
HC WILLOW IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
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 WILLOW IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
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 WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Aetna Commercial |
$337.34
|
| Rate for Payer: Aetna Medicare |
$138.68
|
| Rate for Payer: ASR ASR |
$363.58
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: BCBS Trust/PPO |
$309.04
|
| Rate for Payer: BCN Commercial |
$309.04
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$352.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Healthscope Commercial |
$363.58
|
| Rate for Payer: Healthscope Whirlpool |
$374.82
|
| Rate for Payer: Mclaren Commercial |
$337.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$321.26
|
| Rate for Payer: Priority Health Narrow Network |
$257.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.84
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
IP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$281.12 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Aetna Commercial |
$337.34
|
| Rate for Payer: ASR ASR |
$363.58
|
| Rate for Payer: BCBS Trust/PPO |
$307.80
|
| Rate for Payer: BCN Commercial |
$307.80
|
| Rate for Payer: Cash Price |
$299.86
|
| Rate for Payer: Cofinity Commercial |
$352.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.86
|
| Rate for Payer: Healthscope Commercial |
$363.58
|
| Rate for Payer: Healthscope Whirlpool |
$374.82
|
| Rate for Payer: Mclaren Commercial |
$337.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.60
|
| Rate for Payer: Nomi Health Commercial |
$307.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.84
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
IP
|
$7,901.84
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,926.38 |
| Max. Negotiated Rate |
$7,901.84 |
| Rate for Payer: Aetna Commercial |
$7,111.66
|
| Rate for Payer: ASR ASR |
$7,664.78
|
| Rate for Payer: BCBS Trust/PPO |
$6,488.99
|
| Rate for Payer: BCN Commercial |
$6,488.99
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cofinity Commercial |
$7,427.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,321.47
|
| Rate for Payer: Healthscope Commercial |
$7,664.78
|
| Rate for Payer: Healthscope Whirlpool |
$7,901.84
|
| Rate for Payer: Mclaren Commercial |
$7,111.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,716.56
|
| Rate for Payer: Nomi Health Commercial |
$6,479.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,926.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,953.62
|
|
|
HC WMC PET SKULL TO THIGH
|
Facility
|
OP
|
$7,901.84
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400006
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$7,901.84 |
| Rate for Payer: Aetna Commercial |
$7,111.66
|
| Rate for Payer: Aetna Medicare |
$1,424.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: ASR ASR |
$7,664.78
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$6,515.07
|
| Rate for Payer: BCN Commercial |
$6,515.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cash Price |
$6,321.47
|
| Rate for Payer: Cofinity Commercial |
$7,427.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,321.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$7,664.78
|
| Rate for Payer: Healthscope Whirlpool |
$7,901.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$7,111.66
|
| Rate for Payer: Mclaren Medicaid |
$1,424.81
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$782.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,716.56
|
| Rate for Payer: Nomi Health Commercial |
$6,479.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,926.38
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$1,567.29
|
| Rate for Payer: PHP Medicaid |
$763.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,923.59
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$5,539.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,953.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,208.46
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP DNSP |
$1,424.81
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$265.69
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$265.69 |
| Rate for Payer: Aetna Commercial |
$239.12
|
| Rate for Payer: ASR ASR |
$257.72
|
| Rate for Payer: BCBS Trust/PPO |
$218.18
|
| Rate for Payer: BCN Commercial |
$218.18
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cofinity Commercial |
$249.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$257.72
|
| Rate for Payer: Healthscope Whirlpool |
$265.69
|
| Rate for Payer: Mclaren Commercial |
$239.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.84
|
| Rate for Payer: Nomi Health Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.81
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$265.69
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$98.31 |
| Max. Negotiated Rate |
$265.69 |
| Rate for Payer: Aetna Commercial |
$239.12
|
| Rate for Payer: Aetna Medicare |
$98.31
|
| Rate for Payer: ASR ASR |
$257.72
|
| Rate for Payer: BCBS Complete |
$106.28
|
| Rate for Payer: BCBS Trust/PPO |
$219.06
|
| Rate for Payer: BCN Commercial |
$219.06
|
| Rate for Payer: Cash Price |
$212.55
|
| Rate for Payer: Cofinity Commercial |
$249.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.55
|
| Rate for Payer: Healthscope Commercial |
$257.72
|
| Rate for Payer: Healthscope Whirlpool |
$265.69
|
| Rate for Payer: Mclaren Commercial |
$239.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.84
|
| Rate for Payer: Nomi Health Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.80
|
| Rate for Payer: Priority Health Narrow Network |
$186.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.81
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$456.74
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$168.99 |
| Max. Negotiated Rate |
$456.74 |
| Rate for Payer: Aetna Commercial |
$411.07
|
| Rate for Payer: Aetna Medicare |
$168.99
|
| Rate for Payer: ASR ASR |
$443.04
|
| Rate for Payer: BCBS Complete |
$182.70
|
| Rate for Payer: BCBS Trust/PPO |
$376.58
|
| Rate for Payer: BCN Commercial |
$376.58
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cofinity Commercial |
$429.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.39
|
| Rate for Payer: Healthscope Commercial |
$443.04
|
| Rate for Payer: Healthscope Whirlpool |
$456.74
|
| Rate for Payer: Mclaren Commercial |
$411.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.23
|
| Rate for Payer: Nomi Health Commercial |
$374.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$400.20
|
| Rate for Payer: Priority Health Narrow Network |
$320.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.93
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$456.74
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$342.56 |
| Max. Negotiated Rate |
$456.74 |
| Rate for Payer: Aetna Commercial |
$411.07
|
| Rate for Payer: ASR ASR |
$443.04
|
| Rate for Payer: BCBS Trust/PPO |
$375.07
|
| Rate for Payer: BCN Commercial |
$375.07
|
| Rate for Payer: Cash Price |
$365.39
|
| Rate for Payer: Cofinity Commercial |
$429.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.39
|
| Rate for Payer: Healthscope Commercial |
$443.04
|
| Rate for Payer: Healthscope Whirlpool |
$456.74
|
| Rate for Payer: Mclaren Commercial |
$411.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.23
|
| Rate for Payer: Nomi Health Commercial |
$374.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.93
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$245.70
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.91 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna Commercial |
$221.13
|
| Rate for Payer: Aetna Medicare |
$90.91
|
| Rate for Payer: ASR ASR |
$238.33
|
| Rate for Payer: BCBS Complete |
$98.28
|
| Rate for Payer: BCBS Trust/PPO |
$202.58
|
| Rate for Payer: BCN Commercial |
$202.58
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$230.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$238.33
|
| Rate for Payer: Healthscope Whirlpool |
$245.70
|
| Rate for Payer: Mclaren Commercial |
$221.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$215.28
|
| Rate for Payer: Priority Health Narrow Network |
$172.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.22
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$245.70
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna Commercial |
$221.13
|
| Rate for Payer: ASR ASR |
$238.33
|
| Rate for Payer: BCBS Trust/PPO |
$201.77
|
| Rate for Payer: BCN Commercial |
$201.77
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$230.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$238.33
|
| Rate for Payer: Healthscope Whirlpool |
$245.70
|
| Rate for Payer: Mclaren Commercial |
$221.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.22
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,191.64
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.91 |
| Max. Negotiated Rate |
$1,191.64 |
| Rate for Payer: Aetna Commercial |
$1,072.48
|
| Rate for Payer: Aetna Medicare |
$440.91
|
| Rate for Payer: ASR ASR |
$1,155.89
|
| Rate for Payer: BCBS Complete |
$476.66
|
| Rate for Payer: BCBS Trust/PPO |
$982.51
|
| Rate for Payer: BCN Commercial |
$982.51
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cofinity Commercial |
$1,120.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.31
|
| Rate for Payer: Healthscope Commercial |
$1,155.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,191.64
|
| Rate for Payer: Mclaren Commercial |
$1,072.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$953.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.89
|
| Rate for Payer: Nomi Health Commercial |
$977.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,044.11
|
| Rate for Payer: Priority Health Narrow Network |
$835.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,048.64
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,191.64
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$893.73 |
| Max. Negotiated Rate |
$1,191.64 |
| Rate for Payer: Aetna Commercial |
$1,072.48
|
| Rate for Payer: ASR ASR |
$1,155.89
|
| Rate for Payer: BCBS Trust/PPO |
$978.57
|
| Rate for Payer: BCN Commercial |
$978.57
|
| Rate for Payer: Cash Price |
$953.31
|
| Rate for Payer: Cofinity Commercial |
$1,120.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.31
|
| Rate for Payer: Healthscope Commercial |
$1,155.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,191.64
|
| Rate for Payer: Mclaren Commercial |
$1,072.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.89
|
| Rate for Payer: Nomi Health Commercial |
$977.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,048.64
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$737.09
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.72 |
| Max. Negotiated Rate |
$737.09 |
| Rate for Payer: Aetna Commercial |
$663.38
|
| Rate for Payer: Aetna Medicare |
$272.72
|
| Rate for Payer: ASR ASR |
$714.98
|
| Rate for Payer: BCBS Complete |
$294.84
|
| Rate for Payer: BCBS Trust/PPO |
$607.73
|
| Rate for Payer: BCN Commercial |
$607.73
|
| Rate for Payer: Cash Price |
$589.67
|
| Rate for Payer: Cofinity Commercial |
$692.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.67
|
| Rate for Payer: Healthscope Commercial |
$714.98
|
| Rate for Payer: Healthscope Whirlpool |
$737.09
|
| Rate for Payer: Mclaren Commercial |
$663.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$589.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.53
|
| Rate for Payer: Nomi Health Commercial |
$604.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$645.84
|
| Rate for Payer: Priority Health Narrow Network |
$516.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.64
|
|
