|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$89.78 |
| Rate for Payer: Aetna Commercial |
$80.80
|
| Rate for Payer: ASR ASR |
$87.09
|
| Rate for Payer: ASR Commercial |
$87.09
|
| Rate for Payer: BCBS Trust/PPO |
$73.16
|
| Rate for Payer: BCN Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Healthscope Commercial |
$89.78
|
| Rate for Payer: Healthscope Whirlpool |
$87.09
|
| Rate for Payer: Mclaren Commercial |
$80.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.01
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: ASR Commercial |
$111.01
|
| Rate for Payer: BCBS Trust/PPO |
$93.26
|
| Rate for Payer: BCN Commercial |
$88.73
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$114.44
|
| Rate for Payer: Healthscope Whirlpool |
$111.01
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna Medicare |
$57.22
|
| Rate for Payer: ASR ASR |
$111.01
|
| Rate for Payer: ASR Commercial |
$111.01
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$93.71
|
| Rate for Payer: BCN Commercial |
$88.73
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$114.44
|
| Rate for Payer: Healthscope Whirlpool |
$111.01
|
| Rate for Payer: Mclaren Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.39
|
| Rate for Payer: Priority Health Narrow Network |
$48.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.71
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,822.52 |
| Max. Negotiated Rate |
$2,803.88 |
| Rate for Payer: Aetna Commercial |
$2,523.49
|
| Rate for Payer: ASR ASR |
$2,719.76
|
| Rate for Payer: ASR Commercial |
$2,719.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,284.88
|
| Rate for Payer: BCN Commercial |
$2,173.85
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,635.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Healthscope Commercial |
$2,803.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,719.76
|
| Rate for Payer: Mclaren Commercial |
$2,523.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$2,299.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,467.41
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,822.52 |
| Max. Negotiated Rate |
$12,568.39 |
| Rate for Payer: Aetna Commercial |
$2,523.49
|
| Rate for Payer: Aetna Medicare |
$8,108.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,135.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,135.80
|
| Rate for Payer: ASR ASR |
$2,719.76
|
| Rate for Payer: ASR Commercial |
$2,719.76
|
| Rate for Payer: BCBS Complete |
$4,563.54
|
| Rate for Payer: BCBS MAPPO |
$8,108.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,296.10
|
| Rate for Payer: BCN Commercial |
$2,173.85
|
| Rate for Payer: BCN Medicare Advantage |
$8,108.64
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,635.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,108.64
|
| Rate for Payer: Healthscope Commercial |
$2,803.88
|
| Rate for Payer: Healthscope Whirlpool |
$2,719.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,108.64
|
| Rate for Payer: Mclaren Commercial |
$2,523.49
|
| Rate for Payer: Mclaren Medicaid |
$4,346.23
|
| Rate for Payer: Mclaren Medicare |
$8,108.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,514.07
|
| Rate for Payer: Meridian Medicaid |
$4,563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,324.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$2,299.18
|
| Rate for Payer: PACE Medicare |
$7,703.21
|
| Rate for Payer: PACE SWMI |
$8,108.64
|
| Rate for Payer: PHP Commercial |
$8,919.50
|
| Rate for Payer: PHP Medicaid |
$4,346.23
|
| Rate for Payer: PHP Medicare Advantage |
$8,108.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,346.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,456.76
|
| Rate for Payer: Priority Health Medicare |
$8,108.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,965.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,467.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,108.64
|
| Rate for Payer: UHC Exchange |
$12,568.39
|
| Rate for Payer: UHC Medicare Advantage |
$8,108.64
|
| Rate for Payer: UHCCP DNSP |
$8,108.64
|
| Rate for Payer: UHCCP Medicaid |
$4,346.23
|
| Rate for Payer: VA VA |
$8,108.64
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
IP
|
$688.29
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.39 |
| Max. Negotiated Rate |
$688.29 |
| Rate for Payer: Aetna Commercial |
$619.46
|
| Rate for Payer: ASR ASR |
$667.64
|
| Rate for Payer: ASR Commercial |
$667.64
|
| Rate for Payer: BCBS Trust/PPO |
$560.89
|
| Rate for Payer: BCN Commercial |
$533.63
|
| Rate for Payer: Cash Price |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$646.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.63
|
| Rate for Payer: Healthscope Commercial |
$688.29
|
| Rate for Payer: Healthscope Whirlpool |
$667.64
|
| Rate for Payer: Mclaren Commercial |
$619.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.05
|
| Rate for Payer: Nomi Health Commercial |
$564.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.70
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$688.29
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.32 |
| Max. Negotiated Rate |
$688.29 |
| Rate for Payer: Aetna Commercial |
$619.46
|
| Rate for Payer: Aetna Medicare |
$344.14
|
| Rate for Payer: ASR ASR |
$667.64
|
| Rate for Payer: ASR Commercial |
$667.64
|
| Rate for Payer: BCBS Complete |
$275.32
|
| Rate for Payer: BCBS Trust/PPO |
$563.64
|
| Rate for Payer: BCN Commercial |
$533.63
|
| Rate for Payer: Cash Price |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$646.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.63
|
| Rate for Payer: Healthscope Commercial |
$688.29
|
| Rate for Payer: Healthscope Whirlpool |
$667.64
|
| Rate for Payer: Mclaren Commercial |
$619.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.05
|
| Rate for Payer: Nomi Health Commercial |
$564.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$603.08
|
| Rate for Payer: Priority Health Narrow Network |
$482.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.70
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$86.90
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.98
|
| Rate for Payer: Priority Health Narrow Network |
$53.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$106.12 |
| Rate for Payer: Aetna Commercial |
$95.51
|
| Rate for Payer: ASR ASR |
$102.94
|
| Rate for Payer: ASR Commercial |
$102.94
|
| Rate for Payer: BCBS Trust/PPO |
$86.48
|
| Rate for Payer: BCN Commercial |
$82.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$99.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$106.12
|
| Rate for Payer: Healthscope Whirlpool |
$102.94
|
| Rate for Payer: Mclaren Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.39
|
|
|
HC TENOTOMY
|
Facility
|
IP
|
$2,892.68
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,880.24 |
| Max. Negotiated Rate |
$2,892.68 |
| Rate for Payer: Aetna Commercial |
$2,603.41
|
| Rate for Payer: ASR ASR |
$2,805.90
|
| Rate for Payer: ASR Commercial |
$2,805.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,357.24
|
| Rate for Payer: BCN Commercial |
$2,242.69
|
| Rate for Payer: Cash Price |
$2,314.14
|
| Rate for Payer: Cofinity Commercial |
$2,719.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.14
|
| Rate for Payer: Healthscope Commercial |
$2,892.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,805.90
|
| Rate for Payer: Mclaren Commercial |
$2,603.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,458.78
|
| Rate for Payer: Nomi Health Commercial |
$2,372.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,880.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,545.56
|
|
|
HC TENOTOMY
|
Facility
|
OP
|
$2,892.68
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
36100046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$840.47 |
| Max. Negotiated Rate |
$2,892.68 |
| Rate for Payer: Aetna Commercial |
$2,603.41
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$2,805.90
|
| Rate for Payer: ASR Commercial |
$2,805.90
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,368.82
|
| Rate for Payer: BCN Commercial |
$2,242.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$2,314.14
|
| Rate for Payer: Cash Price |
$2,314.14
|
| Rate for Payer: Cofinity Commercial |
$2,719.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,314.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$2,892.68
|
| Rate for Payer: Healthscope Whirlpool |
$2,805.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$2,603.41
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,458.78
|
| Rate for Payer: Nomi Health Commercial |
$2,372.00
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,880.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,534.57
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,027.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,545.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
HC TENOTOMY ADDUCTOR OF HIP PERCUTANEOUS
|
Facility
|
OP
|
$4,277.92
|
|
| Hospital Charge Code |
36000096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,711.17 |
| Max. Negotiated Rate |
$4,277.92 |
| Rate for Payer: Aetna Commercial |
$3,850.13
|
| Rate for Payer: Aetna Medicare |
$2,138.96
|
| Rate for Payer: ASR ASR |
$4,149.58
|
| Rate for Payer: ASR Commercial |
$4,149.58
|
| Rate for Payer: BCBS Complete |
$1,711.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,503.19
|
| Rate for Payer: BCN Commercial |
$3,316.67
|
| Rate for Payer: Cash Price |
$3,422.34
|
| Rate for Payer: Cofinity Commercial |
$4,021.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,422.34
|
| Rate for Payer: Healthscope Commercial |
$4,277.92
|
| Rate for Payer: Healthscope Whirlpool |
$4,149.58
|
| Rate for Payer: Mclaren Commercial |
$3,850.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,636.23
|
| Rate for Payer: Nomi Health Commercial |
$3,507.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,780.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,748.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,998.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,764.57
|
|
|
HC TENOTOMY ADDUCTOR OF HIP PERCUTANEOUS
|
Facility
|
IP
|
$4,277.92
|
|
| Hospital Charge Code |
36000096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,780.65 |
| Max. Negotiated Rate |
$4,277.92 |
| Rate for Payer: Aetna Commercial |
$3,850.13
|
| Rate for Payer: ASR ASR |
$4,149.58
|
| Rate for Payer: ASR Commercial |
$4,149.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,486.08
|
| Rate for Payer: BCN Commercial |
$3,316.67
|
| Rate for Payer: Cash Price |
$3,422.34
|
| Rate for Payer: Cofinity Commercial |
$4,021.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,422.34
|
| Rate for Payer: Healthscope Commercial |
$4,277.92
|
| Rate for Payer: Healthscope Whirlpool |
$4,149.58
|
| Rate for Payer: Mclaren Commercial |
$3,850.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,636.23
|
| Rate for Payer: Nomi Health Commercial |
$3,507.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,780.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,764.57
|
|
|
HC TENOTOMY ELBOW LATERAL/MEDIAL PERC
|
Facility
|
OP
|
$4,494.21
|
|
|
Service Code
|
CPT 24357
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,703.94 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$4,044.79
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$4,359.38
|
| Rate for Payer: ASR Commercial |
$4,359.38
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,680.31
|
| Rate for Payer: BCN Commercial |
$3,484.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cofinity Commercial |
$4,224.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,595.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$4,494.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,359.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$4,044.79
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,820.08
|
| Rate for Payer: Nomi Health Commercial |
$3,685.25
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,937.83
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$3,150.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,954.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
HC TENOTOMY ELBOW LATERAL/MEDIAL PERC
|
Facility
|
IP
|
$4,494.21
|
|
|
Service Code
|
CPT 24357
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,921.24 |
| Max. Negotiated Rate |
$4,494.21 |
| Rate for Payer: Aetna Commercial |
$4,044.79
|
| Rate for Payer: ASR ASR |
$4,359.38
|
| Rate for Payer: ASR Commercial |
$4,359.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,662.33
|
| Rate for Payer: BCN Commercial |
$3,484.36
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cofinity Commercial |
$4,224.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,595.37
|
| Rate for Payer: Healthscope Commercial |
$4,494.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,359.38
|
| Rate for Payer: Mclaren Commercial |
$4,044.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,820.08
|
| Rate for Payer: Nomi Health Commercial |
$3,685.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,954.90
|
|
|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
IP
|
$4,494.21
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,921.24 |
| Max. Negotiated Rate |
$4,494.21 |
| Rate for Payer: Aetna Commercial |
$4,044.79
|
| Rate for Payer: ASR ASR |
$4,359.38
|
| Rate for Payer: ASR Commercial |
$4,359.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,662.33
|
| Rate for Payer: BCN Commercial |
$3,484.36
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cofinity Commercial |
$4,224.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,595.37
|
| Rate for Payer: Healthscope Commercial |
$4,494.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,359.38
|
| Rate for Payer: Mclaren Commercial |
$4,044.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,820.08
|
| Rate for Payer: Nomi Health Commercial |
$3,685.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,954.90
|
|
|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
OP
|
$4,494.21
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,797.68 |
| Max. Negotiated Rate |
$4,494.21 |
| Rate for Payer: Aetna Commercial |
$4,044.79
|
| Rate for Payer: Aetna Medicare |
$2,247.10
|
| Rate for Payer: ASR ASR |
$4,359.38
|
| Rate for Payer: ASR Commercial |
$4,359.38
|
| Rate for Payer: BCBS Complete |
$1,797.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,680.31
|
| Rate for Payer: BCN Commercial |
$3,484.36
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cofinity Commercial |
$4,224.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,595.37
|
| Rate for Payer: Healthscope Commercial |
$4,494.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,359.38
|
| Rate for Payer: Mclaren Commercial |
$4,044.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,820.08
|
| Rate for Payer: Nomi Health Commercial |
$3,685.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,937.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,150.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,954.90
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
IP
|
$5,235.97
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,403.38 |
| Max. Negotiated Rate |
$5,235.97 |
| Rate for Payer: Aetna Commercial |
$4,712.37
|
| Rate for Payer: ASR ASR |
$5,078.89
|
| Rate for Payer: ASR Commercial |
$5,078.89
|
| Rate for Payer: BCBS Trust/PPO |
$4,266.79
|
| Rate for Payer: BCN Commercial |
$4,059.45
|
| Rate for Payer: Cash Price |
$4,188.78
|
| Rate for Payer: Cofinity Commercial |
$4,921.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,188.78
|
| Rate for Payer: Healthscope Commercial |
$5,235.97
|
| Rate for Payer: Healthscope Whirlpool |
$5,078.89
|
| Rate for Payer: Mclaren Commercial |
$4,712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,450.57
|
| Rate for Payer: Nomi Health Commercial |
$4,293.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,403.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,607.65
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
OP
|
$5,235.97
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,094.39 |
| Max. Negotiated Rate |
$5,235.97 |
| Rate for Payer: Aetna Commercial |
$4,712.37
|
| Rate for Payer: Aetna Medicare |
$2,617.98
|
| Rate for Payer: ASR ASR |
$5,078.89
|
| Rate for Payer: ASR Commercial |
$5,078.89
|
| Rate for Payer: BCBS Complete |
$2,094.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,287.74
|
| Rate for Payer: BCN Commercial |
$4,059.45
|
| Rate for Payer: Cash Price |
$4,188.78
|
| Rate for Payer: Cofinity Commercial |
$4,921.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,188.78
|
| Rate for Payer: Healthscope Commercial |
$5,235.97
|
| Rate for Payer: Healthscope Whirlpool |
$5,078.89
|
| Rate for Payer: Mclaren Commercial |
$4,712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,450.57
|
| Rate for Payer: Nomi Health Commercial |
$4,293.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,403.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,587.76
|
| Rate for Payer: Priority Health Narrow Network |
$3,670.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,607.65
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
OP
|
$3,737.88
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,495.15 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Aetna Commercial |
$3,364.09
|
| Rate for Payer: Aetna Medicare |
$1,868.94
|
| Rate for Payer: ASR ASR |
$3,625.74
|
| Rate for Payer: ASR Commercial |
$3,625.74
|
| Rate for Payer: BCBS Complete |
$1,495.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,060.95
|
| Rate for Payer: BCN Commercial |
$2,897.98
|
| Rate for Payer: Cash Price |
$2,990.30
|
| Rate for Payer: Cofinity Commercial |
$3,513.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,990.30
|
| Rate for Payer: Healthscope Commercial |
$3,737.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,625.74
|
| Rate for Payer: Mclaren Commercial |
$3,364.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,177.20
|
| Rate for Payer: Nomi Health Commercial |
$3,065.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,429.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,275.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,620.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,289.33
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
IP
|
$3,737.88
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,429.62 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Aetna Commercial |
$3,364.09
|
| Rate for Payer: ASR ASR |
$3,625.74
|
| Rate for Payer: ASR Commercial |
$3,625.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,046.00
|
| Rate for Payer: BCN Commercial |
$2,897.98
|
| Rate for Payer: Cash Price |
$2,990.30
|
| Rate for Payer: Cofinity Commercial |
$3,513.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,990.30
|
| Rate for Payer: Healthscope Commercial |
$3,737.88
|
| Rate for Payer: Healthscope Whirlpool |
$3,625.74
|
| Rate for Payer: Mclaren Commercial |
$3,364.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,177.20
|
| Rate for Payer: Nomi Health Commercial |
$3,065.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,429.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,289.33
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
OP
|
$3,570.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,428.01 |
| Max. Negotiated Rate |
$3,570.03 |
| Rate for Payer: Aetna Commercial |
$3,213.03
|
| Rate for Payer: Aetna Medicare |
$1,785.02
|
| Rate for Payer: ASR ASR |
$3,462.93
|
| Rate for Payer: ASR Commercial |
$3,462.93
|
| Rate for Payer: BCBS Complete |
$1,428.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,923.50
|
| Rate for Payer: BCN Commercial |
$2,767.84
|
| Rate for Payer: Cash Price |
$2,856.02
|
| Rate for Payer: Cofinity Commercial |
$3,355.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.02
|
| Rate for Payer: Healthscope Commercial |
$3,570.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,462.93
|
| Rate for Payer: Mclaren Commercial |
$3,213.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.53
|
| Rate for Payer: Nomi Health Commercial |
$2,927.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,128.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,502.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,141.63
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
IP
|
$3,570.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,320.52 |
| Max. Negotiated Rate |
$3,570.03 |
| Rate for Payer: Aetna Commercial |
$3,213.03
|
| Rate for Payer: ASR ASR |
$3,462.93
|
| Rate for Payer: ASR Commercial |
$3,462.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,909.22
|
| Rate for Payer: BCN Commercial |
$2,767.84
|
| Rate for Payer: Cash Price |
$2,856.02
|
| Rate for Payer: Cofinity Commercial |
$3,355.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.02
|
| Rate for Payer: Healthscope Commercial |
$3,570.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,462.93
|
| Rate for Payer: Mclaren Commercial |
$3,213.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.53
|
| Rate for Payer: Nomi Health Commercial |
$2,927.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,141.63
|
|
|
HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
OP
|
$4,590.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.47 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Aetna Commercial |
$4,131.00
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$4,452.30
|
| Rate for Payer: ASR Commercial |
$4,452.30
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,758.75
|
| Rate for Payer: BCN Commercial |
$3,558.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cofinity Commercial |
$4,314.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,672.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$4,590.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,452.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$4,131.00
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.50
|
| Rate for Payer: Nomi Health Commercial |
$3,763.80
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,021.76
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,217.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,039.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
IP
|
$4,590.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,983.50 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Aetna Commercial |
$4,131.00
|
| Rate for Payer: ASR ASR |
$4,452.30
|
| Rate for Payer: ASR Commercial |
$4,452.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,740.39
|
| Rate for Payer: BCN Commercial |
$3,558.63
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cofinity Commercial |
$4,314.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,672.00
|
| Rate for Payer: Healthscope Commercial |
$4,590.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,452.30
|
| Rate for Payer: Mclaren Commercial |
$4,131.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.50
|
| Rate for Payer: Nomi Health Commercial |
$3,763.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,039.20
|
|
