|
HC CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Facility
|
OP
|
$82.19
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Aetna Commercial |
$69.86
|
| Rate for Payer: Aetna Medicare |
$30.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$73.97
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$69.86
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.42
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health SBD |
$51.78
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Facility
|
IP
|
$82.19
|
|
|
Service Code
|
CPT 99484
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.78 |
| Max. Negotiated Rate |
$73.97 |
| Rate for Payer: Aetna Commercial |
$69.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.42
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$70.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.75
|
| Rate for Payer: Healthscope Commercial |
$73.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.86
|
| Rate for Payer: PHP Commercial |
$69.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.42
|
| Rate for Payer: Priority Health SBD |
$51.78
|
|
|
HC CARNITINE
|
Facility
|
OP
|
$59.16
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
30100136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Aetna Commercial |
$50.29
|
| Rate for Payer: Aetna Medicare |
$17.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.09
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$53.24
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.71
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.29
|
| Rate for Payer: PACE Medicare |
$16.03
|
| Rate for Payer: PACE SWMI |
$16.87
|
| Rate for Payer: PHP Commercial |
$50.29
|
| Rate for Payer: PHP Medicare Advantage |
$16.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.45
|
| Rate for Payer: Priority Health Medicare |
$16.87
|
| Rate for Payer: Priority Health SBD |
$37.27
|
| Rate for Payer: Railroad Medicare Medicare |
$16.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.87
|
| Rate for Payer: UHC Medicare Advantage |
$16.87
|
| Rate for Payer: UHCCP Medicaid |
$9.50
|
| Rate for Payer: VA VA |
$16.87
|
|
|
HC CARNITINE
|
Facility
|
IP
|
$59.16
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
30100136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Aetna Commercial |
$50.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.45
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.33
|
| Rate for Payer: Healthscope Commercial |
$53.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.29
|
| Rate for Payer: PHP Commercial |
$50.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.45
|
| Rate for Payer: Priority Health SBD |
$37.27
|
|
|
HC CAR OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC CAR OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200010
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC CAROTENE
|
Facility
|
IP
|
$150.96
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
30100137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.10 |
| Max. Negotiated Rate |
$135.86 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$105.67
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Healthscope Commercial |
$135.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: PHP Commercial |
$128.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health SBD |
$95.10
|
|
|
HC CAROTENE
|
Facility
|
OP
|
$150.96
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
30100137
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$135.86 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.53
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS MAPPO |
$9.22
|
| Rate for Payer: BCN Medicare Advantage |
$9.22
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Cofinity Commercial |
$105.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$135.86
|
| Rate for Payer: Mclaren Medicaid |
$4.94
|
| Rate for Payer: Mclaren Medicare |
$9.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.68
|
| Rate for Payer: Meridian Medicaid |
$5.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: PACE Medicare |
$8.76
|
| Rate for Payer: PACE SWMI |
$9.22
|
| Rate for Payer: PHP Commercial |
$128.32
|
| Rate for Payer: PHP Medicare Advantage |
$9.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health Medicare |
$9.22
|
| Rate for Payer: Priority Health SBD |
$95.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.22
|
| Rate for Payer: UHC Medicare Advantage |
$9.22
|
| Rate for Payer: UHCCP Medicaid |
$5.19
|
| Rate for Payer: VA VA |
$9.22
|
|
|
HC CAROTID/VERTEBRAL LIMITED
|
Facility
|
OP
|
$726.53
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$653.88 |
| Rate for Payer: Aetna Commercial |
$617.55
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$581.22
|
| Rate for Payer: Cash Price |
$581.22
|
| Rate for Payer: Cofinity Commercial |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$508.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$508.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$653.88
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.55
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$617.55
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.24
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$457.71
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$537.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$537.63
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CAROTID/VERTEBRAL LIMITED
|
Facility
|
IP
|
$726.53
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
40200054
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$653.88 |
| Rate for Payer: Aetna Commercial |
$617.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.24
|
| Rate for Payer: Cash Price |
$581.22
|
| Rate for Payer: Cofinity Commercial |
$508.57
|
| Rate for Payer: Cofinity Commercial |
$624.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$508.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.22
|
| Rate for Payer: Healthscope Commercial |
$653.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.55
|
| Rate for Payer: PHP Commercial |
$617.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.24
|
| Rate for Payer: Priority Health SBD |
$457.71
|
|
|
HC CAROTID/VERTEBRAL ULTRASOUND
|
Facility
|
IP
|
$1,382.09
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$870.72 |
| Max. Negotiated Rate |
$1,243.88 |
| Rate for Payer: Aetna Commercial |
$1,174.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$898.36
|
| Rate for Payer: Cash Price |
$1,105.67
|
| Rate for Payer: Cofinity Commercial |
$1,188.60
|
| Rate for Payer: Cofinity Commercial |
$967.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$967.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,105.67
|
| Rate for Payer: Healthscope Commercial |
$1,243.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,174.78
|
| Rate for Payer: PHP Commercial |
$1,174.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.36
|
| Rate for Payer: Priority Health SBD |
$870.72
|
|
|
HC CAROTID/VERTEBRAL ULTRASOUND
|
Facility
|
OP
|
$1,382.09
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
92100001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,243.88 |
| Rate for Payer: Aetna Commercial |
$1,174.78
|
| Rate for Payer: Aetna Medicare |
$245.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$898.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$1,105.67
|
| Rate for Payer: Cash Price |
$1,105.67
|
| Rate for Payer: Cofinity Commercial |
$967.46
|
| Rate for Payer: Cofinity Commercial |
$1,188.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$967.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,105.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,243.88
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,174.78
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$1,174.78
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.36
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health SBD |
$870.72
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.58
|
| Rate for Payer: UHC Core |
$1,022.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$1,022.75
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$132.72
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC CASHEW IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC CASHEW IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200030
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CASSETTES QUEST
|
Facility
|
IP
|
$76.50
|
|
| Hospital Charge Code |
27000458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC CASSETTES QUEST
|
Facility
|
OP
|
$76.50
|
|
| Hospital Charge Code |
27000458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC CAST CLUB FOOT
|
Facility
|
IP
|
$422.52
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
70000011
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$266.19 |
| Max. Negotiated Rate |
$380.27 |
| Rate for Payer: Aetna Commercial |
$359.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.64
|
| Rate for Payer: Cash Price |
$338.02
|
| Rate for Payer: Cofinity Commercial |
$295.76
|
| Rate for Payer: Cofinity Commercial |
$363.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.02
|
| Rate for Payer: Healthscope Commercial |
$380.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.14
|
| Rate for Payer: PHP Commercial |
$359.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.64
|
| Rate for Payer: Priority Health SBD |
$266.19
|
|
|
HC CAST CLUB FOOT
|
Facility
|
OP
|
$422.52
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
70000011
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$359.14
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$338.02
|
| Rate for Payer: Cash Price |
$338.02
|
| Rate for Payer: Cofinity Commercial |
$363.37
|
| Rate for Payer: Cofinity Commercial |
$295.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$380.27
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.14
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$359.14
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.64
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$266.19
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC CAST COLOR ROLL
|
Facility
|
IP
|
$61.55
|
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.78 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna Commercial |
$52.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cofinity Commercial |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.24
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.32
|
| Rate for Payer: PHP Commercial |
$52.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.01
|
| Rate for Payer: Priority Health SBD |
$38.78
|
|
|
HC CAST COLOR ROLL
|
Facility
|
OP
|
$61.55
|
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$55.40 |
| Rate for Payer: Aetna Commercial |
$52.32
|
| Rate for Payer: Aetna Medicare |
$30.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.01
|
| Rate for Payer: BCBS Complete |
$24.62
|
| Rate for Payer: Cash Price |
$49.24
|
| Rate for Payer: Cofinity Commercial |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$52.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.24
|
| Rate for Payer: Healthscope Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.32
|
| Rate for Payer: PHP Commercial |
$52.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.01
|
| Rate for Payer: Priority Health SBD |
$38.78
|
|
|
HC CAST CYLINDER
|
Facility
|
IP
|
$408.07
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
70000006
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$257.08 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$346.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.25
|
| Rate for Payer: Cash Price |
$326.46
|
| Rate for Payer: Cofinity Commercial |
$285.65
|
| Rate for Payer: Cofinity Commercial |
$350.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.46
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.86
|
| Rate for Payer: PHP Commercial |
$346.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.25
|
| Rate for Payer: Priority Health SBD |
$257.08
|
|
|
HC CAST CYLINDER
|
Facility
|
OP
|
$408.07
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
70000006
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$346.86
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$326.46
|
| Rate for Payer: Cash Price |
$326.46
|
| Rate for Payer: Cofinity Commercial |
$350.94
|
| Rate for Payer: Cofinity Commercial |
$285.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.86
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$346.86
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.25
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$257.08
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST FINGER (CONTRACTURE)
|
Facility
|
OP
|
$210.09
|
|
|
Service Code
|
CPT 29086
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$178.58
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$168.07
|
| Rate for Payer: Cash Price |
$168.07
|
| Rate for Payer: Cash Price |
$168.07
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Cofinity Commercial |
$180.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$189.08
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.58
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$178.58
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.56
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$132.36
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Core |
$155.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$155.47
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC CAST FINGER (CONTRACTURE)
|
Facility
|
IP
|
$210.09
|
|
|
Service Code
|
CPT 29086
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$132.36 |
| Max. Negotiated Rate |
$189.08 |
| Rate for Payer: Aetna Commercial |
$178.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.56
|
| Rate for Payer: Cash Price |
$168.07
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Cofinity Commercial |
$180.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.07
|
| Rate for Payer: Healthscope Commercial |
$189.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.58
|
| Rate for Payer: PHP Commercial |
$178.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.56
|
| Rate for Payer: Priority Health SBD |
$132.36
|
|
|
HC CAST GAUNTLET
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
42100002
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$150.03 |
| Max. Negotiated Rate |
$214.33 |
| Rate for Payer: Aetna Commercial |
$202.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.79
|
| Rate for Payer: Cash Price |
$190.51
|
| Rate for Payer: Cofinity Commercial |
$166.70
|
| Rate for Payer: Cofinity Commercial |
$204.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$166.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.51
|
| Rate for Payer: Healthscope Commercial |
$214.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.42
|
| Rate for Payer: PHP Commercial |
$202.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.79
|
| Rate for Payer: Priority Health SBD |
$150.03
|
|
