|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$976.50 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$1,317.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.00
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,317.50
|
| Rate for Payer: PHP Commercial |
$1,317.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.00
|
| Rate for Payer: Priority Health SBD |
$976.50
|
|
|
HC REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.68 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$1,317.50
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$754.99
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.00
|
| Rate for Payer: Cofinity Commercial |
$1,085.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$1,395.00
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,317.50
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$1,317.50
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,085.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$976.50
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$326.79
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$1,385.50
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$527.45
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cofinity Commercial |
$1,401.80
|
| Rate for Payer: Cofinity Commercial |
$1,141.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$1,467.00
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,385.50
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$1,385.50
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$1,026.90
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$294.70
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
HC REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,026.90 |
| Max. Negotiated Rate |
$1,467.00 |
| Rate for Payer: Aetna Commercial |
$1,385.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.50
|
| Rate for Payer: Cash Price |
$1,304.00
|
| Rate for Payer: Cofinity Commercial |
$1,141.00
|
| Rate for Payer: Cofinity Commercial |
$1,401.80
|
| Rate for Payer: Healthscope Commercial |
$1,467.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,385.50
|
| Rate for Payer: PHP Commercial |
$1,385.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.00
|
| Rate for Payer: Priority Health SBD |
$1,026.90
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
IP
|
$1,048.38
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.48 |
| Max. Negotiated Rate |
$943.54 |
| Rate for Payer: Aetna Commercial |
$891.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.45
|
| Rate for Payer: Cash Price |
$838.70
|
| Rate for Payer: Cofinity Commercial |
$901.61
|
| Rate for Payer: Cofinity Commercial |
$733.87
|
| Rate for Payer: Healthscope Commercial |
$943.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.12
|
| Rate for Payer: PHP Commercial |
$891.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.87
|
| Rate for Payer: Priority Health SBD |
$660.48
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
OP
|
$1,048.38
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$891.12
|
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$320.91
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Cash Price |
$838.70
|
| Rate for Payer: Cash Price |
$838.70
|
| Rate for Payer: Cofinity Commercial |
$901.61
|
| Rate for Payer: Cofinity Commercial |
$733.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Healthscope Commercial |
$943.54
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.12
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Commercial |
$891.12
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.40
|
| Rate for Payer: Priority Health SBD |
$660.48
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$32.09
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
IP
|
$4,132.31
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,603.36 |
| Max. Negotiated Rate |
$3,719.08 |
| Rate for Payer: Aetna Commercial |
$3,512.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,686.00
|
| Rate for Payer: Cash Price |
$3,305.85
|
| Rate for Payer: Cofinity Commercial |
$2,892.62
|
| Rate for Payer: Cofinity Commercial |
$3,553.79
|
| Rate for Payer: Healthscope Commercial |
$3,719.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,512.46
|
| Rate for Payer: PHP Commercial |
$3,512.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,892.62
|
| Rate for Payer: Priority Health SBD |
$2,603.36
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
OP
|
$4,132.31
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$623.45 |
| Max. Negotiated Rate |
$4,301.45 |
| Rate for Payer: Aetna Commercial |
$3,512.46
|
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,686.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,787.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,787.60
|
| Rate for Payer: BCBS Complete |
$821.44
|
| Rate for Payer: BCBS MAPPO |
$1,430.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,402.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Cash Price |
$3,305.85
|
| Rate for Payer: Cash Price |
$3,305.85
|
| Rate for Payer: Cofinity Commercial |
$3,553.79
|
| Rate for Payer: Cofinity Commercial |
$2,892.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Healthscope Commercial |
$3,719.08
|
| Rate for Payer: Mclaren Medicaid |
$782.25
|
| Rate for Payer: Mclaren Medicare |
$1,430.08
|
| Rate for Payer: Meridian Medicaid |
$821.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,501.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,512.46
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Commercial |
$3,512.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,892.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,301.45
|
| Rate for Payer: Priority Health Medicare |
$1,430.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,441.16
|
| Rate for Payer: Priority Health SBD |
$2,603.36
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$623.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
IP
|
$4,207.79
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,650.91 |
| Max. Negotiated Rate |
$3,787.01 |
| Rate for Payer: Aetna Commercial |
$3,576.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,735.06
|
| Rate for Payer: Cash Price |
$3,366.23
|
| Rate for Payer: Cofinity Commercial |
$2,945.45
|
| Rate for Payer: Cofinity Commercial |
$3,618.70
|
| Rate for Payer: Healthscope Commercial |
$3,787.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,576.62
|
| Rate for Payer: PHP Commercial |
$3,576.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.45
|
| Rate for Payer: Priority Health SBD |
$2,650.91
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
OP
|
$4,207.79
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.57 |
| Max. Negotiated Rate |
$4,301.45 |
| Rate for Payer: Aetna Commercial |
$3,576.62
|
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,735.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,787.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,787.60
|
| Rate for Payer: BCBS Complete |
$821.44
|
| Rate for Payer: BCBS MAPPO |
$1,430.08
|
| Rate for Payer: BCBS Trust/PPO |
$804.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Cash Price |
$3,366.23
|
| Rate for Payer: Cash Price |
$3,366.23
|
| Rate for Payer: Cofinity Commercial |
$3,618.70
|
| Rate for Payer: Cofinity Commercial |
$2,945.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Healthscope Commercial |
$3,787.01
|
| Rate for Payer: Mclaren Medicaid |
$782.25
|
| Rate for Payer: Mclaren Medicare |
$1,430.08
|
| Rate for Payer: Meridian Medicaid |
$821.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,501.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,576.62
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Commercial |
$3,576.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,301.45
|
| Rate for Payer: Priority Health Medicare |
$1,430.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,441.16
|
| Rate for Payer: Priority Health SBD |
$2,650.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$542.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
HC REPAIR SINGLE ELECTRODE PACEMAKER OR ICD
|
Facility
|
OP
|
$4,789.72
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
36100569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.21 |
| Max. Negotiated Rate |
$10,721.72 |
| Rate for Payer: Aetna Commercial |
$4,071.26
|
| Rate for Payer: Aetna Medicare |
$3,633.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,113.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,367.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,367.78
|
| Rate for Payer: BCBS Complete |
$2,007.08
|
| Rate for Payer: BCBS MAPPO |
$3,494.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,494.22
|
| Rate for Payer: Cash Price |
$3,831.78
|
| Rate for Payer: Cash Price |
$3,831.78
|
| Rate for Payer: Cofinity Commercial |
$3,352.80
|
| Rate for Payer: Cofinity Commercial |
$4,119.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,494.22
|
| Rate for Payer: Healthscope Commercial |
$4,310.75
|
| Rate for Payer: Mclaren Medicaid |
$1,911.34
|
| Rate for Payer: Mclaren Medicare |
$3,494.22
|
| Rate for Payer: Meridian Medicaid |
$2,007.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,668.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,018.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,071.26
|
| Rate for Payer: PACE Medicare |
$3,319.51
|
| Rate for Payer: PACE SWMI |
$3,494.22
|
| Rate for Payer: PHP Commercial |
$4,071.26
|
| Rate for Payer: PHP Medicare Advantage |
$3,494.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,911.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,352.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,721.72
|
| Rate for Payer: Priority Health Medicare |
$3,494.22
|
| Rate for Payer: Priority Health Narrow Network |
$8,577.38
|
| Rate for Payer: Priority Health SBD |
$3,017.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3,494.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.93
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,494.22
|
| Rate for Payer: UHC Exchange |
$377.21
|
| Rate for Payer: UHC Medicare Advantage |
$3,599.05
|
| Rate for Payer: VA VA |
$3,494.22
|
|
|
HC REPAIR SINGLE ELECTRODE PACEMAKER OR ICD
|
Facility
|
IP
|
$4,789.72
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
36100569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,017.52 |
| Max. Negotiated Rate |
$4,310.75 |
| Rate for Payer: Aetna Commercial |
$4,071.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,113.32
|
| Rate for Payer: Cash Price |
$3,831.78
|
| Rate for Payer: Cofinity Commercial |
$3,352.80
|
| Rate for Payer: Cofinity Commercial |
$4,119.16
|
| Rate for Payer: Healthscope Commercial |
$4,310.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,071.26
|
| Rate for Payer: PHP Commercial |
$4,071.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,352.80
|
| Rate for Payer: Priority Health SBD |
$3,017.52
|
|
|
HC REPAIR SPICA/BODY CAST
|
Facility
|
IP
|
$190.11
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
70000017
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$119.77 |
| Max. Negotiated Rate |
$171.10 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$133.08
|
| Rate for Payer: Cofinity Commercial |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$171.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PHP Commercial |
$161.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health SBD |
$119.77
|
|
|
HC REPAIR SPICA/BODY CAST
|
Facility
|
OP
|
$190.11
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
70000017
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$175.25 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$163.49
|
| Rate for Payer: Cofinity Commercial |
$133.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$171.10
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$161.59
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$119.77
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$42.89
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC REPAIR TENDON HAND/FINGER
|
Facility
|
OP
|
$4,132.31
|
|
| Hospital Charge Code |
45000096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,652.92 |
| Max. Negotiated Rate |
$3,719.08 |
| Rate for Payer: Aetna Commercial |
$3,512.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,686.00
|
| Rate for Payer: BCBS Complete |
$1,652.92
|
| Rate for Payer: Cash Price |
$3,305.85
|
| Rate for Payer: Cofinity Commercial |
$2,892.62
|
| Rate for Payer: Cofinity Commercial |
$3,553.79
|
| Rate for Payer: Healthscope Commercial |
$3,719.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,512.46
|
| Rate for Payer: PHP Commercial |
$3,512.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,892.62
|
| Rate for Payer: Priority Health SBD |
$2,603.36
|
|
|
HC REPAIR TENDON HAND/FINGER
|
Facility
|
IP
|
$4,132.31
|
|
| Hospital Charge Code |
45000096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,603.36 |
| Max. Negotiated Rate |
$3,719.08 |
| Rate for Payer: Aetna Commercial |
$3,512.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,686.00
|
| Rate for Payer: Cash Price |
$3,305.85
|
| Rate for Payer: Cofinity Commercial |
$2,892.62
|
| Rate for Payer: Cofinity Commercial |
$3,553.79
|
| Rate for Payer: Healthscope Commercial |
$3,719.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,512.46
|
| Rate for Payer: PHP Commercial |
$3,512.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,892.62
|
| Rate for Payer: Priority Health SBD |
$2,603.36
|
|
|
HC REPAZ CVAD WITH PORT OR PUMP
|
Facility
|
IP
|
$1,610.04
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
36100132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,014.33 |
| Max. Negotiated Rate |
$1,449.04 |
| Rate for Payer: Aetna Commercial |
$1,368.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.53
|
| Rate for Payer: Cash Price |
$1,288.03
|
| Rate for Payer: Cofinity Commercial |
$1,384.63
|
| Rate for Payer: Cofinity Commercial |
$1,127.03
|
| Rate for Payer: Healthscope Commercial |
$1,449.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,368.53
|
| Rate for Payer: PHP Commercial |
$1,368.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.03
|
| Rate for Payer: Priority Health SBD |
$1,014.33
|
|
|
HC REPAZ CVAD WITH PORT OR PUMP
|
Facility
|
OP
|
$1,610.04
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
36100132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$4,461.38 |
| Rate for Payer: Aetna Commercial |
$1,368.53
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$374.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$1,288.03
|
| Rate for Payer: Cash Price |
$1,288.03
|
| Rate for Payer: Cofinity Commercial |
$1,384.63
|
| Rate for Payer: Cofinity Commercial |
$1,127.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$1,449.04
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,368.53
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$1,368.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,461.38
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,569.10
|
| Rate for Payer: Priority Health SBD |
$1,014.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.58
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$177.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC REPLACE AORTIC VALVE OPEN AXILLRY ARTERY APPR
|
Facility
|
IP
|
$65,453.40
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
48100119
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$41,235.64 |
| Max. Negotiated Rate |
$58,908.06 |
| Rate for Payer: Aetna Commercial |
$55,635.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,544.71
|
| Rate for Payer: Cash Price |
$52,362.72
|
| Rate for Payer: Cofinity Commercial |
$45,817.38
|
| Rate for Payer: Cofinity Commercial |
$56,289.92
|
| Rate for Payer: Healthscope Commercial |
$58,908.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55,635.39
|
| Rate for Payer: PHP Commercial |
$55,635.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45,817.38
|
| Rate for Payer: Priority Health SBD |
$41,235.64
|
|
|
HC REPLACE AORTIC VALVE OPEN AXILLRY ARTERY APPR
|
Facility
|
OP
|
$65,453.40
|
|
|
Service Code
|
CPT 33363
|
| Hospital Charge Code |
48100119
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,311.73 |
| Max. Negotiated Rate |
$58,908.06 |
| Rate for Payer: Aetna Commercial |
$55,635.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,544.71
|
| Rate for Payer: BCBS Complete |
$26,181.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,202.56
|
| Rate for Payer: Cash Price |
$52,362.72
|
| Rate for Payer: Cash Price |
$52,362.72
|
| Rate for Payer: Cofinity Commercial |
$56,289.92
|
| Rate for Payer: Cofinity Commercial |
$45,817.38
|
| Rate for Payer: Healthscope Commercial |
$58,908.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55,635.39
|
| Rate for Payer: PHP Commercial |
$55,635.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45,817.38
|
| Rate for Payer: Priority Health SBD |
$41,235.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,442.90
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$1,311.73
|
|
|
HC REPLACE AORTIC VALVE OPEN FEMORAL ARTERY APPR
|
Facility
|
IP
|
$62,393.40
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
48100118
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$39,307.84 |
| Max. Negotiated Rate |
$56,154.06 |
| Rate for Payer: Aetna Commercial |
$53,034.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,555.71
|
| Rate for Payer: Cash Price |
$49,914.72
|
| Rate for Payer: Cofinity Commercial |
$43,675.38
|
| Rate for Payer: Cofinity Commercial |
$53,658.32
|
| Rate for Payer: Healthscope Commercial |
$56,154.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53,034.39
|
| Rate for Payer: PHP Commercial |
$53,034.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,675.38
|
| Rate for Payer: Priority Health SBD |
$39,307.84
|
|
|
HC REPLACE AORTIC VALVE OPEN FEMORAL ARTERY APPR
|
Facility
|
OP
|
$62,393.40
|
|
|
Service Code
|
CPT 33362
|
| Hospital Charge Code |
48100118
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,263.93 |
| Max. Negotiated Rate |
$56,154.06 |
| Rate for Payer: Aetna Commercial |
$53,034.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,555.71
|
| Rate for Payer: BCBS Complete |
$24,957.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,042.02
|
| Rate for Payer: Cash Price |
$49,914.72
|
| Rate for Payer: Cash Price |
$49,914.72
|
| Rate for Payer: Cofinity Commercial |
$53,658.32
|
| Rate for Payer: Cofinity Commercial |
$43,675.38
|
| Rate for Payer: Healthscope Commercial |
$56,154.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53,034.39
|
| Rate for Payer: PHP Commercial |
$53,034.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,675.38
|
| Rate for Payer: Priority Health SBD |
$39,307.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,390.32
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$1,263.93
|
|
|
HC REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPR
|
Facility
|
OP
|
$68,513.40
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
48100120
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,305.84 |
| Max. Negotiated Rate |
$61,662.06 |
| Rate for Payer: Aetna Commercial |
$58,236.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44,533.71
|
| Rate for Payer: BCBS Complete |
$27,405.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,320.86
|
| Rate for Payer: Cash Price |
$54,810.72
|
| Rate for Payer: Cash Price |
$54,810.72
|
| Rate for Payer: Cofinity Commercial |
$58,921.52
|
| Rate for Payer: Cofinity Commercial |
$47,959.38
|
| Rate for Payer: Healthscope Commercial |
$61,662.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58,236.39
|
| Rate for Payer: PHP Commercial |
$58,236.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47,959.38
|
| Rate for Payer: Priority Health SBD |
$43,163.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,436.42
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$1,305.84
|
|
|
HC REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPR
|
Facility
|
IP
|
$68,513.40
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
48100120
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$43,163.44 |
| Max. Negotiated Rate |
$61,662.06 |
| Rate for Payer: Aetna Commercial |
$58,236.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44,533.71
|
| Rate for Payer: Cash Price |
$54,810.72
|
| Rate for Payer: Cofinity Commercial |
$47,959.38
|
| Rate for Payer: Cofinity Commercial |
$58,921.52
|
| Rate for Payer: Healthscope Commercial |
$61,662.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58,236.39
|
| Rate for Payer: PHP Commercial |
$58,236.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47,959.38
|
| Rate for Payer: Priority Health SBD |
$43,163.44
|
|
|
HC REPLACE AORTIC VALVE PERC FEMORAL ARTERY APPR
|
Facility
|
IP
|
$59,333.40
|
|
|
Service Code
|
CPT 33361
|
| Hospital Charge Code |
48100117
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$37,380.04 |
| Max. Negotiated Rate |
$53,400.06 |
| Rate for Payer: Aetna Commercial |
$50,433.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38,566.71
|
| Rate for Payer: Cash Price |
$47,466.72
|
| Rate for Payer: Cofinity Commercial |
$41,533.38
|
| Rate for Payer: Cofinity Commercial |
$51,026.72
|
| Rate for Payer: Healthscope Commercial |
$53,400.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50,433.39
|
| Rate for Payer: PHP Commercial |
$50,433.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41,533.38
|
| Rate for Payer: Priority Health SBD |
$37,380.04
|
|
