|
HC CLOSURE DEVICE
|
Facility
|
OP
|
$1,161.23
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.36 |
| Max. Negotiated Rate |
$1,045.11 |
| Rate for Payer: Aetna Commercial |
$987.05
|
| Rate for Payer: Aetna Medicare |
$580.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.80
|
| Rate for Payer: BCBS Complete |
$464.49
|
| Rate for Payer: Cash Price |
$928.98
|
| Rate for Payer: Cofinity Advantage |
$812.86
|
| Rate for Payer: Cofinity Commercial |
$998.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.98
|
| Rate for Payer: Healthscope Commercial |
$1,045.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$928.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$987.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.92
|
| Rate for Payer: PHP Commercial |
$987.05
|
| Rate for Payer: Priority Health SBD |
$731.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.80
|
| Rate for Payer: UHC Core |
$605.00
|
| Rate for Payer: UHC Exchange |
$456.36
|
|
|
HC CLOSURE DEVICE
|
Facility
|
IP
|
$1,161.23
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$731.57 |
| Max. Negotiated Rate |
$1,045.11 |
| Rate for Payer: Aetna Commercial |
$987.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.80
|
| Rate for Payer: Cash Price |
$928.98
|
| Rate for Payer: Cofinity Advantage |
$812.86
|
| Rate for Payer: Cofinity Commercial |
$998.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.98
|
| Rate for Payer: Healthscope Commercial |
$1,045.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$987.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.92
|
| Rate for Payer: PHP Commercial |
$987.05
|
| Rate for Payer: Priority Health SBD |
$731.57
|
|
|
HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.97 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Advantage |
$503.30
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.25
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: Priority Health SBD |
$452.97
|
|
|
HC CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$195.24
|
| Rate for Payer: BCN Commercial |
$195.24
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Advantage |
$503.30
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Mclaren Medicaid |
$123.43
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.25
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$452.97
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.35
|
| Rate for Payer: UHC Core |
$374.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Exchange |
$282.57
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.19
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCBS Trust/PPO |
$21.48
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$10.54
|
| Rate for Payer: Mclaren Medicare |
$20.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.16
|
| Rate for Payer: Meridian Medicaid |
$21.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$30.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.15
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Priority Health Tiered Network |
$16.12
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.23
|
| Rate for Payer: UHC Core |
$30.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.15
|
| Rate for Payer: UHC Exchange |
$30.23
|
| Rate for Payer: UHC Medicaid |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$10.54
|
| Rate for Payer: VA VA |
$20.15
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$624.24
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$530.60
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Advantage |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$536.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$561.82
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.18
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$530.60
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$393.27
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.76
|
| Rate for Payer: UHC Core |
$325.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$245.33
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$624.24
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.27 |
| Max. Negotiated Rate |
$561.82 |
| Rate for Payer: Aetna Commercial |
$530.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.76
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Advantage |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$536.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Healthscope Commercial |
$561.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.18
|
| Rate for Payer: PHP Commercial |
$530.60
|
| Rate for Payer: Priority Health SBD |
$393.27
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
OP
|
$647.81
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.35 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$550.64
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$121.35
|
| Rate for Payer: BCN Commercial |
$121.35
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cofinity Advantage |
$453.47
|
| Rate for Payer: Cofinity Commercial |
$557.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$583.03
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.64
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.86
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$550.64
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$408.12
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.08
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$254.59
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
IP
|
$647.81
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.12 |
| Max. Negotiated Rate |
$583.03 |
| Rate for Payer: Aetna Commercial |
$550.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.08
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cofinity Advantage |
$453.47
|
| Rate for Payer: Cofinity Commercial |
$557.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.25
|
| Rate for Payer: Healthscope Commercial |
$583.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.86
|
| Rate for Payer: PHP Commercial |
$550.64
|
| Rate for Payer: Priority Health SBD |
$408.12
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
IP
|
$647.81
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.12 |
| Max. Negotiated Rate |
$583.03 |
| Rate for Payer: Aetna Commercial |
$550.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.08
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cofinity Advantage |
$453.47
|
| Rate for Payer: Cofinity Commercial |
$557.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.25
|
| Rate for Payer: Healthscope Commercial |
$583.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.86
|
| Rate for Payer: PHP Commercial |
$550.64
|
| Rate for Payer: Priority Health SBD |
$408.12
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
OP
|
$647.81
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$550.64
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$194.48
|
| Rate for Payer: BCN Commercial |
$194.48
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cash Price |
$518.25
|
| Rate for Payer: Cofinity Advantage |
$453.47
|
| Rate for Payer: Cofinity Commercial |
$557.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$583.03
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.64
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.86
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$550.64
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$408.12
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.08
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$254.59
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
76100566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$265.88
|
| Rate for Payer: BCN Commercial |
$265.88
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Advantage |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.50
|
| Rate for Payer: UHC Core |
$328.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$247.59
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
76100566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Advantage |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
IP
|
$335.08
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.10 |
| Max. Negotiated Rate |
$301.57 |
| Rate for Payer: Aetna Commercial |
$284.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.80
|
| Rate for Payer: Cash Price |
$268.06
|
| Rate for Payer: Cofinity Advantage |
$234.56
|
| Rate for Payer: Cofinity Commercial |
$288.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.06
|
| Rate for Payer: Healthscope Commercial |
$301.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.31
|
| Rate for Payer: PHP Commercial |
$284.82
|
| Rate for Payer: Priority Health SBD |
$211.10
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
OP
|
$335.08
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$284.82
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$268.06
|
| Rate for Payer: Cash Price |
$268.06
|
| Rate for Payer: Cash Price |
$268.06
|
| Rate for Payer: Cofinity Advantage |
$234.56
|
| Rate for Payer: Cofinity Commercial |
$288.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$301.57
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.82
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.31
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$284.82
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$211.10
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.80
|
| Rate for Payer: UHC Core |
$174.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$131.69
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
IP
|
$624.24
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.27 |
| Max. Negotiated Rate |
$561.82 |
| Rate for Payer: Aetna Commercial |
$530.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.76
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Advantage |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$536.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Healthscope Commercial |
$561.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.18
|
| Rate for Payer: PHP Commercial |
$530.60
|
| Rate for Payer: Priority Health SBD |
$393.27
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
OP
|
$624.24
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$530.60
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cash Price |
$499.39
|
| Rate for Payer: Cofinity Advantage |
$436.97
|
| Rate for Payer: Cofinity Commercial |
$536.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$561.82
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.60
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.18
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$530.60
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$393.27
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.76
|
| Rate for Payer: UHC Core |
$325.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$245.33
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
76100551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.45 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Aetna Commercial |
$607.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.75
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Advantage |
$500.50
|
| Rate for Payer: Cofinity Commercial |
$614.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Healthscope Commercial |
$643.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PHP Commercial |
$607.75
|
| Rate for Payer: Priority Health SBD |
$450.45
|
|
|
HC CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
76100551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.31 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$607.75
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$66.31
|
| Rate for Payer: BCN Commercial |
$66.31
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cofinity Advantage |
$500.50
|
| Rate for Payer: Cofinity Commercial |
$614.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$643.50
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.75
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$536.25
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$607.75
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$450.45
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.75
|
| Rate for Payer: UHC Core |
$372.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$281.00
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$678.30
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Commercial |
$576.55
|
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$163.70
|
| Rate for Payer: BCN Commercial |
$163.70
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Advantage |
$474.81
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.55
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.73
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$576.55
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health SBD |
$427.33
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.89
|
| Rate for Payer: UHC Core |
$353.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$266.57
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$678.30
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.33 |
| Max. Negotiated Rate |
$610.47 |
| Rate for Payer: Aetna Commercial |
$576.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.89
|
| Rate for Payer: Cash Price |
$542.64
|
| Rate for Payer: Cofinity Advantage |
$474.81
|
| Rate for Payer: Cofinity Commercial |
$583.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.64
|
| Rate for Payer: Healthscope Commercial |
$610.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$508.73
|
| Rate for Payer: PHP Commercial |
$576.55
|
| Rate for Payer: Priority Health SBD |
$427.33
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
OP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$126.93 |
| Rate for Payer: Aetna Commercial |
$119.88
|
| Rate for Payer: Aetna Medicare |
$70.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.67
|
| Rate for Payer: BCBS Complete |
$56.41
|
| Rate for Payer: BCBS Trust/PPO |
$119.83
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$119.83
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Advantage |
$98.72
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.82
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.77
|
| Rate for Payer: PHP Commercial |
$119.88
|
| Rate for Payer: Priority Health SBD |
$88.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.67
|
| Rate for Payer: UHC Core |
$73.48
|
| Rate for Payer: UHC Exchange |
$55.42
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
IP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.85 |
| Max. Negotiated Rate |
$126.93 |
| Rate for Payer: Aetna Commercial |
$119.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.67
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Advantage |
$98.72
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.82
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.77
|
| Rate for Payer: PHP Commercial |
$119.88
|
| Rate for Payer: Priority Health SBD |
$88.85
|
|
|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: Priority Health SBD |
$57.49
|
|
