|
HC ART CATH INSERT
|
Facility
|
OP
|
$452.71
|
|
| Hospital Charge Code |
45000029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.08 |
| Max. Negotiated Rate |
$407.44 |
| Rate for Payer: Aetna Commercial |
$384.80
|
| Rate for Payer: Aetna Medicare |
$226.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.26
|
| Rate for Payer: BCBS Complete |
$181.08
|
| Rate for Payer: Cash Price |
$362.17
|
| Rate for Payer: Cofinity Commercial |
$316.90
|
| Rate for Payer: Cofinity Commercial |
$389.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.17
|
| Rate for Payer: Healthscope Commercial |
$407.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.80
|
| Rate for Payer: PHP Commercial |
$384.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.26
|
| Rate for Payer: Priority Health SBD |
$285.21
|
|
|
HC ARTERIAL DUPLEX IMAG BIL LOWER EXTREMITY
|
Facility
|
OP
|
$1,588.11
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,429.30 |
| Rate for Payer: Aetna Commercial |
$1,349.89
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,032.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$900.76
|
| Rate for Payer: BCN Commercial |
$900.76
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,270.49
|
| Rate for Payer: Cash Price |
$1,270.49
|
| Rate for Payer: Cofinity Commercial |
$1,365.77
|
| Rate for Payer: Cofinity Commercial |
$1,111.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,111.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,270.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,429.30
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,349.89
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,349.89
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,000.51
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,175.20
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC ARTERIAL DUPLEX IMAG BIL LOWER EXTREMITY
|
Facility
|
IP
|
$1,588.11
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,000.51 |
| Max. Negotiated Rate |
$1,429.30 |
| Rate for Payer: Aetna Commercial |
$1,349.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,032.27
|
| Rate for Payer: Cash Price |
$1,270.49
|
| Rate for Payer: Cofinity Commercial |
$1,111.68
|
| Rate for Payer: Cofinity Commercial |
$1,365.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,111.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,270.49
|
| Rate for Payer: Healthscope Commercial |
$1,429.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,349.89
|
| Rate for Payer: PHP Commercial |
$1,349.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.27
|
| Rate for Payer: Priority Health SBD |
$1,000.51
|
|
|
HC ARTERIAL DUPLEX IMAG BIL UPPER EXTREMITY
|
Facility
|
IP
|
$1,308.89
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$1,178.00 |
| Rate for Payer: Aetna Commercial |
$1,112.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.78
|
| Rate for Payer: Cash Price |
$1,047.11
|
| Rate for Payer: Cofinity Commercial |
$1,125.65
|
| Rate for Payer: Cofinity Commercial |
$916.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$916.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.11
|
| Rate for Payer: Healthscope Commercial |
$1,178.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.56
|
| Rate for Payer: PHP Commercial |
$1,112.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.78
|
| Rate for Payer: Priority Health SBD |
$824.60
|
|
|
HC ARTERIAL DUPLEX IMAG BIL UPPER EXTREMITY
|
Facility
|
OP
|
$1,308.89
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,178.00 |
| Rate for Payer: Aetna Commercial |
$1,112.56
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$711.73
|
| Rate for Payer: BCN Commercial |
$711.73
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,047.11
|
| Rate for Payer: Cash Price |
$1,047.11
|
| Rate for Payer: Cofinity Commercial |
$916.22
|
| Rate for Payer: Cofinity Commercial |
$1,125.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$916.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,178.00
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.56
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,112.56
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$824.60
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$968.58
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC ARTERIAL PUNCTURE
|
Facility
|
IP
|
$132.01
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
36100442
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.17 |
| Max. Negotiated Rate |
$118.81 |
| Rate for Payer: Aetna Commercial |
$112.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.81
|
| Rate for Payer: Cash Price |
$105.61
|
| Rate for Payer: Cofinity Commercial |
$113.53
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.61
|
| Rate for Payer: Healthscope Commercial |
$118.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.21
|
| Rate for Payer: PHP Commercial |
$112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.81
|
| Rate for Payer: Priority Health SBD |
$83.17
|
|
|
HC ARTERIAL PUNCTURE
|
Facility
|
OP
|
$132.01
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
36100442
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$112.21
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$74.74
|
| Rate for Payer: BCN Commercial |
$74.74
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$105.61
|
| Rate for Payer: Cash Price |
$105.61
|
| Rate for Payer: Cash Price |
$105.61
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Cofinity Commercial |
$113.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$118.81
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.21
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$112.21
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$83.17
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.65
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC ARTERIAL TRANSCATH THROMBOLYSIS
|
Facility
|
IP
|
$5,108.99
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
36100371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,218.66 |
| Max. Negotiated Rate |
$4,598.09 |
| Rate for Payer: Aetna Commercial |
$4,342.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,320.84
|
| Rate for Payer: Cash Price |
$4,087.19
|
| Rate for Payer: Cofinity Commercial |
$3,576.29
|
| Rate for Payer: Cofinity Commercial |
$4,393.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,576.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,087.19
|
| Rate for Payer: Healthscope Commercial |
$4,598.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,342.64
|
| Rate for Payer: PHP Commercial |
$4,342.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,320.84
|
| Rate for Payer: Priority Health SBD |
$3,218.66
|
|
|
HC ARTERIAL TRANSCATH THROMBOLYSIS
|
Facility
|
OP
|
$5,108.99
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
36100371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.85 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Commercial |
$4,342.64
|
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,320.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.57
|
| Rate for Payer: BCN Commercial |
$1,895.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Cash Price |
$4,087.19
|
| Rate for Payer: Cash Price |
$4,087.19
|
| Rate for Payer: Cash Price |
$4,087.19
|
| Rate for Payer: Cofinity Commercial |
$3,576.29
|
| Rate for Payer: Cofinity Commercial |
$4,393.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,576.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,087.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$4,598.09
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,342.64
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$4,342.64
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,320.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Priority Health SBD |
$3,218.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.85
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,981.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
HC ART FLOW LOWER COMPLETE
|
Facility
|
OP
|
$863.96
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$777.56 |
| Rate for Payer: Aetna Commercial |
$734.37
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$482.86
|
| Rate for Payer: BCN Commercial |
$482.86
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$691.17
|
| Rate for Payer: Cash Price |
$691.17
|
| Rate for Payer: Cofinity Commercial |
$743.01
|
| Rate for Payer: Cofinity Commercial |
$604.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$777.56
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.37
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$734.37
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$544.29
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$639.33
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC ART FLOW LOWER COMPLETE
|
Facility
|
IP
|
$863.96
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100030
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$544.29 |
| Max. Negotiated Rate |
$777.56 |
| Rate for Payer: Aetna Commercial |
$734.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.57
|
| Rate for Payer: Cash Price |
$691.17
|
| Rate for Payer: Cofinity Commercial |
$604.77
|
| Rate for Payer: Cofinity Commercial |
$743.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.17
|
| Rate for Payer: Healthscope Commercial |
$777.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.37
|
| Rate for Payer: PHP Commercial |
$734.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.57
|
| Rate for Payer: Priority Health SBD |
$544.29
|
|
|
HC ART FLOW LOWER LIMITED
|
Facility
|
IP
|
$724.60
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$456.50 |
| Max. Negotiated Rate |
$652.14 |
| Rate for Payer: Aetna Commercial |
$615.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.99
|
| Rate for Payer: Cash Price |
$579.68
|
| Rate for Payer: Cofinity Commercial |
$507.22
|
| Rate for Payer: Cofinity Commercial |
$623.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$507.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.68
|
| Rate for Payer: Healthscope Commercial |
$652.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.91
|
| Rate for Payer: PHP Commercial |
$615.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.99
|
| Rate for Payer: Priority Health SBD |
$456.50
|
|
|
HC ART FLOW LOWER LIMITED
|
Facility
|
OP
|
$724.60
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$652.14 |
| Rate for Payer: Aetna Commercial |
$615.91
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$313.04
|
| Rate for Payer: BCN Commercial |
$313.04
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$579.68
|
| Rate for Payer: Cash Price |
$579.68
|
| Rate for Payer: Cofinity Commercial |
$623.16
|
| Rate for Payer: Cofinity Commercial |
$507.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$507.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$652.14
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$615.91
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$615.91
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$456.50
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$536.20
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC ART FLOW UPPER COMPLETE
|
Facility
|
IP
|
$942.50
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100018
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$593.78 |
| Max. Negotiated Rate |
$848.25 |
| Rate for Payer: Aetna Commercial |
$801.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.62
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cofinity Commercial |
$659.75
|
| Rate for Payer: Cofinity Commercial |
$810.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$659.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.00
|
| Rate for Payer: Healthscope Commercial |
$848.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.12
|
| Rate for Payer: PHP Commercial |
$801.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.62
|
| Rate for Payer: Priority Health SBD |
$593.78
|
|
|
HC ART FLOW UPPER COMPLETE
|
Facility
|
OP
|
$942.50
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100018
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$848.25 |
| Rate for Payer: Aetna Commercial |
$801.12
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$482.86
|
| Rate for Payer: BCN Commercial |
$482.86
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cofinity Commercial |
$810.55
|
| Rate for Payer: Cofinity Commercial |
$659.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$659.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$754.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$848.25
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$801.12
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$801.12
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$593.78
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$697.45
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC ART FLOW UPPER LIMITED
|
Facility
|
OP
|
$790.47
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100031
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$711.42 |
| Rate for Payer: Aetna Commercial |
$671.90
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$313.04
|
| Rate for Payer: BCN Commercial |
$313.04
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$632.38
|
| Rate for Payer: Cash Price |
$632.38
|
| Rate for Payer: Cofinity Commercial |
$679.80
|
| Rate for Payer: Cofinity Commercial |
$553.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$711.42
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.90
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$671.90
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$498.00
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$584.95
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC ART FLOW UPPER LIMITED
|
Facility
|
IP
|
$790.47
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100031
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$498.00 |
| Max. Negotiated Rate |
$711.42 |
| Rate for Payer: Aetna Commercial |
$671.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.81
|
| Rate for Payer: Cash Price |
$632.38
|
| Rate for Payer: Cofinity Commercial |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$679.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.38
|
| Rate for Payer: Healthscope Commercial |
$711.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.90
|
| Rate for Payer: PHP Commercial |
$671.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.81
|
| Rate for Payer: Priority Health SBD |
$498.00
|
|
|
HC ARTHROCENTESIS
|
Facility
|
IP
|
$377.89
|
|
| Hospital Charge Code |
45000030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.07 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna Commercial |
$321.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.63
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$264.52
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Healthscope Commercial |
$340.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: PHP Commercial |
$321.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health SBD |
$238.07
|
|
|
HC ARTHROCENTESIS
|
Facility
|
OP
|
$377.89
|
|
| Hospital Charge Code |
45000030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna Commercial |
$321.21
|
| Rate for Payer: Aetna Medicare |
$188.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.63
|
| Rate for Payer: BCBS Complete |
$151.16
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$264.52
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Healthscope Commercial |
$340.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: PHP Commercial |
$321.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health SBD |
$238.07
|
|
|
HC ARTHROCENTESIS INTERMED JT
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
36100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
|
|
HC ARTHROCENTESIS INTERMED JT
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
36100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.13
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC ARTHROCENTESIS INTERMED JT BIL
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
36100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.71 |
| Max. Negotiated Rate |
$393.87 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.46
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$306.34
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health SBD |
$275.71
|
|
|
HC ARTHROCENTESIS INTERMED JT BIL
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
36100025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Cofinity Commercial |
$306.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$275.71
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.13
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC ARTHROCENTESIS INTERMED JT BIL W US GUIDE
|
Facility
|
IP
|
$1,463.18
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
36100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.80 |
| Max. Negotiated Rate |
$1,316.86 |
| Rate for Payer: Aetna Commercial |
$1,243.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.07
|
| Rate for Payer: Cash Price |
$1,170.54
|
| Rate for Payer: Cofinity Commercial |
$1,024.23
|
| Rate for Payer: Cofinity Commercial |
$1,258.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,024.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.54
|
| Rate for Payer: Healthscope Commercial |
$1,316.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,243.70
|
| Rate for Payer: PHP Commercial |
$1,243.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$951.07
|
| Rate for Payer: Priority Health SBD |
$921.80
|
|
|
HC ARTHROCENTESIS INTERMED JT BIL W US GUIDE
|
Facility
|
OP
|
$1,463.18
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
36100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$1,243.70
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$414.76
|
| Rate for Payer: BCN Commercial |
$414.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$1,170.54
|
| Rate for Payer: Cash Price |
$1,170.54
|
| Rate for Payer: Cash Price |
$1,170.54
|
| Rate for Payer: Cofinity Commercial |
$1,258.33
|
| Rate for Payer: Cofinity Commercial |
$1,024.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,024.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,170.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,316.86
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,243.70
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$1,243.70
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$951.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$921.80
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.30
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
