|
HC CLOSURE DEVICE
|
Facility
|
OP
|
$1,138.46
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.38 |
| Max. Negotiated Rate |
$1,024.61 |
| Rate for Payer: Aetna Commercial |
$967.69
|
| Rate for Payer: Aetna Medicare |
$569.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.00
|
| Rate for Payer: BCBS Complete |
$455.38
|
| Rate for Payer: Cash Price |
$910.77
|
| Rate for Payer: Cofinity Commercial |
$796.92
|
| Rate for Payer: Cofinity Commercial |
$979.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.77
|
| Rate for Payer: Healthscope Commercial |
$1,024.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.69
|
| Rate for Payer: PHP Commercial |
$967.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.00
|
| Rate for Payer: Priority Health SBD |
$717.23
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$56.72 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| 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 |
$11.34
|
| Rate for Payer: BCBS MAPPO |
$20.15
|
| Rate for Payer: BCN Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| 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 |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.15
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$20.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$20.15
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.15
|
| Rate for Payer: UHC Medicare Advantage |
$20.15
|
| Rate for Payer: UHCCP Medicaid |
$11.34
|
| Rate for Payer: VA VA |
$20.15
|
|
|
HC CLOZAPINE LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
30100159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.56 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health SBD |
$385.56
|
|
|
HC CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
76100375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$385.56
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Cofinity Commercial |
$444.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$400.12
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CLSD TX IP JT DISLOCATION W/MANIP W/O ANES
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$571.60 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health SBD |
$400.12
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
IP
|
$635.11
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$571.60 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$444.58
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health SBD |
$400.12
|
|
|
HC CLSD TX PELVIC RING FX W/O MANIPULATION
|
Facility
|
OP
|
$635.11
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$539.84
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cash Price |
$508.09
|
| Rate for Payer: Cofinity Commercial |
$546.19
|
| Rate for Payer: Cofinity Commercial |
$444.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$444.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$571.60
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.84
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$539.84
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.82
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$400.12
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
IP
|
$328.51
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.96 |
| Max. Negotiated Rate |
$295.66 |
| Rate for Payer: Aetna Commercial |
$279.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.53
|
| Rate for Payer: Cash Price |
$262.81
|
| Rate for Payer: Cofinity Commercial |
$229.96
|
| Rate for Payer: Cofinity Commercial |
$282.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.81
|
| Rate for Payer: Healthscope Commercial |
$295.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.23
|
| Rate for Payer: PHP Commercial |
$279.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.53
|
| Rate for Payer: Priority Health SBD |
$206.96
|
|
|
HC CL TX GREATER HUMERAL TUBEROSITY FX W/O MAN
|
Facility
|
OP
|
$328.51
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$279.23
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$262.81
|
| Rate for Payer: Cash Price |
$262.81
|
| Rate for Payer: Cofinity Commercial |
$282.52
|
| Rate for Payer: Cofinity Commercial |
$229.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$295.66
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.23
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$279.23
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.53
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$206.96
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$385.56
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CL TX INTERCONDYL SPI&/TUBRST FX KNE W/WO MAN
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
76100374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.56 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health SBD |
$385.56
|
|
|
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Commercial |
$565.25
|
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$571.90
|
| Rate for Payer: Cofinity Commercial |
$465.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$465.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Healthscope Commercial |
$598.50
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.25
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Commercial |
$565.25
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Priority Health SBD |
$418.95
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$131.71
|
| Rate for Payer: VA VA |
$233.95
|
|
|
HC CL TX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
76100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.95 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$565.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.25
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$465.50
|
| Rate for Payer: Cofinity Commercial |
$571.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$465.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$532.00
|
| Rate for Payer: Healthscope Commercial |
$598.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$565.25
|
| Rate for Payer: PHP Commercial |
$565.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health SBD |
$418.95
|
|
|
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 Commercial |
$121.29
|
| Rate for Payer: Cofinity Commercial |
$98.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.72
|
| 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: PHP Commercial |
$119.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.67
|
| Rate for Payer: Priority Health SBD |
$88.85
|
|
|
HC CMS CLINIC SUPPORT
|
Facility
|
OP
|
$141.03
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.41 |
| 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: Cash Price |
$112.82
|
| Rate for Payer: Cofinity Commercial |
$121.29
|
| Rate for Payer: Cofinity Commercial |
$98.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.72
|
| 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: PHP Commercial |
$119.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.67
|
| Rate for Payer: Priority Health SBD |
$88.85
|
|
|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.16
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health SBD |
$56.37
|
|
|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$56.37
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC CMV DNA PCR QUANTITATIVE
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
30600152
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$109.24 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health SBD |
$109.24
|
|
|
HC CMV DNA PCR QUANTITATIVE
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
30600152
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$109.24
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC COAGULATION INTERPRETATION
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
30500075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$16.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.35
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: BCBS MAPPO |
$15.48
|
| Rate for Payer: BCN Medicare Advantage |
$15.48
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.48
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$8.30
|
| Rate for Payer: Mclaren Medicare |
$15.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.25
|
| Rate for Payer: Meridian Medicaid |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PACE Medicare |
$14.71
|
| Rate for Payer: PACE SWMI |
$15.48
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$15.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$15.48
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$15.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.48
|
| Rate for Payer: UHC Medicare Advantage |
$15.48
|
| Rate for Payer: UHCCP Medicaid |
$8.72
|
| Rate for Payer: VA VA |
$15.48
|
|
|
HC COAGULATION INTERPRETATION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
30500075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$76.63
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$68.97 |
| Rate for Payer: Aetna Commercial |
$65.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.81
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cofinity Commercial |
$53.64
|
| Rate for Payer: Cofinity Commercial |
$65.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.30
|
| Rate for Payer: Healthscope Commercial |
$68.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.14
|
| Rate for Payer: PHP Commercial |
$65.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: Priority Health SBD |
$48.28
|
|
|
HC COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$76.63
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$68.97 |
| Rate for Payer: Aetna Commercial |
$65.14
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cofinity Commercial |
$65.90
|
| Rate for Payer: Cofinity Commercial |
$53.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$68.97
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.14
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$65.14
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health SBD |
$48.28
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$2.41
|
| Rate for Payer: VA VA |
$4.28
|
|
