|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$137.49
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$28.39
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$96.24
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health SBD |
$86.62
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$137.49
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.37
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Cofinity Commercial |
$96.24
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health SBD |
$86.62
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$137.49
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$41.98
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Cofinity Commercial |
$96.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health SBD |
$86.62
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$28.49
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$389.19
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$245.19 |
| Max. Negotiated Rate |
$350.27 |
| Rate for Payer: Aetna Commercial |
$330.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.97
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cofinity Commercial |
$272.43
|
| Rate for Payer: Cofinity Commercial |
$334.70
|
| Rate for Payer: Healthscope Commercial |
$350.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.81
|
| Rate for Payer: PHP Commercial |
$330.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.43
|
| Rate for Payer: Priority Health SBD |
$245.19
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$389.19
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$350.27 |
| Rate for Payer: Aetna Commercial |
$330.81
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.97
|
| 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 |
$69.04
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Cofinity Commercial |
$334.70
|
| Rate for Payer: Cofinity Commercial |
$272.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$350.27
|
| 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 |
$330.81
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$330.81
|
| 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 |
$272.43
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$245.19
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| 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 |
$73.40
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| 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 |
$297.81
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$297.81
|
| 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 |
$245.26
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$51.74
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$220.73 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.74
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$245.26
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health SBD |
$220.73
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$541.49
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$487.34 |
| Rate for Payer: Aetna Commercial |
$460.27
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$52.06
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$433.19
|
| Rate for Payer: Cash Price |
$433.19
|
| Rate for Payer: Cofinity Commercial |
$379.04
|
| Rate for Payer: Cofinity Commercial |
$465.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$487.34
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.27
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$460.27
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.04
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health SBD |
$341.14
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$48.79
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$541.49
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$341.14 |
| Max. Negotiated Rate |
$487.34 |
| Rate for Payer: Aetna Commercial |
$460.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.97
|
| Rate for Payer: Cash Price |
$433.19
|
| Rate for Payer: Cofinity Commercial |
$379.04
|
| Rate for Payer: Cofinity Commercial |
$465.68
|
| Rate for Payer: Healthscope Commercial |
$487.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.27
|
| Rate for Payer: PHP Commercial |
$460.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.04
|
| Rate for Payer: Priority Health SBD |
$341.14
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$55.77
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.41
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.22
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$39.95
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.41
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.22
|
| Rate for Payer: Priority Health SBD |
$147.80
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$370.34
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$333.31 |
| Rate for Payer: Aetna Commercial |
$314.79
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.72
|
| 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 |
$61.52
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cofinity Commercial |
$318.49
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$333.31
|
| 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 |
$314.79
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$314.79
|
| 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 |
$259.24
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$233.31
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$49.12
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
IP
|
$370.34
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$333.31 |
| Rate for Payer: Aetna Commercial |
$314.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.72
|
| Rate for Payer: Cash Price |
$296.27
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Cofinity Commercial |
$318.49
|
| Rate for Payer: Healthscope Commercial |
$333.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.79
|
| Rate for Payer: PHP Commercial |
$314.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.24
|
| Rate for Payer: Priority Health SBD |
$233.31
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$66.64
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$59.98
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC Core |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$59.98 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.88
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$66.64
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health SBD |
$59.98
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$22.80
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna Commercial |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.82
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.38
|
| Rate for Payer: PHP Commercial |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health SBD |
$14.36
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$22.80
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna Commercial |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.82
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.38
|
| Rate for Payer: PHP Commercial |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.96
|
| Rate for Payer: Priority Health SBD |
$14.36
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,615.05
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.39 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,922.79
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,999.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cofinity Commercial |
$3,230.54
|
| Rate for Payer: Cofinity Commercial |
$3,968.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$4,153.54
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,922.79
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,922.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,907.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.43
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$330.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
IP
|
$4,615.05
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,907.48 |
| Max. Negotiated Rate |
$4,153.54 |
| Rate for Payer: Aetna Commercial |
$3,922.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,999.78
|
| Rate for Payer: Cash Price |
$3,692.04
|
| Rate for Payer: Cofinity Commercial |
$3,230.54
|
| Rate for Payer: Cofinity Commercial |
$3,968.94
|
| Rate for Payer: Healthscope Commercial |
$4,153.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,922.79
|
| Rate for Payer: PHP Commercial |
$3,922.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,230.54
|
| Rate for Payer: Priority Health SBD |
$2,907.48
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
IP
|
$3,693.58
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,326.96 |
| Max. Negotiated Rate |
$3,324.22 |
| Rate for Payer: Aetna Commercial |
$3,139.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.83
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cofinity Commercial |
$2,585.51
|
| Rate for Payer: Cofinity Commercial |
$3,176.48
|
| Rate for Payer: Healthscope Commercial |
$3,324.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.54
|
| Rate for Payer: PHP Commercial |
$3,139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.51
|
| Rate for Payer: Priority Health SBD |
$2,326.96
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
OP
|
$3,693.58
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Commercial |
$3,139.54
|
| Rate for Payer: Aetna Medicare |
$2,598.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.94
|
| Rate for Payer: BCBS Complete |
$1,435.05
|
| Rate for Payer: BCBS MAPPO |
$2,498.35
|
| Rate for Payer: BCBS Trust/PPO |
$967.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,498.35
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cash Price |
$2,954.86
|
| Rate for Payer: Cofinity Commercial |
$3,176.48
|
| Rate for Payer: Cofinity Commercial |
$2,585.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,498.35
|
| Rate for Payer: Healthscope Commercial |
$3,324.22
|
| Rate for Payer: Mclaren Medicaid |
$1,366.60
|
| Rate for Payer: Mclaren Medicare |
$2,498.35
|
| Rate for Payer: Meridian Medicaid |
$1,435.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,623.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,873.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.54
|
| Rate for Payer: PACE Medicare |
$2,373.43
|
| Rate for Payer: PACE SWMI |
$2,498.35
|
| Rate for Payer: PHP Commercial |
$3,139.54
|
| Rate for Payer: PHP Medicare Advantage |
$2,498.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,366.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.51
|
| Rate for Payer: Priority Health Medicare |
$2,498.35
|
| Rate for Payer: Priority Health SBD |
$2,326.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2,498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.31
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,498.35
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Medicare Advantage |
$2,573.30
|
| Rate for Payer: VA VA |
$2,498.35
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
OP
|
$4,195.50
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.08 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,566.18
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,727.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cofinity Commercial |
$3,608.13
|
| Rate for Payer: Cofinity Commercial |
$2,936.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,775.95
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,566.18
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,566.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,936.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,643.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.99
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$329.08
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
IP
|
$4,195.50
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,643.16 |
| Max. Negotiated Rate |
$3,775.95 |
| Rate for Payer: Aetna Commercial |
$3,566.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,727.08
|
| Rate for Payer: Cash Price |
$3,356.40
|
| Rate for Payer: Cofinity Commercial |
$2,936.85
|
| Rate for Payer: Cofinity Commercial |
$3,608.13
|
| Rate for Payer: Healthscope Commercial |
$3,775.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,566.18
|
| Rate for Payer: PHP Commercial |
$3,566.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,936.85
|
| Rate for Payer: Priority Health SBD |
$2,643.16
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
IP
|
$682.65
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.07 |
| Max. Negotiated Rate |
$614.38 |
| Rate for Payer: Aetna Commercial |
$580.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.72
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cofinity Commercial |
$477.86
|
| Rate for Payer: Cofinity Commercial |
$587.08
|
| Rate for Payer: Healthscope Commercial |
$614.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.25
|
| Rate for Payer: PHP Commercial |
$580.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.86
|
| Rate for Payer: Priority Health SBD |
$430.07
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$682.65
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.71 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$580.25
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.71
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cash Price |
$546.12
|
| Rate for Payer: Cofinity Commercial |
$587.08
|
| Rate for Payer: Cofinity Commercial |
$477.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$614.38
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$580.25
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$580.25
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$430.07
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
