|
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: 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 |
$328.42
|
| Rate for Payer: Priority Health Narrow Network |
$262.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.84
|
|
|
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 |
$762.48 |
| Max. Negotiated Rate |
$7,746.90 |
| Rate for Payer: Aetna Commercial |
$6,972.21
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$7,514.49
|
| Rate for Payer: ASR Commercial |
$7,514.49
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$6,343.94
|
| Rate for Payer: BCN Commercial |
$6,006.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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 |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$7,746.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,514.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$6,972.21
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| 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 |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| 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 |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$5,430.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,817.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
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 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
|
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 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 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 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 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 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 |
$584.13
|
| 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 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
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
OP
|
$421.54
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.62 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Medicare |
$210.77
|
| Rate for Payer: ASR ASR |
$408.89
|
| Rate for Payer: ASR Commercial |
$408.89
|
| Rate for Payer: BCBS Complete |
$168.62
|
| Rate for Payer: BCBS Trust/PPO |
$345.20
|
| Rate for Payer: BCN Commercial |
$326.82
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$396.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$421.54
|
| Rate for Payer: Healthscope Whirlpool |
$408.89
|
| Rate for Payer: Mclaren Commercial |
$379.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.35
|
| Rate for Payer: Priority Health Narrow Network |
$295.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.96
|
|
|
HC WOUND REPAIR SIMPLE UP TO 12.5 CM
|
Facility
|
IP
|
$421.54
|
|
| Hospital Charge Code |
45000073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$421.54 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: ASR ASR |
$408.89
|
| Rate for Payer: ASR Commercial |
$408.89
|
| Rate for Payer: BCBS Trust/PPO |
$343.51
|
| Rate for Payer: BCN Commercial |
$326.82
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$396.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$421.54
|
| Rate for Payer: Healthscope Whirlpool |
$408.89
|
| Rate for Payer: Mclaren Commercial |
$379.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.96
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
OP
|
$122.06
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$109.85
|
| Rate for Payer: Aetna Medicare |
$61.03
|
| Rate for Payer: ASR ASR |
$118.40
|
| Rate for Payer: ASR Commercial |
$118.40
|
| Rate for Payer: BCBS Complete |
$48.82
|
| Rate for Payer: BCBS Trust/PPO |
$99.95
|
| Rate for Payer: BCN Commercial |
$94.63
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$114.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.65
|
| Rate for Payer: Healthscope Commercial |
$122.06
|
| Rate for Payer: Healthscope Whirlpool |
$118.40
|
| Rate for Payer: Mclaren Commercial |
$109.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.75
|
| Rate for Payer: Nomi Health Commercial |
$100.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.95
|
| Rate for Payer: Priority Health Narrow Network |
$85.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.41
|
|
|
HC WRIST-HAND ORTHOSIS
|
Facility
|
IP
|
$122.06
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
27400016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.34 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: Aetna Commercial |
$109.85
|
| Rate for Payer: ASR ASR |
$118.40
|
| Rate for Payer: ASR Commercial |
$118.40
|
| Rate for Payer: BCBS Trust/PPO |
$99.47
|
| Rate for Payer: BCN Commercial |
$94.63
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$114.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.65
|
| Rate for Payer: Healthscope Commercial |
$122.06
|
| Rate for Payer: Healthscope Whirlpool |
$118.40
|
| Rate for Payer: Mclaren Commercial |
$109.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.75
|
| Rate for Payer: Nomi Health Commercial |
$100.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.41
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
OP
|
$250.29
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$250.29 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: ASR ASR |
$242.78
|
| Rate for Payer: ASR Commercial |
$242.78
|
| Rate for Payer: BCBS Complete |
$100.12
|
| Rate for Payer: BCBS Trust/PPO |
$204.96
|
| Rate for Payer: BCN Commercial |
$194.05
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$235.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$250.29
|
| Rate for Payer: Healthscope Whirlpool |
$242.78
|
| Rate for Payer: Mclaren Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.30
|
| Rate for Payer: Priority Health Narrow Network |
$175.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.26
|
|
|
HC XENON 133 PER 10 MCI
|
Facility
|
IP
|
$250.29
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
34300024
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$250.29 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: ASR ASR |
$242.78
|
| Rate for Payer: ASR Commercial |
$242.78
|
| Rate for Payer: BCBS Trust/PPO |
$203.96
|
| Rate for Payer: BCN Commercial |
$194.05
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$235.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$250.29
|
| Rate for Payer: Healthscope Whirlpool |
$242.78
|
| Rate for Payer: Mclaren Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.26
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
IP
|
$6.94
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Aetna Commercial |
$6.25
|
| Rate for Payer: ASR ASR |
$6.73
|
| Rate for Payer: ASR Commercial |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$5.66
|
| Rate for Payer: BCN Commercial |
$5.38
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.55
|
| Rate for Payer: Healthscope Commercial |
$6.94
|
| Rate for Payer: Healthscope Whirlpool |
$6.73
|
| Rate for Payer: Mclaren Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.90
|
| Rate for Payer: Nomi Health Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.11
|
|
|
HC XEOMIN PER 1 UNIT (INCOBOTULINUMTOXINA)
|
Facility
|
OP
|
$6.94
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$6.25
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: ASR ASR |
$6.73
|
| Rate for Payer: ASR Commercial |
$6.73
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.68
|
| Rate for Payer: BCN Commercial |
$5.38
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$6.94
|
| Rate for Payer: Healthscope Whirlpool |
$6.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$6.25
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicare |
$5.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.90
|
| Rate for Payer: Nomi Health Commercial |
$5.69
|
| Rate for Payer: PACE Medicare |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$6.13
|
| Rate for Payer: PHP Medicaid |
$2.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.08
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.86
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$8.63
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP DNSP |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: VA VA |
$5.57
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
OP
|
$1,412.71
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.08 |
| Max. Negotiated Rate |
$1,412.71 |
| Rate for Payer: Aetna Commercial |
$1,271.44
|
| Rate for Payer: Aetna Medicare |
$706.36
|
| Rate for Payer: ASR ASR |
$1,370.33
|
| Rate for Payer: ASR Commercial |
$1,370.33
|
| Rate for Payer: BCBS Complete |
$565.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.87
|
| Rate for Payer: BCN Commercial |
$1,095.27
|
| Rate for Payer: Cash Price |
$1,130.17
|
| Rate for Payer: Cofinity Commercial |
$1,327.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.17
|
| Rate for Payer: Healthscope Commercial |
$1,412.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.33
|
| Rate for Payer: Mclaren Commercial |
$1,271.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.80
|
| Rate for Payer: Nomi Health Commercial |
$1,158.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,237.82
|
| Rate for Payer: Priority Health Narrow Network |
$990.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.18
|
|
|
HC XPRESS-WAY CATHETER
|
Facility
|
IP
|
$1,412.71
|
|
| Hospital Charge Code |
27200226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$918.26 |
| Max. Negotiated Rate |
$1,412.71 |
| Rate for Payer: Aetna Commercial |
$1,271.44
|
| Rate for Payer: ASR ASR |
$1,370.33
|
| Rate for Payer: ASR Commercial |
$1,370.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.22
|
| Rate for Payer: BCN Commercial |
$1,095.27
|
| Rate for Payer: Cash Price |
$1,130.17
|
| Rate for Payer: Cofinity Commercial |
$1,327.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,130.17
|
| Rate for Payer: Healthscope Commercial |
$1,412.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,370.33
|
| Rate for Payer: Mclaren Commercial |
$1,271.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.80
|
| Rate for Payer: Nomi Health Commercial |
$1,158.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$918.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,243.18
|
|
