|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.38
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$88.02
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$55.45 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$74.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.21
|
| Rate for Payer: Cash Price |
$70.42
|
| Rate for Payer: Cofinity Commercial |
$61.61
|
| Rate for Payer: Cofinity Commercial |
$75.70
|
| Rate for Payer: Healthscope Commercial |
$79.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.82
|
| Rate for Payer: PHP Commercial |
$74.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health SBD |
$55.45
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$88.02
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$74.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.21
|
| Rate for Payer: BCBS Complete |
$35.21
|
| Rate for Payer: BCBS Trust/PPO |
$60.76
|
| Rate for Payer: Cash Price |
$70.42
|
| Rate for Payer: Cash Price |
$70.42
|
| Rate for Payer: Cofinity Commercial |
$61.61
|
| Rate for Payer: Cofinity Commercial |
$75.70
|
| Rate for Payer: Healthscope Commercial |
$79.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.82
|
| Rate for Payer: PHP Commercial |
$74.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health SBD |
$55.45
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: BCBS Complete |
$44.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.17
|
| Rate for Payer: UHC Exchange |
$26.52
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health SBD |
$70.69
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,748.90
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.55 |
| Max. Negotiated Rate |
$25,402.85 |
| Rate for Payer: Aetna Commercial |
$2,336.56
|
| Rate for Payer: Aetna Medicare |
$7,861.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,786.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,449.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,449.24
|
| Rate for Payer: BCBS Complete |
$4,342.11
|
| Rate for Payer: BCBS MAPPO |
$7,559.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,183.83
|
| Rate for Payer: BCN Medicare Advantage |
$7,559.39
|
| Rate for Payer: Cash Price |
$2,199.12
|
| Rate for Payer: Cash Price |
$2,199.12
|
| Rate for Payer: Cofinity Commercial |
$2,364.05
|
| Rate for Payer: Cofinity Commercial |
$1,924.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,559.39
|
| Rate for Payer: Healthscope Commercial |
$2,474.01
|
| Rate for Payer: Mclaren Medicaid |
$4,134.99
|
| Rate for Payer: Mclaren Medicare |
$7,559.39
|
| Rate for Payer: Meridian Medicaid |
$4,342.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,937.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,693.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,336.56
|
| Rate for Payer: PACE Medicare |
$7,181.42
|
| Rate for Payer: PACE SWMI |
$7,559.39
|
| Rate for Payer: PHP Commercial |
$2,336.56
|
| Rate for Payer: PHP Medicare Advantage |
$7,559.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,134.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,924.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,402.85
|
| Rate for Payer: Priority Health Medicare |
$7,559.39
|
| Rate for Payer: Priority Health Narrow Network |
$20,322.28
|
| Rate for Payer: Priority Health SBD |
$1,731.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7,559.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,559.39
|
| Rate for Payer: UHC Exchange |
$154.55
|
| Rate for Payer: UHC Medicare Advantage |
$7,786.17
|
| Rate for Payer: VA VA |
$7,559.39
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,748.90
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,731.81 |
| Max. Negotiated Rate |
$2,474.01 |
| Rate for Payer: Aetna Commercial |
$2,336.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,786.78
|
| Rate for Payer: Cash Price |
$2,199.12
|
| Rate for Payer: Cofinity Commercial |
$2,364.05
|
| Rate for Payer: Cofinity Commercial |
$1,924.23
|
| Rate for Payer: Healthscope Commercial |
$2,474.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,336.56
|
| Rate for Payer: PHP Commercial |
$2,336.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,924.23
|
| Rate for Payer: Priority Health SBD |
$1,731.81
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
IP
|
$674.79
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.12 |
| Max. Negotiated Rate |
$607.31 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.61
|
| Rate for Payer: Cash Price |
$539.83
|
| Rate for Payer: Cofinity Commercial |
$472.35
|
| Rate for Payer: Cofinity Commercial |
$580.32
|
| Rate for Payer: Healthscope Commercial |
$607.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.57
|
| Rate for Payer: PHP Commercial |
$573.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.35
|
| Rate for Payer: Priority Health SBD |
$425.12
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$674.79
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.92 |
| Max. Negotiated Rate |
$607.31 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.61
|
| Rate for Payer: BCBS Complete |
$269.92
|
| Rate for Payer: Cash Price |
$539.83
|
| Rate for Payer: Cofinity Commercial |
$472.35
|
| Rate for Payer: Cofinity Commercial |
$580.32
|
| Rate for Payer: Healthscope Commercial |
$607.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.57
|
| Rate for Payer: PHP Commercial |
$573.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.35
|
| Rate for Payer: Priority Health SBD |
$425.12
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$22.55
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.38
|
| Rate for Payer: UHC Exchange |
$33.07
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC TENOTOMY
|
Facility
|
OP
|
$2,835.96
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.75 |
| Max. Negotiated Rate |
$4,301.45 |
| Rate for Payer: Aetna Commercial |
$2,410.57
|
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,843.37
|
| 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 |
$659.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Cash Price |
$2,268.77
|
| Rate for Payer: Cash Price |
$2,268.77
|
| Rate for Payer: Cofinity Commercial |
$2,438.93
|
| Rate for Payer: Cofinity Commercial |
$1,985.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Healthscope Commercial |
$2,552.36
|
| 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 |
$2,410.57
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Commercial |
$2,410.57
|
| 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 |
$1,985.17
|
| 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 |
$1,786.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.82
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$180.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
HC TENOTOMY
|
Facility
|
IP
|
$2,835.96
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,786.65 |
| Max. Negotiated Rate |
$2,552.36 |
| Rate for Payer: Aetna Commercial |
$2,410.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,843.37
|
| Rate for Payer: Cash Price |
$2,268.77
|
| Rate for Payer: Cofinity Commercial |
$1,985.17
|
| Rate for Payer: Cofinity Commercial |
$2,438.93
|
| Rate for Payer: Healthscope Commercial |
$2,552.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,410.57
|
| Rate for Payer: PHP Commercial |
$2,410.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,985.17
|
| Rate for Payer: Priority Health SBD |
$1,786.65
|
|
|
HC TENOTOMY ADDUCTOR OF HIP PERCUTANEOUS
|
Facility
|
IP
|
$4,194.04
|
|
| Hospital Charge Code |
36000096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,642.25 |
| Max. Negotiated Rate |
$3,774.64 |
| Rate for Payer: Aetna Commercial |
$3,564.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,726.13
|
| Rate for Payer: Cash Price |
$3,355.23
|
| Rate for Payer: Cofinity Commercial |
$2,935.83
|
| Rate for Payer: Cofinity Commercial |
$3,606.87
|
| Rate for Payer: Healthscope Commercial |
$3,774.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,564.93
|
| Rate for Payer: PHP Commercial |
$3,564.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.83
|
| Rate for Payer: Priority Health SBD |
$2,642.25
|
|
|
HC TENOTOMY ADDUCTOR OF HIP PERCUTANEOUS
|
Facility
|
OP
|
$4,194.04
|
|
| Hospital Charge Code |
36000096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.62 |
| Max. Negotiated Rate |
$3,774.64 |
| Rate for Payer: Aetna Commercial |
$3,564.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,726.13
|
| Rate for Payer: BCBS Complete |
$1,677.62
|
| Rate for Payer: Cash Price |
$3,355.23
|
| Rate for Payer: Cofinity Commercial |
$2,935.83
|
| Rate for Payer: Cofinity Commercial |
$3,606.87
|
| Rate for Payer: Healthscope Commercial |
$3,774.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,564.93
|
| Rate for Payer: PHP Commercial |
$3,564.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,935.83
|
| Rate for Payer: Priority Health SBD |
$2,642.25
|
|
|
HC TENOTOMY ELBOW LATERAL/MEDIAL PERC
|
Facility
|
IP
|
$4,406.09
|
|
|
Service Code
|
CPT 24357
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,775.84 |
| Max. Negotiated Rate |
$3,965.48 |
| Rate for Payer: Aetna Commercial |
$3,745.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,863.96
|
| Rate for Payer: Cash Price |
$3,524.87
|
| Rate for Payer: Cofinity Commercial |
$3,084.26
|
| Rate for Payer: Cofinity Commercial |
$3,789.24
|
| Rate for Payer: Healthscope Commercial |
$3,965.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,745.18
|
| Rate for Payer: PHP Commercial |
$3,745.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,084.26
|
| Rate for Payer: Priority Health SBD |
$2,775.84
|
|
|
HC TENOTOMY ELBOW LATERAL/MEDIAL PERC
|
Facility
|
OP
|
$4,406.09
|
|
|
Service Code
|
CPT 24357
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.51 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Commercial |
$3,745.18
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,863.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$3,524.87
|
| Rate for Payer: Cash Price |
$3,524.87
|
| Rate for Payer: Cofinity Commercial |
$3,789.24
|
| Rate for Payer: Cofinity Commercial |
$3,084.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$3,965.48
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,745.18
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$3,745.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,084.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Priority Health SBD |
$2,775.84
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$416.51
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
IP
|
$4,406.09
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,775.84 |
| Max. Negotiated Rate |
$3,965.48 |
| Rate for Payer: Aetna Commercial |
$3,745.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,863.96
|
| Rate for Payer: Cash Price |
$3,524.87
|
| Rate for Payer: Cofinity Commercial |
$3,084.26
|
| Rate for Payer: Cofinity Commercial |
$3,789.24
|
| Rate for Payer: Healthscope Commercial |
$3,965.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,745.18
|
| Rate for Payer: PHP Commercial |
$3,745.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,084.26
|
| Rate for Payer: Priority Health SBD |
$2,775.84
|
|
|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
OP
|
$4,406.09
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,762.44 |
| Max. Negotiated Rate |
$3,965.48 |
| Rate for Payer: Aetna Commercial |
$3,745.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,863.96
|
| Rate for Payer: BCBS Complete |
$1,762.44
|
| Rate for Payer: Cash Price |
$3,524.87
|
| Rate for Payer: Cofinity Commercial |
$3,084.26
|
| Rate for Payer: Cofinity Commercial |
$3,789.24
|
| Rate for Payer: Healthscope Commercial |
$3,965.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,745.18
|
| Rate for Payer: PHP Commercial |
$3,745.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,084.26
|
| Rate for Payer: Priority Health SBD |
$2,775.84
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
IP
|
$5,133.30
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,233.98 |
| Max. Negotiated Rate |
$4,619.97 |
| Rate for Payer: Aetna Commercial |
$4,363.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,336.64
|
| Rate for Payer: Cash Price |
$4,106.64
|
| Rate for Payer: Cofinity Commercial |
$3,593.31
|
| Rate for Payer: Cofinity Commercial |
$4,414.64
|
| Rate for Payer: Healthscope Commercial |
$4,619.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,363.30
|
| Rate for Payer: PHP Commercial |
$4,363.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,593.31
|
| Rate for Payer: Priority Health SBD |
$3,233.98
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
OP
|
$5,133.30
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,053.32 |
| Max. Negotiated Rate |
$4,619.97 |
| Rate for Payer: Aetna Commercial |
$4,363.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,336.64
|
| Rate for Payer: BCBS Complete |
$2,053.32
|
| Rate for Payer: Cash Price |
$4,106.64
|
| Rate for Payer: Cofinity Commercial |
$3,593.31
|
| Rate for Payer: Cofinity Commercial |
$4,414.64
|
| Rate for Payer: Healthscope Commercial |
$4,619.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,363.30
|
| Rate for Payer: PHP Commercial |
$4,363.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,593.31
|
| Rate for Payer: Priority Health SBD |
$3,233.98
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
IP
|
$3,664.59
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,308.69 |
| Max. Negotiated Rate |
$3,298.13 |
| Rate for Payer: Aetna Commercial |
$3,114.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,381.98
|
| Rate for Payer: Cash Price |
$2,931.67
|
| Rate for Payer: Cofinity Commercial |
$2,565.21
|
| Rate for Payer: Cofinity Commercial |
$3,151.55
|
| Rate for Payer: Healthscope Commercial |
$3,298.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,114.90
|
| Rate for Payer: PHP Commercial |
$3,114.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,565.21
|
| Rate for Payer: Priority Health SBD |
$2,308.69
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
OP
|
$3,664.59
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,465.84 |
| Max. Negotiated Rate |
$3,298.13 |
| Rate for Payer: Aetna Commercial |
$3,114.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,381.98
|
| Rate for Payer: BCBS Complete |
$1,465.84
|
| Rate for Payer: Cash Price |
$2,931.67
|
| Rate for Payer: Cofinity Commercial |
$2,565.21
|
| Rate for Payer: Cofinity Commercial |
$3,151.55
|
| Rate for Payer: Healthscope Commercial |
$3,298.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,114.90
|
| Rate for Payer: PHP Commercial |
$3,114.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,565.21
|
| Rate for Payer: Priority Health SBD |
$2,308.69
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
IP
|
$3,500.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,205.02 |
| Max. Negotiated Rate |
$3,150.03 |
| Rate for Payer: Aetna Commercial |
$2,975.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.02
|
| Rate for Payer: Cash Price |
$2,800.02
|
| Rate for Payer: Cofinity Commercial |
$2,450.02
|
| Rate for Payer: Cofinity Commercial |
$3,010.03
|
| Rate for Payer: Healthscope Commercial |
$3,150.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.03
|
| Rate for Payer: PHP Commercial |
$2,975.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.02
|
| Rate for Payer: Priority Health SBD |
$2,205.02
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
OP
|
$3,500.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,400.01 |
| Max. Negotiated Rate |
$3,150.03 |
| Rate for Payer: Aetna Commercial |
$2,975.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.02
|
| Rate for Payer: BCBS Complete |
$1,400.01
|
| Rate for Payer: Cash Price |
$2,800.02
|
| Rate for Payer: Cofinity Commercial |
$2,450.02
|
| Rate for Payer: Cofinity Commercial |
$3,010.03
|
| Rate for Payer: Healthscope Commercial |
$3,150.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.03
|
| Rate for Payer: PHP Commercial |
$2,975.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.02
|
| Rate for Payer: Priority Health SBD |
$2,205.02
|
|
