|
HC ST JUDE ICD SINGLE
|
Facility
|
IP
|
$14,066.21
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,861.71 |
| Max. Negotiated Rate |
$12,659.59 |
| Rate for Payer: Aetna Commercial |
$11,956.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,143.04
|
| Rate for Payer: Cash Price |
$11,252.97
|
| Rate for Payer: Cofinity Commercial |
$12,096.94
|
| Rate for Payer: Cofinity Commercial |
$9,846.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,846.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,252.97
|
| Rate for Payer: Healthscope Commercial |
$12,659.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,956.28
|
| Rate for Payer: PHP Commercial |
$11,956.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,143.04
|
| Rate for Payer: Priority Health SBD |
$8,861.71
|
|
|
HC ST JUDE SINGLE PACEMAKER
|
Facility
|
IP
|
$7,178.76
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500011
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,522.62 |
| Max. Negotiated Rate |
$6,460.88 |
| Rate for Payer: Aetna Commercial |
$6,101.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,666.19
|
| Rate for Payer: Cash Price |
$5,743.01
|
| Rate for Payer: Cofinity Commercial |
$5,025.13
|
| Rate for Payer: Cofinity Commercial |
$6,173.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,025.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,743.01
|
| Rate for Payer: Healthscope Commercial |
$6,460.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,101.95
|
| Rate for Payer: PHP Commercial |
$6,101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,666.19
|
| Rate for Payer: Priority Health SBD |
$4,522.62
|
|
|
HC ST JUDE SINGLE PACEMAKER
|
Facility
|
OP
|
$7,178.76
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500011
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,871.50 |
| Max. Negotiated Rate |
$6,460.88 |
| Rate for Payer: Aetna Commercial |
$6,101.95
|
| Rate for Payer: Aetna Medicare |
$3,589.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,666.19
|
| Rate for Payer: BCBS Complete |
$2,871.50
|
| Rate for Payer: Cash Price |
$5,743.01
|
| Rate for Payer: Cofinity Commercial |
$5,025.13
|
| Rate for Payer: Cofinity Commercial |
$6,173.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,025.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,743.01
|
| Rate for Payer: Healthscope Commercial |
$6,460.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,101.95
|
| Rate for Payer: PHP Commercial |
$6,101.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,666.19
|
| Rate for Payer: Priority Health SBD |
$4,522.62
|
|
|
HC ST JUDE TACHY (ICD) LEAD
|
Facility
|
OP
|
$8,164.72
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,265.89 |
| Max. Negotiated Rate |
$7,348.25 |
| Rate for Payer: Aetna Commercial |
$6,940.01
|
| Rate for Payer: Aetna Medicare |
$4,082.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,307.07
|
| Rate for Payer: BCBS Complete |
$3,265.89
|
| Rate for Payer: Cash Price |
$6,531.78
|
| Rate for Payer: Cofinity Commercial |
$5,715.30
|
| Rate for Payer: Cofinity Commercial |
$7,021.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,715.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,531.78
|
| Rate for Payer: Healthscope Commercial |
$7,348.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,940.01
|
| Rate for Payer: PHP Commercial |
$6,940.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,307.07
|
| Rate for Payer: Priority Health SBD |
$5,143.77
|
|
|
HC ST JUDE TACHY (ICD) LEAD
|
Facility
|
IP
|
$8,164.72
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,143.77 |
| Max. Negotiated Rate |
$7,348.25 |
| Rate for Payer: Aetna Commercial |
$6,940.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,307.07
|
| Rate for Payer: Cash Price |
$6,531.78
|
| Rate for Payer: Cofinity Commercial |
$5,715.30
|
| Rate for Payer: Cofinity Commercial |
$7,021.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,715.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,531.78
|
| Rate for Payer: Healthscope Commercial |
$7,348.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,940.01
|
| Rate for Payer: PHP Commercial |
$6,940.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,307.07
|
| Rate for Payer: Priority Health SBD |
$5,143.77
|
|
|
HC STOOL CULTURE
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
30600073
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$5.31
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC STOOL CULTURE
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
30600073
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
HC STOOL CULTURE CMPT
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
30600074
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
HC STOOL CULTURE CMPT
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
30600074
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$5.31
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC STOOL CULTURE CMPT2
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600069
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$9.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.66
|
| Rate for Payer: Priority Health SBD |
$8.39
|
|
|
HC STOOL CULTURE CMPT2
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600069
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$9.32
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: PACE Medicare |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.66
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health SBD |
$8.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
| Rate for Payer: UHCCP Medicaid |
$3.76
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC STOOL CULTURE CMPT 3
|
Facility
|
OP
|
$42.55
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600177
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Aetna Commercial |
$36.17
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Cofinity Commercial |
$36.59
|
| Rate for Payer: Cofinity Commercial |
$29.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$38.30
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.17
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$36.17
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.66
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$26.81
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.07
|
| Rate for Payer: UHCCP Medicaid |
$9.05
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC STOOL CULTURE CMPT 3
|
Facility
|
IP
|
$42.55
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600177
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Aetna Commercial |
$36.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.66
|
| Rate for Payer: Cash Price |
$34.04
|
| Rate for Payer: Cofinity Commercial |
$29.79
|
| Rate for Payer: Cofinity Commercial |
$36.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.04
|
| Rate for Payer: Healthscope Commercial |
$38.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.17
|
| Rate for Payer: PHP Commercial |
$36.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.66
|
| Rate for Payer: Priority Health SBD |
$26.81
|
|
|
HC STRAPPING ANKLE AND OR FOOT
|
Facility
|
OP
|
$134.52
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
42000005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$114.34
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Commercial |
$115.69
|
| Rate for Payer: Cofinity Commercial |
$94.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$121.07
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.34
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$114.34
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.44
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$84.75
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Core |
$99.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$99.54
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC STRAPPING ANKLE AND OR FOOT
|
Facility
|
IP
|
$134.52
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
42000005
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$121.07 |
| Rate for Payer: Aetna Commercial |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.44
|
| Rate for Payer: Cash Price |
$107.62
|
| Rate for Payer: Cofinity Commercial |
$115.69
|
| Rate for Payer: Cofinity Commercial |
$94.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.62
|
| Rate for Payer: Healthscope Commercial |
$121.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.34
|
| Rate for Payer: PHP Commercial |
$114.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.44
|
| Rate for Payer: Priority Health SBD |
$84.75
|
|
|
HC STRAPPING CASTING UNLISTED
|
Facility
|
OP
|
$232.22
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
42000053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$197.39
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$185.78
|
| Rate for Payer: Cash Price |
$185.78
|
| Rate for Payer: Cash Price |
$185.78
|
| Rate for Payer: Cofinity Commercial |
$162.55
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.39
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$197.39
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.94
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$146.30
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Core |
$171.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$171.84
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC STRAPPING CASTING UNLISTED
|
Facility
|
IP
|
$232.22
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
42000053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$197.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.94
|
| Rate for Payer: Cash Price |
$185.78
|
| Rate for Payer: Cofinity Commercial |
$162.55
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.78
|
| Rate for Payer: Healthscope Commercial |
$209.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.39
|
| Rate for Payer: PHP Commercial |
$197.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.94
|
| Rate for Payer: Priority Health SBD |
$146.30
|
|
|
HC STRAPPING CHEST KINESIOTAPING
|
Facility
|
IP
|
$121.67
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
42000052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Aetna Commercial |
$103.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.09
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.34
|
| Rate for Payer: Healthscope Commercial |
$109.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.42
|
| Rate for Payer: PHP Commercial |
$103.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health SBD |
$76.65
|
|
|
HC STRAPPING CHEST KINESIOTAPING
|
Facility
|
OP
|
$121.67
|
|
|
Service Code
|
CPT 29200
|
| Hospital Charge Code |
42000052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$103.42
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$109.50
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.42
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$103.42
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$76.65
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Core |
$90.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Exchange |
$90.04
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
42000002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health SBD |
$62.27
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
42000002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$62.27
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$73.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$73.14
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
|
OP
|
$111.05
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
43000006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$94.39
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cofinity Commercial |
$77.73
|
| Rate for Payer: Cofinity Commercial |
$95.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$99.94
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.39
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$94.39
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.18
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$69.96
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$82.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$82.18
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$111.05
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
43000006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$99.94 |
| Rate for Payer: Aetna Commercial |
$94.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.18
|
| Rate for Payer: Cash Price |
$88.84
|
| Rate for Payer: Cofinity Commercial |
$77.73
|
| Rate for Payer: Cofinity Commercial |
$95.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.84
|
| Rate for Payer: Healthscope Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.39
|
| Rate for Payer: PHP Commercial |
$94.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.18
|
| Rate for Payer: Priority Health SBD |
$69.96
|
|
|
HC STRAPPING HIP
|
Facility
|
OP
|
$123.37
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
42000003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$104.86
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.10
|
| Rate for Payer: Cofinity Commercial |
$86.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$111.03
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.86
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$104.86
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.19
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$77.72
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$91.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$91.29
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC STRAPPING HIP
|
Facility
|
IP
|
$123.37
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
42000003
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.72 |
| Max. Negotiated Rate |
$111.03 |
| Rate for Payer: Aetna Commercial |
$104.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.19
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.10
|
| Rate for Payer: Cofinity Commercial |
$86.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$111.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.86
|
| Rate for Payer: PHP Commercial |
$104.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.19
|
| Rate for Payer: Priority Health SBD |
$77.72
|
|
