|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$7.62
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.57
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Priority Health Tiered Network |
$11.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.86
|
| Rate for Payer: UHC Core |
$21.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$21.86
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$6.93
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$10.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.88
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$19.88
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$91.58
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$82.42 |
| Rate for Payer: Aetna Commercial |
$77.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.53
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cofinity Advantage |
$64.11
|
| Rate for Payer: Cofinity Commercial |
$78.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.26
|
| Rate for Payer: Healthscope Commercial |
$82.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.69
|
| Rate for Payer: PHP Commercial |
$77.84
|
| Rate for Payer: Priority Health SBD |
$57.70
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$91.58
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$35.99 |
| Max. Negotiated Rate |
$82.42 |
| Rate for Payer: Aetna Commercial |
$77.84
|
| Rate for Payer: Aetna Medicare |
$45.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.53
|
| Rate for Payer: BCBS Complete |
$36.63
|
| Rate for Payer: BCBS Trust/PPO |
$58.12
|
| Rate for Payer: BCN Commercial |
$58.12
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cofinity Advantage |
$64.11
|
| Rate for Payer: Cofinity Commercial |
$78.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.26
|
| Rate for Payer: Healthscope Commercial |
$82.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.69
|
| Rate for Payer: PHP Commercial |
$77.84
|
| Rate for Payer: Priority Health SBD |
$57.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.53
|
| Rate for Payer: UHC Core |
$47.71
|
| Rate for Payer: UHC Exchange |
$35.99
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$116.73
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.87
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Advantage |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$100.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$105.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: PHP Commercial |
$99.22
|
| Rate for Payer: Priority Health SBD |
$73.54
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$116.73
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Medicare |
$58.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.87
|
| Rate for Payer: BCBS Complete |
$46.69
|
| Rate for Payer: BCBS Trust/PPO |
$25.59
|
| Rate for Payer: BCN Commercial |
$25.59
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Advantage |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$100.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$105.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: PHP Commercial |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.00
|
| Rate for Payer: Priority Health SBD |
$73.54
|
| Rate for Payer: Priority Health Tiered Network |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.87
|
| Rate for Payer: UHC Core |
$60.82
|
| Rate for Payer: UHC Exchange |
$45.87
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,859.96
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,123.96 |
| Max. Negotiated Rate |
$26,665.62 |
| Rate for Payer: Aetna Commercial |
$2,430.97
|
| Rate for Payer: Aetna Medicare |
$8,575.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,858.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,307.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,307.04
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$5,518.42
|
| Rate for Payer: BCN Commercial |
$5,518.42
|
| Rate for Payer: BCN Medicare Advantage |
$8,245.63
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cofinity Advantage |
$2,001.97
|
| Rate for Payer: Cofinity Commercial |
$2,459.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,287.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,245.63
|
| Rate for Payer: Healthscope Commercial |
$2,573.96
|
| Rate for Payer: Mclaren Medicaid |
$4,312.46
|
| Rate for Payer: Mclaren Medicare |
$8,245.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,657.91
|
| Rate for Payer: Meridian Medicaid |
$8,657.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,482.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,070.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,430.97
|
| Rate for Payer: Nomi Health Commercial |
$24,736.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,144.97
|
| Rate for Payer: PACE Medicare |
$7,833.35
|
| Rate for Payer: PACE SWMI |
$8,245.63
|
| Rate for Payer: PHP Commercial |
$2,430.97
|
| Rate for Payer: PHP Medicare Advantage |
$8,245.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,312.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,665.62
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health SBD |
$1,801.77
|
| Rate for Payer: Priority Health Tiered Network |
$21,332.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,858.97
|
| Rate for Payer: UHC Core |
$1,490.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,245.63
|
| Rate for Payer: UHC Exchange |
$1,123.96
|
| Rate for Payer: UHC Medicaid |
$4,312.46
|
| Rate for Payer: UHCCP Medicaid |
$4,312.46
|
| Rate for Payer: VA VA |
$8,245.63
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,859.96
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,801.77 |
| Max. Negotiated Rate |
$2,573.96 |
| Rate for Payer: Aetna Commercial |
$2,430.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,858.97
|
| Rate for Payer: Cash Price |
$2,287.97
|
| Rate for Payer: Cofinity Advantage |
$2,001.97
|
| Rate for Payer: Cofinity Commercial |
$2,459.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,287.97
|
| Rate for Payer: Healthscope Commercial |
$2,573.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,430.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,144.97
|
| Rate for Payer: PHP Commercial |
$2,430.97
|
| Rate for Payer: Priority Health SBD |
$1,801.77
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
IP
|
$702.06
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.30 |
| Max. Negotiated Rate |
$631.85 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.34
|
| Rate for Payer: Cash Price |
$561.65
|
| Rate for Payer: Cofinity Advantage |
$491.44
|
| Rate for Payer: Cofinity Commercial |
$603.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.65
|
| Rate for Payer: Healthscope Commercial |
$631.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.54
|
| Rate for Payer: PHP Commercial |
$596.75
|
| Rate for Payer: Priority Health SBD |
$442.30
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$702.06
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.91 |
| Max. Negotiated Rate |
$631.85 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Aetna Medicare |
$351.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.34
|
| Rate for Payer: BCBS Complete |
$280.82
|
| Rate for Payer: Cash Price |
$561.65
|
| Rate for Payer: Cofinity Advantage |
$491.44
|
| Rate for Payer: Cofinity Commercial |
$603.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.65
|
| Rate for Payer: Healthscope Commercial |
$631.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.54
|
| Rate for Payer: PHP Commercial |
$596.75
|
| Rate for Payer: Priority Health SBD |
$442.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.34
|
| Rate for Payer: UHC Core |
$365.77
|
| Rate for Payer: UHC Exchange |
$275.91
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna Medicare |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: BCBS Complete |
$43.30
|
| Rate for Payer: BCBS Trust/PPO |
$30.15
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
| Rate for Payer: Priority Health Tiered Network |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.36
|
| Rate for Payer: UHC Core |
$56.39
|
| Rate for Payer: UHC Exchange |
$42.54
|
|
|
HC TENOTOMY
|
Facility
|
IP
|
$2,950.53
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,858.83 |
| Max. Negotiated Rate |
$2,655.48 |
| Rate for Payer: Aetna Commercial |
$2,507.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.84
|
| Rate for Payer: Cash Price |
$2,360.42
|
| Rate for Payer: Cofinity Advantage |
$2,065.37
|
| Rate for Payer: Cofinity Commercial |
$2,537.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,360.42
|
| Rate for Payer: Healthscope Commercial |
$2,655.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,507.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,212.90
|
| Rate for Payer: PHP Commercial |
$2,507.95
|
| Rate for Payer: Priority Health SBD |
$1,858.83
|
|
|
HC TENOTOMY
|
Facility
|
OP
|
$2,950.53
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$2,507.95
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.84
|
| 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 |
$869.70
|
| Rate for Payer: BCN Commercial |
$869.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$2,360.42
|
| Rate for Payer: Cash Price |
$2,360.42
|
| Rate for Payer: Cash Price |
$2,360.42
|
| Rate for Payer: Cofinity Advantage |
$2,065.37
|
| Rate for Payer: Cofinity Commercial |
$2,537.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,360.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$2,655.48
|
| 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 |
$2,507.95
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,212.90
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$2,507.95
|
| 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 |
$1,858.83
|
| 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 |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
HC TENOTOMY ADDUCTOR OF HIP PERCUTANEOUS
|
Facility
|
IP
|
$4,363.48
|
|
| Hospital Charge Code |
36000096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,748.99 |
| Max. Negotiated Rate |
$3,927.13 |
| Rate for Payer: Aetna Commercial |
$3,708.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,836.26
|
| Rate for Payer: Cash Price |
$3,490.78
|
| Rate for Payer: Cofinity Advantage |
$3,054.44
|
| Rate for Payer: Cofinity Commercial |
$3,752.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,490.78
|
| Rate for Payer: Healthscope Commercial |
$3,927.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,708.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,272.61
|
| Rate for Payer: PHP Commercial |
$3,708.96
|
| Rate for Payer: Priority Health SBD |
$2,748.99
|
|
|
HC TENOTOMY ADDUCTOR OF HIP PERCUTANEOUS
|
Facility
|
OP
|
$4,363.48
|
|
| Hospital Charge Code |
36000096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,745.39 |
| Max. Negotiated Rate |
$3,927.13 |
| Rate for Payer: Aetna Commercial |
$3,708.96
|
| Rate for Payer: Aetna Medicare |
$2,181.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,836.26
|
| Rate for Payer: BCBS Complete |
$1,745.39
|
| Rate for Payer: Cash Price |
$3,490.78
|
| Rate for Payer: Cofinity Advantage |
$3,054.44
|
| Rate for Payer: Cofinity Commercial |
$3,752.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,490.78
|
| Rate for Payer: Healthscope Commercial |
$3,927.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,490.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,708.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,272.61
|
| Rate for Payer: PHP Commercial |
$3,708.96
|
| Rate for Payer: Priority Health SBD |
$2,748.99
|
|
|
HC TENOTOMY ELBOW LATERAL/MEDIAL PERC
|
Facility
|
IP
|
$4,584.09
|
|
|
Service Code
|
CPT 24357
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,887.98 |
| Max. Negotiated Rate |
$4,125.68 |
| Rate for Payer: Aetna Commercial |
$3,896.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,979.66
|
| Rate for Payer: Cash Price |
$3,667.27
|
| Rate for Payer: Cofinity Advantage |
$3,208.86
|
| Rate for Payer: Cofinity Commercial |
$3,942.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,667.27
|
| Rate for Payer: Healthscope Commercial |
$4,125.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,896.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,438.07
|
| Rate for Payer: PHP Commercial |
$3,896.48
|
| Rate for Payer: Priority Health SBD |
$2,887.98
|
|
|
HC TENOTOMY ELBOW LATERAL/MEDIAL PERC
|
Facility
|
OP
|
$4,584.09
|
|
|
Service Code
|
CPT 24357
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,346.71 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$3,896.48
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,979.66
|
| 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 |
$1,346.71
|
| Rate for Payer: BCN Commercial |
$1,346.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$3,667.27
|
| Rate for Payer: Cash Price |
$3,667.27
|
| Rate for Payer: Cash Price |
$3,667.27
|
| Rate for Payer: Cofinity Advantage |
$3,208.86
|
| Rate for Payer: Cofinity Commercial |
$3,942.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,667.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$4,125.68
|
| 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 |
$3,896.48
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,438.07
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,896.48
|
| 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 |
$2,887.98
|
| 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) |
$2,979.66
|
| Rate for Payer: UHC Core |
$2,388.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$1,801.55
|
| 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 TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
IP
|
$4,584.09
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,887.98 |
| Max. Negotiated Rate |
$4,125.68 |
| Rate for Payer: Aetna Commercial |
$3,896.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,979.66
|
| Rate for Payer: Cash Price |
$3,667.27
|
| Rate for Payer: Cofinity Advantage |
$3,208.86
|
| Rate for Payer: Cofinity Commercial |
$3,942.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,667.27
|
| Rate for Payer: Healthscope Commercial |
$4,125.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,896.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,438.07
|
| Rate for Payer: PHP Commercial |
$3,896.48
|
| Rate for Payer: Priority Health SBD |
$2,887.98
|
|
|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
OP
|
$4,584.09
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,833.64 |
| Max. Negotiated Rate |
$4,125.68 |
| Rate for Payer: Aetna Commercial |
$3,896.48
|
| Rate for Payer: Aetna Medicare |
$2,292.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,979.66
|
| Rate for Payer: BCBS Complete |
$1,833.64
|
| Rate for Payer: Cash Price |
$3,667.27
|
| Rate for Payer: Cofinity Advantage |
$3,208.86
|
| Rate for Payer: Cofinity Commercial |
$3,942.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,667.27
|
| Rate for Payer: Healthscope Commercial |
$4,125.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,896.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,438.07
|
| Rate for Payer: PHP Commercial |
$3,896.48
|
| Rate for Payer: Priority Health SBD |
$2,887.98
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
OP
|
$5,340.69
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,136.28 |
| Max. Negotiated Rate |
$4,806.62 |
| Rate for Payer: Aetna Commercial |
$4,539.59
|
| Rate for Payer: Aetna Medicare |
$2,670.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,471.45
|
| Rate for Payer: BCBS Complete |
$2,136.28
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cofinity Advantage |
$3,738.48
|
| Rate for Payer: Cofinity Commercial |
$4,592.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,272.55
|
| Rate for Payer: Healthscope Commercial |
$4,806.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,539.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,005.52
|
| Rate for Payer: PHP Commercial |
$4,539.59
|
| Rate for Payer: Priority Health SBD |
$3,364.63
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
IP
|
$5,340.69
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,364.63 |
| Max. Negotiated Rate |
$4,806.62 |
| Rate for Payer: Aetna Commercial |
$4,539.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,471.45
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cofinity Advantage |
$3,738.48
|
| Rate for Payer: Cofinity Commercial |
$4,592.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,272.55
|
| Rate for Payer: Healthscope Commercial |
$4,806.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,539.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,005.52
|
| Rate for Payer: PHP Commercial |
$4,539.59
|
| Rate for Payer: Priority Health SBD |
$3,364.63
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
IP
|
$3,812.64
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,401.96 |
| Max. Negotiated Rate |
$3,431.38 |
| Rate for Payer: Aetna Commercial |
$3,240.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,478.22
|
| Rate for Payer: Cash Price |
$3,050.11
|
| Rate for Payer: Cofinity Advantage |
$2,668.85
|
| Rate for Payer: Cofinity Commercial |
$3,278.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,050.11
|
| Rate for Payer: Healthscope Commercial |
$3,431.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,240.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,859.48
|
| Rate for Payer: PHP Commercial |
$3,240.74
|
| Rate for Payer: Priority Health SBD |
$2,401.96
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
OP
|
$3,812.64
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,525.06 |
| Max. Negotiated Rate |
$3,431.38 |
| Rate for Payer: Aetna Commercial |
$3,240.74
|
| Rate for Payer: Aetna Medicare |
$1,906.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,478.22
|
| Rate for Payer: BCBS Complete |
$1,525.06
|
| Rate for Payer: Cash Price |
$3,050.11
|
| Rate for Payer: Cofinity Advantage |
$2,668.85
|
| Rate for Payer: Cofinity Commercial |
$3,278.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,050.11
|
| Rate for Payer: Healthscope Commercial |
$3,431.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,050.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,240.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,859.48
|
| Rate for Payer: PHP Commercial |
$3,240.74
|
| Rate for Payer: Priority Health SBD |
$2,401.96
|
|
