|
HC REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Facility
|
IP
|
$1,927.80
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,214.51 |
| Max. Negotiated Rate |
$1,735.02 |
| Rate for Payer: Aetna Commercial |
$1,638.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.07
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cofinity Advantage |
$1,349.46
|
| Rate for Payer: Cofinity Commercial |
$1,657.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,542.24
|
| Rate for Payer: Healthscope Commercial |
$1,735.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,638.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.85
|
| Rate for Payer: PHP Commercial |
$1,638.63
|
| Rate for Payer: Priority Health SBD |
$1,214.51
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Facility
|
OP
|
$1,927.80
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,735.02 |
| Rate for Payer: Aetna Commercial |
$1,638.63
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$280.32
|
| Rate for Payer: BCN Commercial |
$280.32
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cash Price |
$1,542.24
|
| Rate for Payer: Cofinity Advantage |
$1,349.46
|
| Rate for Payer: Cofinity Commercial |
$1,657.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,542.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,735.02
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,638.63
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.85
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$1,638.63
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$1,214.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.07
|
| Rate for Payer: UHC Core |
$1,004.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$757.63
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5CM
|
Facility
|
OP
|
$1,603.27
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,442.94 |
| Rate for Payer: Aetna Commercial |
$1,362.78
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$478.99
|
| Rate for Payer: BCN Commercial |
$478.99
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cofinity Advantage |
$1,122.29
|
| Rate for Payer: Cofinity Commercial |
$1,378.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,282.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,442.94
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,362.78
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.45
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$1,362.78
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$1,010.06
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.13
|
| Rate for Payer: UHC Core |
$835.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$630.09
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5CM
|
Facility
|
IP
|
$1,603.27
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,010.06 |
| Max. Negotiated Rate |
$1,442.94 |
| Rate for Payer: Aetna Commercial |
$1,362.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.13
|
| Rate for Payer: Cash Price |
$1,282.62
|
| Rate for Payer: Cofinity Advantage |
$1,122.29
|
| Rate for Payer: Cofinity Commercial |
$1,378.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,282.62
|
| Rate for Payer: Healthscope Commercial |
$1,442.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,362.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.45
|
| Rate for Payer: PHP Commercial |
$1,362.78
|
| Rate for Payer: Priority Health SBD |
$1,010.06
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
IP
|
$3,431.75
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,162.00 |
| Max. Negotiated Rate |
$3,088.57 |
| Rate for Payer: Aetna Commercial |
$2,916.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,230.64
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cofinity Advantage |
$2,402.22
|
| Rate for Payer: Cofinity Commercial |
$2,951.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,745.40
|
| Rate for Payer: Healthscope Commercial |
$3,088.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,916.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,573.81
|
| Rate for Payer: PHP Commercial |
$2,916.99
|
| Rate for Payer: Priority Health SBD |
$2,162.00
|
|
|
HC REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<
|
Facility
|
OP
|
$3,431.75
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,025.27 |
| Max. Negotiated Rate |
$3,088.57 |
| Rate for Payer: Aetna Commercial |
$2,916.99
|
| Rate for Payer: Aetna Medicare |
$1,715.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,230.64
|
| Rate for Payer: BCBS Complete |
$1,372.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.27
|
| Rate for Payer: BCN Commercial |
$1,025.27
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cash Price |
$2,745.40
|
| Rate for Payer: Cofinity Advantage |
$2,402.22
|
| Rate for Payer: Cofinity Commercial |
$2,951.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,745.40
|
| Rate for Payer: Healthscope Commercial |
$3,088.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,745.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,916.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,573.81
|
| Rate for Payer: PHP Commercial |
$2,916.99
|
| Rate for Payer: Priority Health SBD |
$2,162.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,230.64
|
| Rate for Payer: UHC Core |
$1,787.94
|
| Rate for Payer: UHC Exchange |
$1,348.68
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
IP
|
$1,090.74
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.17 |
| Max. Negotiated Rate |
$981.67 |
| Rate for Payer: Aetna Commercial |
$927.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.98
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Advantage |
$763.52
|
| Rate for Payer: Cofinity Commercial |
$938.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Healthscope Commercial |
$981.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: PHP Commercial |
$927.13
|
| Rate for Payer: Priority Health SBD |
$687.17
|
|
|
HC REPAIR CVAC WO PORT OR PUMP
|
Facility
|
OP
|
$1,090.74
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
36100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Commercial |
$927.13
|
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$423.27
|
| Rate for Payer: BCN Commercial |
$423.27
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Advantage |
$763.52
|
| Rate for Payer: Cofinity Commercial |
$938.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$981.67
|
| Rate for Payer: Mclaren Medicaid |
$326.90
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$927.13
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health SBD |
$687.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.98
|
| Rate for Payer: UHC Core |
$568.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Exchange |
$428.66
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC REPAIR ECTROPION EXTENSIVE
|
Facility
|
IP
|
$4,403.39
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,774.14 |
| Max. Negotiated Rate |
$3,963.05 |
| Rate for Payer: Aetna Commercial |
$3,742.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.20
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cofinity Advantage |
$3,082.37
|
| Rate for Payer: Cofinity Commercial |
$3,786.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,522.71
|
| Rate for Payer: Healthscope Commercial |
$3,963.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,742.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,302.54
|
| Rate for Payer: PHP Commercial |
$3,742.88
|
| Rate for Payer: Priority Health SBD |
$2,774.14
|
|
|
HC REPAIR ECTROPION EXTENSIVE
|
Facility
|
OP
|
$4,403.39
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
76100568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,171.11 |
| Max. Negotiated Rate |
$7,660.92 |
| Rate for Payer: Aetna Commercial |
$3,742.88
|
| Rate for Payer: Aetna Medicare |
$2,463.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,961.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,961.18
|
| Rate for Payer: BCBS Complete |
$1,301.02
|
| Rate for Payer: BCBS MAPPO |
$2,368.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.11
|
| Rate for Payer: BCN Commercial |
$1,171.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,368.94
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cash Price |
$3,522.71
|
| Rate for Payer: Cofinity Advantage |
$3,082.37
|
| Rate for Payer: Cofinity Commercial |
$3,786.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,522.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,368.94
|
| Rate for Payer: Healthscope Commercial |
$3,963.05
|
| Rate for Payer: Mclaren Medicaid |
$1,238.96
|
| Rate for Payer: Mclaren Medicare |
$2,368.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,487.39
|
| Rate for Payer: Meridian Medicaid |
$2,487.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,724.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,605.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,742.88
|
| Rate for Payer: Nomi Health Commercial |
$7,106.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,302.54
|
| Rate for Payer: PACE Medicare |
$2,250.49
|
| Rate for Payer: PACE SWMI |
$2,368.94
|
| Rate for Payer: PHP Commercial |
$3,742.88
|
| Rate for Payer: PHP Medicare Advantage |
$2,368.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,238.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,660.92
|
| Rate for Payer: Priority Health Medicare |
$2,368.94
|
| Rate for Payer: Priority Health SBD |
$2,774.14
|
| Rate for Payer: Priority Health Tiered Network |
$6,128.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,368.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,862.20
|
| Rate for Payer: UHC Core |
$2,294.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,368.94
|
| Rate for Payer: UHC Exchange |
$1,730.53
|
| Rate for Payer: UHC Medicaid |
$1,238.96
|
| Rate for Payer: UHCCP Medicaid |
$1,238.96
|
| Rate for Payer: VA VA |
$2,368.94
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
OP
|
$4,729.92
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$4,020.43
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.16
|
| Rate for Payer: BCN Commercial |
$1,850.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cofinity Advantage |
$3,310.94
|
| Rate for Payer: Cofinity Commercial |
$4,067.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$4,256.93
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,547.44
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$4,020.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$2,979.85
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC REPAIR EXT TENDON FINGER WO GRAFT EA
|
Facility
|
IP
|
$4,729.92
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,979.85 |
| Max. Negotiated Rate |
$4,256.93 |
| Rate for Payer: Aetna Commercial |
$4,020.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,074.45
|
| Rate for Payer: Cash Price |
$3,783.94
|
| Rate for Payer: Cofinity Advantage |
$3,310.94
|
| Rate for Payer: Cofinity Commercial |
$4,067.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,783.94
|
| Rate for Payer: Healthscope Commercial |
$4,256.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,020.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,547.44
|
| Rate for Payer: PHP Commercial |
$4,020.43
|
| Rate for Payer: Priority Health SBD |
$2,979.85
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
OP
|
$4,377.79
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$3,721.12
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,845.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.73
|
| Rate for Payer: BCN Commercial |
$1,061.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cofinity Advantage |
$3,064.45
|
| Rate for Payer: Cofinity Commercial |
$3,764.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,502.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$3,940.01
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,721.12
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,283.34
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$3,721.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$2,758.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,845.56
|
| Rate for Payer: UHC Core |
$2,280.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Exchange |
$1,720.47
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC REPAIR FINGER TENDON
|
Facility
|
IP
|
$4,377.79
|
|
|
Service Code
|
CPT 26432
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,758.01 |
| Max. Negotiated Rate |
$3,940.01 |
| Rate for Payer: Aetna Commercial |
$3,721.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,845.56
|
| Rate for Payer: Cash Price |
$3,502.23
|
| Rate for Payer: Cofinity Advantage |
$3,064.45
|
| Rate for Payer: Cofinity Commercial |
$3,764.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,502.23
|
| Rate for Payer: Healthscope Commercial |
$3,940.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,721.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,283.34
|
| Rate for Payer: PHP Commercial |
$3,721.12
|
| Rate for Payer: Priority Health SBD |
$2,758.01
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20CM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
76100567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.02 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Aetna Commercial |
$895.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.10
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cofinity Advantage |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.20
|
| Rate for Payer: Healthscope Commercial |
$948.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.50
|
| Rate for Payer: PHP Commercial |
$895.90
|
| Rate for Payer: Priority Health SBD |
$664.02
|
|
|
HC REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20CM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
76100567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$895.90
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$280.32
|
| Rate for Payer: BCN Commercial |
$280.32
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Cofinity Advantage |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$948.60
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.90
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$790.50
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$895.90
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$664.02
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.10
|
| Rate for Payer: UHC Core |
$549.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$414.22
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC REPAIR LIP AND BORDER
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$988.47 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Aetna Commercial |
$1,333.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.85
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cofinity Advantage |
$1,098.30
|
| Rate for Payer: Cofinity Commercial |
$1,349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.20
|
| Rate for Payer: Healthscope Commercial |
$1,412.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,176.75
|
| Rate for Payer: PHP Commercial |
$1,333.65
|
| Rate for Payer: Priority Health SBD |
$988.47
|
|
|
HC REPAIR LIP AND BORDER
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,333.65
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$497.64
|
| Rate for Payer: BCN Commercial |
$497.64
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cofinity Advantage |
$1,098.30
|
| Rate for Payer: Cofinity Commercial |
$1,349.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,255.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,412.10
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,333.65
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,176.75
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,333.65
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$988.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,019.85
|
| Rate for Payer: UHC Core |
$817.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$616.62
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC REPAIR OF CIRCUMCISION
|
Facility
|
IP
|
$5,930.28
|
|
|
Service Code
|
CPT 54163
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,736.08 |
| Max. Negotiated Rate |
$5,337.25 |
| Rate for Payer: Aetna Commercial |
$5,040.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,854.68
|
| Rate for Payer: Cash Price |
$4,744.22
|
| Rate for Payer: Cofinity Advantage |
$4,151.20
|
| Rate for Payer: Cofinity Commercial |
$5,100.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,744.22
|
| Rate for Payer: Healthscope Commercial |
$5,337.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,040.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,447.71
|
| Rate for Payer: PHP Commercial |
$5,040.74
|
| Rate for Payer: Priority Health SBD |
$3,736.08
|
|
|
HC REPAIR OF CIRCUMCISION
|
Facility
|
OP
|
$5,930.28
|
|
|
Service Code
|
CPT 54163
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$5,040.74
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,854.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,897.55
|
| Rate for Payer: BCN Commercial |
$1,897.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$4,744.22
|
| Rate for Payer: Cash Price |
$4,744.22
|
| Rate for Payer: Cash Price |
$4,744.22
|
| Rate for Payer: Cofinity Advantage |
$4,151.20
|
| Rate for Payer: Cofinity Commercial |
$5,100.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,744.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$5,337.25
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,040.74
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,447.71
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$5,040.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$3,736.08
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,854.68
|
| Rate for Payer: UHC Core |
$3,089.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$2,330.60
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC REPAIR SINGLE ELECTRODE PACEMAKER OR ICD
|
Facility
|
OP
|
$4,983.22
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
36100569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,583.65 |
| Max. Negotiated Rate |
$12,041.54 |
| Rate for Payer: Aetna Commercial |
$4,235.74
|
| Rate for Payer: Aetna Medicare |
$3,872.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,239.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,654.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,654.40
|
| Rate for Payer: BCBS Complete |
$2,044.96
|
| Rate for Payer: BCBS MAPPO |
$3,723.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.65
|
| Rate for Payer: BCN Commercial |
$1,583.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,723.52
|
| Rate for Payer: Cash Price |
$3,986.58
|
| Rate for Payer: Cash Price |
$3,986.58
|
| Rate for Payer: Cash Price |
$3,986.58
|
| Rate for Payer: Cofinity Advantage |
$3,488.25
|
| Rate for Payer: Cofinity Commercial |
$4,285.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,986.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,723.52
|
| Rate for Payer: Healthscope Commercial |
$4,484.90
|
| Rate for Payer: Mclaren Medicaid |
$1,947.40
|
| Rate for Payer: Mclaren Medicare |
$3,723.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,909.70
|
| Rate for Payer: Meridian Medicaid |
$3,909.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,282.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,095.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,235.74
|
| Rate for Payer: Nomi Health Commercial |
$11,170.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,737.41
|
| Rate for Payer: PACE Medicare |
$3,537.34
|
| Rate for Payer: PACE SWMI |
$3,723.52
|
| Rate for Payer: PHP Commercial |
$4,235.74
|
| Rate for Payer: PHP Medicare Advantage |
$3,723.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,947.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,041.54
|
| Rate for Payer: Priority Health Medicare |
$3,723.52
|
| Rate for Payer: Priority Health SBD |
$3,139.43
|
| Rate for Payer: Priority Health Tiered Network |
$9,633.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,723.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,723.52
|
| Rate for Payer: UHC Medicaid |
$1,947.40
|
| Rate for Payer: UHCCP Medicaid |
$1,947.40
|
| Rate for Payer: VA VA |
$3,723.52
|
|
|
HC REPAIR SINGLE ELECTRODE PACEMAKER OR ICD
|
Facility
|
IP
|
$4,983.22
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
36100569
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,139.43 |
| Max. Negotiated Rate |
$4,484.90 |
| Rate for Payer: Aetna Commercial |
$4,235.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,239.09
|
| Rate for Payer: Cash Price |
$3,986.58
|
| Rate for Payer: Cofinity Advantage |
$3,488.25
|
| Rate for Payer: Cofinity Commercial |
$4,285.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,986.58
|
| Rate for Payer: Healthscope Commercial |
$4,484.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,235.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,737.41
|
| Rate for Payer: PHP Commercial |
$4,235.74
|
| Rate for Payer: Priority Health SBD |
$3,139.43
|
|
|
HC REPAIR SPICA/BODY CAST
|
Facility
|
OP
|
$197.79
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
70000017
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna Commercial |
$168.12
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$56.22
|
| Rate for Payer: BCN Commercial |
$56.22
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cofinity Advantage |
$138.45
|
| Rate for Payer: Cofinity Commercial |
$170.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$178.01
|
| Rate for Payer: Mclaren Medicaid |
$84.68
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$170.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.12
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.34
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$168.12
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health SBD |
$124.61
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.56
|
| Rate for Payer: UHC Core |
$103.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$77.73
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC REPAIR SPICA/BODY CAST
|
Facility
|
IP
|
$197.79
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
70000017
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$178.01 |
| Rate for Payer: Aetna Commercial |
$168.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.56
|
| Rate for Payer: Cash Price |
$158.23
|
| Rate for Payer: Cofinity Advantage |
$138.45
|
| Rate for Payer: Cofinity Commercial |
$170.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.23
|
| Rate for Payer: Healthscope Commercial |
$178.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.34
|
| Rate for Payer: PHP Commercial |
$168.12
|
| Rate for Payer: Priority Health SBD |
$124.61
|
|
|
HC REPAIR TENDON HAND/FINGER
|
Facility
|
OP
|
$4,299.26
|
|
| Hospital Charge Code |
45000096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$3,869.33 |
| Rate for Payer: Aetna Commercial |
$3,654.37
|
| Rate for Payer: Aetna Medicare |
$2,149.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,794.52
|
| Rate for Payer: BCBS Complete |
$1,719.70
|
| Rate for Payer: Cash Price |
$3,439.41
|
| Rate for Payer: Cash Price |
$3,439.41
|
| Rate for Payer: Cofinity Advantage |
$3,009.48
|
| Rate for Payer: Cofinity Commercial |
$3,697.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,439.41
|
| Rate for Payer: Healthscope Commercial |
$3,869.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,439.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,654.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,224.45
|
| Rate for Payer: PHP Commercial |
$3,654.37
|
| Rate for Payer: Priority Health SBD |
$2,708.53
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
