|
HC OR SEDATION PER MINUTE
|
Facility
|
OP
|
$14.28
|
|
| Hospital Charge Code |
37000026
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.28
|
| Rate for Payer: UHC Core |
$7.44
|
| Rate for Payer: UHC Exchange |
$5.61
|
|
|
HC OR SEDATION PER MINUTE
|
Facility
|
IP
|
$14.28
|
|
| Hospital Charge Code |
37000026
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health SBD |
$9.00
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
IP
|
$125.74
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$113.17 |
| Rate for Payer: Aetna Commercial |
$106.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.73
|
| Rate for Payer: Cash Price |
$100.59
|
| Rate for Payer: Cofinity Advantage |
$88.02
|
| Rate for Payer: Cofinity Commercial |
$108.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.59
|
| Rate for Payer: Healthscope Commercial |
$113.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.31
|
| Rate for Payer: PHP Commercial |
$106.88
|
| Rate for Payer: Priority Health SBD |
$79.22
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$125.74
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$106.88
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$54.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$100.59
|
| Rate for Payer: Cash Price |
$100.59
|
| Rate for Payer: Cofinity Advantage |
$88.02
|
| Rate for Payer: Cofinity Commercial |
$108.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$113.17
|
| Rate for Payer: Mclaren Medicaid |
$26.84
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.88
|
| Rate for Payer: Nomi Health Commercial |
$153.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.31
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$106.88
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.31
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$79.22
|
| Rate for Payer: Priority Health Tiered Network |
$41.05
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.97
|
| Rate for Payer: UHC Core |
$76.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$76.97
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$54.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$26.84
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$153.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.31
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Priority Health Tiered Network |
$41.05
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.97
|
| Rate for Payer: UHC Core |
$76.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$76.97
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
OP
|
$149.64
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.19
|
| Rate for Payer: Aetna Medicare |
$74.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.27
|
| Rate for Payer: BCBS Complete |
$59.86
|
| Rate for Payer: BCBS Trust/PPO |
$70.43
|
| Rate for Payer: BCN Commercial |
$70.43
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cofinity Advantage |
$104.75
|
| Rate for Payer: Cofinity Commercial |
$128.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.71
|
| Rate for Payer: Healthscope Commercial |
$134.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.19
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.23
|
| Rate for Payer: PHP Commercial |
$127.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.32
|
| Rate for Payer: Priority Health SBD |
$94.27
|
| Rate for Payer: Priority Health Tiered Network |
$39.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.27
|
| Rate for Payer: UHC Core |
$77.96
|
| Rate for Payer: UHC Exchange |
$58.81
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
IP
|
$149.64
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$94.27 |
| Max. Negotiated Rate |
$134.68 |
| Rate for Payer: Aetna Commercial |
$127.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.27
|
| Rate for Payer: Cash Price |
$119.71
|
| Rate for Payer: Cofinity Advantage |
$104.75
|
| Rate for Payer: Cofinity Commercial |
$128.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.71
|
| Rate for Payer: Healthscope Commercial |
$134.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.23
|
| Rate for Payer: PHP Commercial |
$127.19
|
| Rate for Payer: Priority Health SBD |
$94.27
|
|
|
HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN
|
Facility
|
OP
|
$137.09
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: BCBS Complete |
$54.84
|
| Rate for Payer: BCBS Trust/PPO |
$64.53
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Advantage |
$95.96
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36.00
|
| Rate for Payer: Priority Health SBD |
$86.37
|
| Rate for Payer: Priority Health Tiered Network |
$28.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.11
|
| Rate for Payer: UHC Core |
$71.42
|
| Rate for Payer: UHC Exchange |
$53.88
|
|
|
HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN
|
Facility
|
IP
|
$137.09
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Advantage |
$95.96
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health SBD |
$86.37
|
|
|
HC OSCILLATOR INIT DAY
|
Facility
|
IP
|
$2,458.59
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,548.91 |
| Max. Negotiated Rate |
$2,212.73 |
| Rate for Payer: Aetna Commercial |
$2,089.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.08
|
| Rate for Payer: Cash Price |
$1,966.87
|
| Rate for Payer: Cofinity Advantage |
$1,721.01
|
| Rate for Payer: Cofinity Commercial |
$2,114.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.87
|
| Rate for Payer: Healthscope Commercial |
$2,212.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,843.94
|
| Rate for Payer: PHP Commercial |
$2,089.80
|
| Rate for Payer: Priority Health SBD |
$1,548.91
|
|
|
HC OSCILLATOR INIT DAY
|
Facility
|
OP
|
$2,458.59
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$2,212.73 |
| Rate for Payer: Aetna Commercial |
$2,089.80
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$84.39
|
| Rate for Payer: BCN Commercial |
$84.39
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,966.87
|
| Rate for Payer: Cash Price |
$1,966.87
|
| Rate for Payer: Cofinity Advantage |
$1,721.01
|
| Rate for Payer: Cofinity Commercial |
$2,114.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$2,212.73
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.80
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,843.94
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$2,089.80
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$1,548.91
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,598.08
|
| Rate for Payer: UHC Core |
$1,280.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$966.23
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC OSCILLATOR SUB DAY
|
Facility
|
IP
|
$1,375.25
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$866.41 |
| Max. Negotiated Rate |
$1,237.72 |
| Rate for Payer: Aetna Commercial |
$1,168.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.91
|
| Rate for Payer: Cash Price |
$1,100.20
|
| Rate for Payer: Cofinity Advantage |
$962.67
|
| Rate for Payer: Cofinity Commercial |
$1,182.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.20
|
| Rate for Payer: Healthscope Commercial |
$1,237.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,168.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,031.44
|
| Rate for Payer: PHP Commercial |
$1,168.96
|
| Rate for Payer: Priority Health SBD |
$866.41
|
|
|
HC OSCILLATOR SUB DAY
|
Facility
|
OP
|
$1,375.25
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$1,990.71 |
| Rate for Payer: Aetna Commercial |
$1,168.96
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$62.18
|
| Rate for Payer: BCN Commercial |
$62.18
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,100.20
|
| Rate for Payer: Cash Price |
$1,100.20
|
| Rate for Payer: Cofinity Advantage |
$962.67
|
| Rate for Payer: Cofinity Commercial |
$1,182.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,237.72
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,168.96
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,031.44
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$1,168.96
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$866.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$893.91
|
| Rate for Payer: UHC Core |
$716.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$540.47
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
OP
|
$56.04
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
30100378
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$50.44 |
| Rate for Payer: Aetna Commercial |
$47.63
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: BCBS Complete |
$3.63
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$7.05
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$44.83
|
| Rate for Payer: Cash Price |
$44.83
|
| Rate for Payer: Cofinity Advantage |
$39.23
|
| Rate for Payer: Cofinity Commercial |
$48.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.63
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.03
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$47.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health SBD |
$35.31
|
| Rate for Payer: Priority Health Tiered Network |
$5.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.92
|
| Rate for Payer: UHC Core |
$9.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.61
|
| Rate for Payer: UHC Exchange |
$9.92
|
| Rate for Payer: UHC Medicaid |
$3.46
|
| Rate for Payer: UHCCP Medicaid |
$3.46
|
| Rate for Payer: VA VA |
$6.61
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
IP
|
$56.04
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
30100378
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.31 |
| Max. Negotiated Rate |
$50.44 |
| Rate for Payer: Aetna Commercial |
$47.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.43
|
| Rate for Payer: Cash Price |
$44.83
|
| Rate for Payer: Cofinity Advantage |
$39.23
|
| Rate for Payer: Cofinity Commercial |
$48.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.83
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.03
|
| Rate for Payer: PHP Commercial |
$47.63
|
| Rate for Payer: Priority Health SBD |
$35.31
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$54.94
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
30100379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$49.45 |
| Rate for Payer: Aetna Commercial |
$46.70
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.53
|
| Rate for Payer: BCBS Complete |
$3.75
|
| Rate for Payer: BCBS MAPPO |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$7.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.82
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Advantage |
$38.46
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.82
|
| Rate for Payer: Healthscope Commercial |
$49.45
|
| Rate for Payer: Mclaren Medicaid |
$3.57
|
| Rate for Payer: Mclaren Medicare |
$6.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.16
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.20
|
| Rate for Payer: PACE Medicare |
$6.48
|
| Rate for Payer: PACE SWMI |
$6.82
|
| Rate for Payer: PHP Commercial |
$46.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.82
|
| Rate for Payer: Priority Health Medicare |
$6.82
|
| Rate for Payer: Priority Health SBD |
$34.61
|
| Rate for Payer: Priority Health Tiered Network |
$5.46
|
| Rate for Payer: Railroad Medicare Medicare |
$6.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.23
|
| Rate for Payer: UHC Core |
$10.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.82
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UHC Medicaid |
$3.57
|
| Rate for Payer: UHCCP Medicaid |
$3.57
|
| Rate for Payer: VA VA |
$6.82
|
|
|
HC OSMOLALITY URINE
|
Facility
|
IP
|
$54.94
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
30100379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$49.45 |
| Rate for Payer: Aetna Commercial |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Advantage |
$38.46
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Healthscope Commercial |
$49.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.20
|
| Rate for Payer: PHP Commercial |
$46.70
|
| Rate for Payer: Priority Health SBD |
$34.61
|
|
|
HC OSMOTIC FRAGILITY RBC
|
Facility
|
OP
|
$134.05
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
30500052
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Aetna Commercial |
$113.94
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.70
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$14.24
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.36
|
| Rate for Payer: Cash Price |
$107.24
|
| Rate for Payer: Cash Price |
$107.24
|
| Rate for Payer: Cofinity Advantage |
$93.83
|
| Rate for Payer: Cofinity Commercial |
$115.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$120.64
|
| Rate for Payer: Mclaren Medicaid |
$6.99
|
| Rate for Payer: Mclaren Medicare |
$13.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.03
|
| Rate for Payer: Meridian Medicaid |
$14.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.94
|
| Rate for Payer: Nomi Health Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.54
|
| Rate for Payer: PACE Medicare |
$12.69
|
| Rate for Payer: PACE SWMI |
$13.36
|
| Rate for Payer: PHP Commercial |
$113.94
|
| Rate for Payer: PHP Medicare Advantage |
$13.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.36
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: Priority Health SBD |
$84.45
|
| Rate for Payer: Priority Health Tiered Network |
$10.69
|
| Rate for Payer: Railroad Medicare Medicare |
$13.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.04
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.36
|
| Rate for Payer: UHC Exchange |
$20.04
|
| Rate for Payer: UHC Medicaid |
$6.99
|
| Rate for Payer: UHCCP Medicaid |
$6.99
|
| Rate for Payer: VA VA |
$13.36
|
|
|
HC OSMOTIC FRAGILITY RBC
|
Facility
|
IP
|
$134.05
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
30500052
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$120.64 |
| Rate for Payer: Aetna Commercial |
$113.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.13
|
| Rate for Payer: Cash Price |
$107.24
|
| Rate for Payer: Cofinity Advantage |
$93.83
|
| Rate for Payer: Cofinity Commercial |
$115.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.24
|
| Rate for Payer: Healthscope Commercial |
$120.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.54
|
| Rate for Payer: PHP Commercial |
$113.94
|
| Rate for Payer: Priority Health SBD |
$84.45
|
|
|
HC OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Facility
|
IP
|
$8,531.28
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
76100365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,374.71 |
| Max. Negotiated Rate |
$7,678.15 |
| Rate for Payer: Aetna Commercial |
$7,251.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,545.33
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Advantage |
$5,971.90
|
| Rate for Payer: Cofinity Commercial |
$7,336.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Healthscope Commercial |
$7,678.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: PHP Commercial |
$7,251.59
|
| Rate for Payer: Priority Health SBD |
$5,374.71
|
|
|
HC OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Facility
|
OP
|
$8,531.28
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
76100365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$7,251.59
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,545.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.52
|
| Rate for Payer: BCN Commercial |
$1,395.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Advantage |
$5,971.90
|
| Rate for Payer: Cofinity Commercial |
$7,336.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$7,678.15
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$7,251.59
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$5,374.71
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,545.33
|
| Rate for Payer: UHC Core |
$4,444.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$3,352.79
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC OSTECTOMY COMPLETE 2,3 OR 4TH METATARSAL HEAD
|
Facility
|
OP
|
$8,531.28
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$7,251.59
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,545.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.52
|
| Rate for Payer: BCN Commercial |
$1,395.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Advantage |
$5,971.90
|
| Rate for Payer: Cofinity Commercial |
$7,336.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$7,678.15
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$7,251.59
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$5,374.71
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,545.33
|
| Rate for Payer: UHC Core |
$4,444.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$3,352.79
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC OSTECTOMY COMPLETE 2,3 OR 4TH METATARSAL HEAD
|
Facility
|
IP
|
$8,531.28
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
76100366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,374.71 |
| Max. Negotiated Rate |
$7,678.15 |
| Rate for Payer: Aetna Commercial |
$7,251.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,545.33
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Advantage |
$5,971.90
|
| Rate for Payer: Cofinity Commercial |
$7,336.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Healthscope Commercial |
$7,678.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: PHP Commercial |
$7,251.59
|
| Rate for Payer: Priority Health SBD |
$5,374.71
|
|
|
HC OSTECTOMY COMPLETE 5TH METATARSAL HEAD
|
Facility
|
OP
|
$8,531.28
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
76100367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$7,251.59
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,545.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.52
|
| Rate for Payer: BCN Commercial |
$1,395.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cash Price |
$6,825.02
|
| Rate for Payer: Cofinity Advantage |
$5,971.90
|
| Rate for Payer: Cofinity Commercial |
$7,336.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,825.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$7,678.15
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,251.59
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,398.46
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$7,251.59
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$5,374.71
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,545.33
|
| Rate for Payer: UHC Core |
$4,444.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$3,352.79
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
