|
HC WHITE HICKORY IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC WHITE PINE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC WHITE PINE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
IP
|
$892.19
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$892.19 |
| Rate for Payer: Aetna Commercial |
$802.97
|
| Rate for Payer: ASR ASR |
$865.42
|
| Rate for Payer: ASR Commercial |
$865.42
|
| Rate for Payer: BCBS Trust/PPO |
$727.05
|
| Rate for Payer: BCN Commercial |
$691.71
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cofinity Commercial |
$838.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.75
|
| Rate for Payer: Healthscope Commercial |
$892.19
|
| Rate for Payer: Healthscope Whirlpool |
$865.42
|
| Rate for Payer: Mclaren Commercial |
$802.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.36
|
| Rate for Payer: Nomi Health Commercial |
$731.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.13
|
|
|
HC WHOLE BLOOD DIRECT
|
Facility
|
OP
|
$892.19
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
39000074
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$892.19 |
| Rate for Payer: Aetna Commercial |
$802.97
|
| Rate for Payer: Aetna Medicare |
$220.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.71
|
| Rate for Payer: ASR ASR |
$865.42
|
| Rate for Payer: ASR Commercial |
$865.42
|
| Rate for Payer: BCBS Complete |
$124.14
|
| Rate for Payer: BCBS MAPPO |
$220.57
|
| Rate for Payer: BCBS Trust/PPO |
$730.61
|
| Rate for Payer: BCN Commercial |
$691.71
|
| Rate for Payer: BCN Medicare Advantage |
$220.57
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cash Price |
$713.75
|
| Rate for Payer: Cofinity Commercial |
$838.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$892.19
|
| Rate for Payer: Healthscope Whirlpool |
$865.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$220.57
|
| Rate for Payer: Mclaren Commercial |
$802.97
|
| Rate for Payer: Mclaren Medicaid |
$118.23
|
| Rate for Payer: Mclaren Medicare |
$220.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.60
|
| Rate for Payer: Meridian Medicaid |
$124.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.36
|
| Rate for Payer: Nomi Health Commercial |
$731.60
|
| Rate for Payer: PACE Medicare |
$209.54
|
| Rate for Payer: PACE SWMI |
$220.57
|
| Rate for Payer: PHP Commercial |
$242.63
|
| Rate for Payer: PHP Medicaid |
$118.23
|
| Rate for Payer: PHP Medicare Advantage |
$220.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.79
|
| Rate for Payer: Priority Health Medicare |
$220.57
|
| Rate for Payer: Priority Health Narrow Network |
$356.63
|
| Rate for Payer: Railroad Medicare Medicare |
$220.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$785.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.57
|
| Rate for Payer: UHC Exchange |
$341.88
|
| Rate for Payer: UHC Medicare Advantage |
$220.57
|
| Rate for Payer: UHCCP DNSP |
$220.57
|
| Rate for Payer: UHCCP Medicaid |
$118.23
|
| Rate for Payer: VA VA |
$220.57
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
OP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.74 |
| Max. Negotiated Rate |
$509.35 |
| Rate for Payer: Aetna Commercial |
$458.42
|
| Rate for Payer: Aetna Medicare |
$254.68
|
| Rate for Payer: ASR ASR |
$494.07
|
| Rate for Payer: ASR Commercial |
$494.07
|
| Rate for Payer: BCBS Complete |
$203.74
|
| Rate for Payer: BCBS Trust/PPO |
$417.11
|
| Rate for Payer: BCN Commercial |
$394.90
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$478.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Healthscope Commercial |
$509.35
|
| Rate for Payer: Healthscope Whirlpool |
$494.07
|
| Rate for Payer: Mclaren Commercial |
$458.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: Nomi Health Commercial |
$417.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.29
|
| Rate for Payer: Priority Health Narrow Network |
$357.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.23
|
|
|
HC WHOLEY EXCHANGE
|
Facility
|
IP
|
$509.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.08 |
| Max. Negotiated Rate |
$509.35 |
| Rate for Payer: Aetna Commercial |
$458.42
|
| Rate for Payer: ASR ASR |
$494.07
|
| Rate for Payer: ASR Commercial |
$494.07
|
| Rate for Payer: BCBS Trust/PPO |
$415.07
|
| Rate for Payer: BCN Commercial |
$394.90
|
| Rate for Payer: Cash Price |
$407.48
|
| Rate for Payer: Cofinity Commercial |
$478.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.48
|
| Rate for Payer: Healthscope Commercial |
$509.35
|
| Rate for Payer: Healthscope Whirlpool |
$494.07
|
| Rate for Payer: Mclaren Commercial |
$458.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.95
|
| Rate for Payer: Nomi Health Commercial |
$417.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.23
|
|
|
HC WILLOW IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC WILLOW IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC WMC FDG PER DOSE
|
Facility
|
OP
|
$374.82
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300026
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Aetna Commercial |
$337.34
|
| Rate for Payer: Aetna Medicare |
$187.41
|
| Rate for Payer: ASR ASR |
$363.58
|
| Rate for Payer: ASR Commercial |
$363.58
|
| Rate for Payer: BCBS Complete |
$149.93
|
| Rate for Payer: BCBS Trust/PPO |
$306.94
|
| Rate for Payer: BCN Commercial |
$290.60
|
| 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 |
$374.82
|
| Rate for Payer: Healthscope Whirlpool |
$363.58
|
| 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: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: 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 |
$243.63 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Aetna Commercial |
$337.34
|
| Rate for Payer: ASR ASR |
$363.58
|
| Rate for Payer: ASR Commercial |
$363.58
|
| Rate for Payer: BCBS Trust/PPO |
$305.44
|
| Rate for Payer: BCN Commercial |
$290.60
|
| 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 |
$374.82
|
| Rate for Payer: Healthscope Whirlpool |
$363.58
|
| 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: Priority Health Cigna Priority Health |
$243.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.84
|
|
|
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 |
$5,035.48 |
| 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: ASR Commercial |
$7,514.49
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.95
|
| 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 Commercial |
$6,584.86
|
| Rate for Payer: Nomi Health Commercial |
$6,352.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,817.27
|
|
|
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 |
$766.00 |
| Max. Negotiated Rate |
$7,746.90 |
| Rate for Payer: Aetna Commercial |
$6,972.21
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$7,514.49
|
| Rate for Payer: ASR Commercial |
$7,514.49
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$6,343.94
|
| Rate for Payer: BCN Commercial |
$6,006.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| 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 |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$7,746.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,514.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$6,972.21
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,584.86
|
| Rate for Payer: Nomi Health Commercial |
$6,352.46
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,035.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,787.83
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$5,430.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,817.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
OP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$260.48 |
| Rate for Payer: Aetna Commercial |
$234.43
|
| Rate for Payer: Aetna Medicare |
$130.24
|
| Rate for Payer: ASR ASR |
$252.67
|
| Rate for Payer: ASR Commercial |
$252.67
|
| Rate for Payer: BCBS Complete |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$213.31
|
| Rate for Payer: BCN Commercial |
$201.95
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$244.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Healthscope Commercial |
$260.48
|
| Rate for Payer: Healthscope Whirlpool |
$252.67
|
| Rate for Payer: Mclaren Commercial |
$234.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$213.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.23
|
| Rate for Payer: Priority Health Narrow Network |
$182.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.22
|
|
|
HC WORK CONDITIONING EACH ADD HR
|
Facility
|
IP
|
$260.48
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$260.48 |
| Rate for Payer: Aetna Commercial |
$234.43
|
| Rate for Payer: ASR ASR |
$252.67
|
| Rate for Payer: ASR Commercial |
$252.67
|
| Rate for Payer: BCBS Trust/PPO |
$212.27
|
| Rate for Payer: BCN Commercial |
$201.95
|
| Rate for Payer: Cash Price |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$244.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.38
|
| Rate for Payer: Healthscope Commercial |
$260.48
|
| Rate for Payer: Healthscope Whirlpool |
$252.67
|
| Rate for Payer: Mclaren Commercial |
$234.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.41
|
| Rate for Payer: Nomi Health Commercial |
$213.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.22
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
IP
|
$447.78
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$291.06 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$403.00
|
| Rate for Payer: ASR ASR |
$434.35
|
| Rate for Payer: ASR Commercial |
$434.35
|
| Rate for Payer: BCBS Trust/PPO |
$364.90
|
| Rate for Payer: BCN Commercial |
$347.16
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cofinity Commercial |
$420.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.22
|
| Rate for Payer: Healthscope Commercial |
$447.78
|
| Rate for Payer: Healthscope Whirlpool |
$434.35
|
| Rate for Payer: Mclaren Commercial |
$403.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.61
|
| Rate for Payer: Nomi Health Commercial |
$367.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.05
|
|
|
HC WORK CONDITIONING INITIAL 2 HRS
|
Facility
|
OP
|
$447.78
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$403.00
|
| Rate for Payer: Aetna Medicare |
$223.89
|
| Rate for Payer: ASR ASR |
$434.35
|
| Rate for Payer: ASR Commercial |
$434.35
|
| Rate for Payer: BCBS Complete |
$179.11
|
| Rate for Payer: BCBS Trust/PPO |
$366.69
|
| Rate for Payer: BCN Commercial |
$347.16
|
| Rate for Payer: Cash Price |
$358.22
|
| Rate for Payer: Cofinity Commercial |
$420.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.22
|
| Rate for Payer: Healthscope Commercial |
$447.78
|
| Rate for Payer: Healthscope Whirlpool |
$434.35
|
| Rate for Payer: Mclaren Commercial |
$403.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.61
|
| Rate for Payer: Nomi Health Commercial |
$367.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.34
|
| Rate for Payer: Priority Health Narrow Network |
$313.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.05
|
|
|
HC WOUND CROWN
|
Facility
|
IP
|
$240.88
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna Commercial |
$216.79
|
| Rate for Payer: ASR ASR |
$233.65
|
| Rate for Payer: ASR Commercial |
$233.65
|
| Rate for Payer: BCBS Trust/PPO |
$196.29
|
| Rate for Payer: BCN Commercial |
$186.75
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$226.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Healthscope Whirlpool |
$233.65
|
| Rate for Payer: Mclaren Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Nomi Health Commercial |
$197.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.97
|
|
|
HC WOUND CROWN
|
Facility
|
OP
|
$240.88
|
|
| Hospital Charge Code |
27000618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$240.88 |
| Rate for Payer: Aetna Commercial |
$216.79
|
| Rate for Payer: Aetna Medicare |
$120.44
|
| Rate for Payer: ASR ASR |
$233.65
|
| Rate for Payer: ASR Commercial |
$233.65
|
| Rate for Payer: BCBS Complete |
$96.35
|
| Rate for Payer: BCBS Trust/PPO |
$197.26
|
| Rate for Payer: BCN Commercial |
$186.75
|
| Rate for Payer: Cash Price |
$192.70
|
| Rate for Payer: Cofinity Commercial |
$226.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.70
|
| Rate for Payer: Healthscope Commercial |
$240.88
|
| Rate for Payer: Healthscope Whirlpool |
$233.65
|
| Rate for Payer: Mclaren Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Nomi Health Commercial |
$197.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.06
|
| Rate for Payer: Priority Health Narrow Network |
$168.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.97
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
OP
|
$1,168.27
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$467.31 |
| Max. Negotiated Rate |
$1,168.27 |
| Rate for Payer: Aetna Commercial |
$1,051.44
|
| Rate for Payer: Aetna Medicare |
$584.14
|
| Rate for Payer: ASR ASR |
$1,133.22
|
| Rate for Payer: ASR Commercial |
$1,133.22
|
| Rate for Payer: BCBS Complete |
$467.31
|
| Rate for Payer: BCBS Trust/PPO |
$956.70
|
| Rate for Payer: BCN Commercial |
$905.76
|
| Rate for Payer: Cash Price |
$934.62
|
| Rate for Payer: Cofinity Commercial |
$1,098.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.62
|
| Rate for Payer: Healthscope Commercial |
$1,168.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,133.22
|
| Rate for Payer: Mclaren Commercial |
$1,051.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.03
|
| Rate for Payer: Nomi Health Commercial |
$957.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,023.64
|
| Rate for Payer: Priority Health Narrow Network |
$818.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.08
|
|
|
HC WOUND REPAIR COMPLEX
|
Facility
|
IP
|
$1,168.27
|
|
| Hospital Charge Code |
45000076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$759.38 |
| Max. Negotiated Rate |
$1,168.27 |
| Rate for Payer: Aetna Commercial |
$1,051.44
|
| Rate for Payer: ASR ASR |
$1,133.22
|
| Rate for Payer: ASR Commercial |
$1,133.22
|
| Rate for Payer: BCBS Trust/PPO |
$952.02
|
| Rate for Payer: BCN Commercial |
$905.76
|
| Rate for Payer: Cash Price |
$934.62
|
| Rate for Payer: Cofinity Commercial |
$1,098.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$934.62
|
| Rate for Payer: Healthscope Commercial |
$1,168.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,133.22
|
| Rate for Payer: Mclaren Commercial |
$1,051.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.03
|
| Rate for Payer: Nomi Health Commercial |
$957.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.08
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
IP
|
$722.64
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.72 |
| Max. Negotiated Rate |
$722.64 |
| Rate for Payer: Aetna Commercial |
$650.38
|
| Rate for Payer: ASR ASR |
$700.96
|
| Rate for Payer: ASR Commercial |
$700.96
|
| Rate for Payer: BCBS Trust/PPO |
$588.88
|
| Rate for Payer: BCN Commercial |
$560.26
|
| Rate for Payer: Cash Price |
$578.11
|
| Rate for Payer: Cofinity Commercial |
$679.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.11
|
| Rate for Payer: Healthscope Commercial |
$722.64
|
| Rate for Payer: Healthscope Whirlpool |
$700.96
|
| Rate for Payer: Mclaren Commercial |
$650.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.24
|
| Rate for Payer: Nomi Health Commercial |
$592.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$635.92
|
|
|
HC WOUND REPAIR INTERMEDIATE
|
Facility
|
OP
|
$722.64
|
|
| Hospital Charge Code |
45000075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.06 |
| Max. Negotiated Rate |
$722.64 |
| Rate for Payer: Aetna Commercial |
$650.38
|
| Rate for Payer: Aetna Medicare |
$361.32
|
| Rate for Payer: ASR ASR |
$700.96
|
| Rate for Payer: ASR Commercial |
$700.96
|
| Rate for Payer: BCBS Complete |
$289.06
|
| Rate for Payer: BCBS Trust/PPO |
$591.77
|
| Rate for Payer: BCN Commercial |
$560.26
|
| Rate for Payer: Cash Price |
$578.11
|
| Rate for Payer: Cofinity Commercial |
$679.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.11
|
| Rate for Payer: Healthscope Commercial |
$722.64
|
| Rate for Payer: Healthscope Whirlpool |
$700.96
|
| Rate for Payer: Mclaren Commercial |
$650.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.24
|
| Rate for Payer: Nomi Health Commercial |
$592.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.18
|
| Rate for Payer: Priority Health Narrow Network |
$506.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$635.92
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
OP
|
$535.95
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.38 |
| Max. Negotiated Rate |
$535.95 |
| Rate for Payer: Aetna Commercial |
$482.36
|
| Rate for Payer: Aetna Medicare |
$267.98
|
| Rate for Payer: ASR ASR |
$519.87
|
| Rate for Payer: ASR Commercial |
$519.87
|
| Rate for Payer: BCBS Complete |
$214.38
|
| Rate for Payer: BCBS Trust/PPO |
$438.89
|
| Rate for Payer: BCN Commercial |
$415.52
|
| Rate for Payer: Cash Price |
$428.76
|
| Rate for Payer: Cofinity Commercial |
$503.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.76
|
| Rate for Payer: Healthscope Commercial |
$535.95
|
| Rate for Payer: Healthscope Whirlpool |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$482.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.56
|
| Rate for Payer: Nomi Health Commercial |
$439.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.60
|
| Rate for Payer: Priority Health Narrow Network |
$375.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.64
|
|
|
HC WOUND REPAIR SIMPLE 12.6 CM OR GREATER
|
Facility
|
IP
|
$535.95
|
|
| Hospital Charge Code |
45000074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.37 |
| Max. Negotiated Rate |
$535.95 |
| Rate for Payer: Aetna Commercial |
$482.36
|
| Rate for Payer: ASR ASR |
$519.87
|
| Rate for Payer: ASR Commercial |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$436.75
|
| Rate for Payer: BCN Commercial |
$415.52
|
| Rate for Payer: Cash Price |
$428.76
|
| Rate for Payer: Cofinity Commercial |
$503.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.76
|
| Rate for Payer: Healthscope Commercial |
$535.95
|
| Rate for Payer: Healthscope Whirlpool |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$482.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.56
|
| Rate for Payer: Nomi Health Commercial |
$439.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$471.64
|
|
