|
HC SPLINT SHORT ARM STATIC
|
Facility
|
IP
|
$244.08
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$153.77 |
| Max. Negotiated Rate |
$219.67 |
| Rate for Payer: Aetna Commercial |
$207.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.65
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cofinity Advantage |
$170.86
|
| Rate for Payer: Cofinity Commercial |
$209.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.26
|
| Rate for Payer: Healthscope Commercial |
$219.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.06
|
| Rate for Payer: PHP Commercial |
$207.47
|
| Rate for Payer: Priority Health SBD |
$153.77
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$244.08
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$207.47
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$73.55
|
| Rate for Payer: BCN Commercial |
$73.55
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cofinity Advantage |
$170.86
|
| Rate for Payer: Cofinity Commercial |
$209.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$219.67
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.47
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.06
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$207.47
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$153.77
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.65
|
| Rate for Payer: UHC Core |
$127.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$95.92
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
IP
|
$385.31
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$242.75 |
| Max. Negotiated Rate |
$346.78 |
| Rate for Payer: Aetna Commercial |
$327.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.45
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cofinity Advantage |
$269.72
|
| Rate for Payer: Cofinity Commercial |
$331.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.25
|
| Rate for Payer: Healthscope Commercial |
$346.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.98
|
| Rate for Payer: PHP Commercial |
$327.51
|
| Rate for Payer: Priority Health SBD |
$242.75
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$385.31
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna Commercial |
$327.51
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.45
|
| 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 |
$81.15
|
| Rate for Payer: BCN Commercial |
$81.15
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cofinity Advantage |
$269.72
|
| Rate for Payer: Cofinity Commercial |
$331.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$346.78
|
| 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 |
$327.51
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.98
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$327.51
|
| 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 |
$242.75
|
| 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) |
$250.45
|
| Rate for Payer: UHC Core |
$200.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$151.43
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC SPLINT SUPPLIES MISC
|
Facility
|
IP
|
$76.50
|
|
| Hospital Charge Code |
27200394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Advantage |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.38
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC SPLINT SUPPLIES MISC
|
Facility
|
OP
|
$76.50
|
|
| Hospital Charge Code |
27200394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.73
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Advantage |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.38
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.73
|
| Rate for Payer: UHC Core |
$39.86
|
| Rate for Payer: UHC Exchange |
$30.06
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$13.06
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Advantage |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.38
|
| Rate for Payer: UHC Core |
$51.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$38.92
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Advantage |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health SBD |
$62.40
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$23.73
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$20.17
|
| Rate for Payer: Aetna Medicare |
$11.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.42
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Advantage |
$16.61
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: PHP Commercial |
$20.17
|
| Rate for Payer: Priority Health SBD |
$14.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.87
|
| Rate for Payer: UHC Core |
$11.87
|
| Rate for Payer: UHC Exchange |
$11.87
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$23.73
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$20.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.42
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Advantage |
$16.61
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: PHP Commercial |
$20.17
|
| Rate for Payer: Priority Health SBD |
$14.95
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,942.72
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$4,201.31
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,212.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,164.24
|
| Rate for Payer: BCN Commercial |
$2,164.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cofinity Advantage |
$3,459.90
|
| Rate for Payer: Cofinity Commercial |
$4,250.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,448.45
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.31
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.04
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$4,201.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$3,113.91
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
IP
|
$4,942.72
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,113.91 |
| Max. Negotiated Rate |
$4,448.45 |
| Rate for Payer: Aetna Commercial |
$4,201.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,212.77
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cofinity Advantage |
$3,459.90
|
| Rate for Payer: Cofinity Commercial |
$4,250.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.18
|
| Rate for Payer: Healthscope Commercial |
$4,448.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.04
|
| Rate for Payer: PHP Commercial |
$4,201.31
|
| Rate for Payer: Priority Health SBD |
$3,113.91
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
IP
|
$3,842.80
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,420.96 |
| Max. Negotiated Rate |
$3,458.52 |
| Rate for Payer: Aetna Commercial |
$3,266.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.82
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cofinity Advantage |
$2,689.96
|
| Rate for Payer: Cofinity Commercial |
$3,304.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.24
|
| Rate for Payer: Healthscope Commercial |
$3,458.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,882.10
|
| Rate for Payer: PHP Commercial |
$3,266.38
|
| Rate for Payer: Priority Health SBD |
$2,420.96
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
OP
|
$3,842.80
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,275.55 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Commercial |
$3,266.38
|
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,497.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.55
|
| Rate for Payer: BCN Commercial |
$1,275.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cofinity Advantage |
$2,689.96
|
| Rate for Payer: Cofinity Commercial |
$3,304.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Healthscope Commercial |
$3,458.52
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.38
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,882.10
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Commercial |
$3,266.38
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health SBD |
$2,420.96
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
IP
|
$4,365.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,749.95 |
| Max. Negotiated Rate |
$3,928.50 |
| Rate for Payer: Aetna Commercial |
$3,710.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,837.25
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cofinity Advantage |
$3,055.50
|
| Rate for Payer: Cofinity Commercial |
$3,753.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,492.00
|
| Rate for Payer: Healthscope Commercial |
$3,928.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,710.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,273.75
|
| Rate for Payer: PHP Commercial |
$3,710.25
|
| Rate for Payer: Priority Health SBD |
$2,749.95
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
OP
|
$4,365.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.74 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,710.25
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,837.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.74
|
| Rate for Payer: BCN Commercial |
$1,620.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cash Price |
$3,492.00
|
| Rate for Payer: Cofinity Advantage |
$3,055.50
|
| Rate for Payer: Cofinity Commercial |
$3,753.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,492.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,928.50
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,710.25
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,273.75
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,710.25
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,749.95
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
IP
|
$710.23
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.44 |
| Max. Negotiated Rate |
$639.21 |
| Rate for Payer: Aetna Commercial |
$603.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.65
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cofinity Advantage |
$497.16
|
| Rate for Payer: Cofinity Commercial |
$610.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.18
|
| Rate for Payer: Healthscope Commercial |
$639.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.67
|
| Rate for Payer: PHP Commercial |
$603.70
|
| Rate for Payer: Priority Health SBD |
$447.44
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$710.23
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$603.70
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$105.13
|
| Rate for Payer: BCN Commercial |
$105.13
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cash Price |
$568.18
|
| Rate for Payer: Cofinity Advantage |
$497.16
|
| Rate for Payer: Cofinity Commercial |
$610.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$639.21
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.70
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.67
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$603.70
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$447.44
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
IP
|
$1,118.31
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.54 |
| Max. Negotiated Rate |
$1,006.48 |
| Rate for Payer: Aetna Commercial |
$950.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.90
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cofinity Advantage |
$782.82
|
| Rate for Payer: Cofinity Commercial |
$961.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.65
|
| Rate for Payer: Healthscope Commercial |
$1,006.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.73
|
| Rate for Payer: PHP Commercial |
$950.56
|
| Rate for Payer: Priority Health SBD |
$704.54
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
OP
|
$1,118.31
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.44 |
| Max. Negotiated Rate |
$1,006.48 |
| Rate for Payer: Aetna Commercial |
$950.56
|
| Rate for Payer: Aetna Medicare |
$559.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$726.90
|
| Rate for Payer: BCBS Complete |
$447.32
|
| Rate for Payer: BCBS Trust/PPO |
$437.44
|
| Rate for Payer: BCN Commercial |
$437.44
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cash Price |
$894.65
|
| Rate for Payer: Cofinity Advantage |
$782.82
|
| Rate for Payer: Cofinity Commercial |
$961.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.65
|
| Rate for Payer: Healthscope Commercial |
$1,006.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$894.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.73
|
| Rate for Payer: PHP Commercial |
$950.56
|
| Rate for Payer: Priority Health SBD |
$704.54
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,388.13
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,024.52 |
| Max. Negotiated Rate |
$5,749.32 |
| Rate for Payer: Aetna Commercial |
$5,429.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,152.28
|
| Rate for Payer: Cash Price |
$5,110.50
|
| Rate for Payer: Cofinity Advantage |
$4,471.69
|
| Rate for Payer: Cofinity Commercial |
$5,493.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.50
|
| Rate for Payer: Healthscope Commercial |
$5,749.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.10
|
| Rate for Payer: PHP Commercial |
$5,429.91
|
| Rate for Payer: Priority Health SBD |
$4,024.52
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
OP
|
$6,388.13
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,555.25 |
| Max. Negotiated Rate |
$5,749.32 |
| Rate for Payer: Aetna Commercial |
$5,429.91
|
| Rate for Payer: Aetna Medicare |
$3,194.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,152.28
|
| Rate for Payer: BCBS Complete |
$2,555.25
|
| Rate for Payer: Cash Price |
$5,110.50
|
| Rate for Payer: Cofinity Advantage |
$4,471.69
|
| Rate for Payer: Cofinity Commercial |
$5,493.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,110.50
|
| Rate for Payer: Healthscope Commercial |
$5,749.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,110.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,429.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,791.10
|
| Rate for Payer: PHP Commercial |
$5,429.91
|
| Rate for Payer: Priority Health SBD |
$4,024.52
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
IP
|
$2,493.73
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,571.05 |
| Max. Negotiated Rate |
$2,244.36 |
| Rate for Payer: Aetna Commercial |
$2,119.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.92
|
| Rate for Payer: Cash Price |
$1,994.98
|
| Rate for Payer: Cofinity Advantage |
$1,745.61
|
| Rate for Payer: Cofinity Commercial |
$2,144.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.98
|
| Rate for Payer: Healthscope Commercial |
$2,244.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,870.30
|
| Rate for Payer: PHP Commercial |
$2,119.67
|
| Rate for Payer: Priority Health SBD |
$1,571.05
|
|
|
HC SPYGLASS FORCEPS
|
Facility
|
OP
|
$2,493.73
|
|
| Hospital Charge Code |
27200151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$980.04 |
| Max. Negotiated Rate |
$2,244.36 |
| Rate for Payer: Aetna Commercial |
$2,119.67
|
| Rate for Payer: Aetna Medicare |
$1,246.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.92
|
| Rate for Payer: BCBS Complete |
$997.49
|
| Rate for Payer: Cash Price |
$1,994.98
|
| Rate for Payer: Cofinity Advantage |
$1,745.61
|
| Rate for Payer: Cofinity Commercial |
$2,144.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,994.98
|
| Rate for Payer: Healthscope Commercial |
$2,244.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,994.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,870.30
|
| Rate for Payer: PHP Commercial |
$2,119.67
|
| Rate for Payer: Priority Health SBD |
$1,571.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,620.92
|
| Rate for Payer: UHC Core |
$1,299.23
|
| Rate for Payer: UHC Exchange |
$980.04
|
|
|
HC SP Z ANGIO SUPERSEL ECT RENAL BIL
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
36100350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.74 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.74
|
| Rate for Payer: BCN Commercial |
$1,620.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
