|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$352.12
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$264.09 |
| Max. Negotiated Rate |
$352.12 |
| Rate for Payer: Aetna Commercial |
$316.91
|
| Rate for Payer: ASR ASR |
$341.56
|
| Rate for Payer: BCBS Trust/PPO |
$289.16
|
| Rate for Payer: BCN Commercial |
$289.16
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cofinity Commercial |
$330.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.70
|
| Rate for Payer: Healthscope Commercial |
$341.56
|
| Rate for Payer: Healthscope Whirlpool |
$352.12
|
| Rate for Payer: Mclaren Commercial |
$316.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.30
|
| Rate for Payer: Nomi Health Commercial |
$288.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.87
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$352.12
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$352.12 |
| Rate for Payer: Aetna Commercial |
$316.91
|
| Rate for Payer: Aetna Medicare |
$130.28
|
| Rate for Payer: ASR ASR |
$341.56
|
| Rate for Payer: BCBS Complete |
$140.85
|
| Rate for Payer: BCBS Trust/PPO |
$290.32
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$290.32
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cofinity Commercial |
$330.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.70
|
| Rate for Payer: Healthscope Commercial |
$341.56
|
| Rate for Payer: Healthscope Whirlpool |
$352.12
|
| Rate for Payer: Mclaren Commercial |
$316.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$281.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.30
|
| Rate for Payer: Nomi Health Commercial |
$288.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$308.53
|
| Rate for Payer: Priority Health Narrow Network |
$246.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.87
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$105.27
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.95 |
| Max. Negotiated Rate |
$105.27 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: ASR ASR |
$102.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.45
|
| Rate for Payer: BCN Commercial |
$86.45
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$102.11
|
| Rate for Payer: Healthscope Whirlpool |
$105.27
|
| Rate for Payer: Mclaren Commercial |
$94.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Nomi Health Commercial |
$86.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.64
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$105.27
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$105.27 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Medicare |
$38.95
|
| Rate for Payer: ASR ASR |
$102.11
|
| Rate for Payer: BCBS Complete |
$42.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.80
|
| Rate for Payer: BCN Commercial |
$86.80
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$102.11
|
| Rate for Payer: Healthscope Whirlpool |
$105.27
|
| Rate for Payer: Mclaren Commercial |
$94.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.48
|
| Rate for Payer: Nomi Health Commercial |
$86.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.24
|
| Rate for Payer: Priority Health Narrow Network |
$73.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.64
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,848.75
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,386.56 |
| Max. Negotiated Rate |
$9,848.75 |
| Rate for Payer: Aetna Commercial |
$8,863.88
|
| Rate for Payer: ASR ASR |
$9,553.29
|
| Rate for Payer: BCBS Trust/PPO |
$8,087.79
|
| Rate for Payer: BCN Commercial |
$8,087.79
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cofinity Commercial |
$9,257.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.00
|
| Rate for Payer: Healthscope Commercial |
$9,553.29
|
| Rate for Payer: Healthscope Whirlpool |
$9,848.75
|
| Rate for Payer: Mclaren Commercial |
$8,863.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,371.44
|
| Rate for Payer: Nomi Health Commercial |
$8,075.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,386.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,666.90
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,848.75
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$9,848.75 |
| Rate for Payer: Aetna Commercial |
$8,863.88
|
| Rate for Payer: Aetna Medicare |
$6,350.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: ASR ASR |
$9,553.29
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$8,120.29
|
| Rate for Payer: BCN Commercial |
$8,120.29
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cash Price |
$7,879.00
|
| Rate for Payer: Cofinity Commercial |
$9,257.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,879.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Healthscope Commercial |
$9,553.29
|
| Rate for Payer: Healthscope Whirlpool |
$9,848.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,350.08
|
| Rate for Payer: Mclaren Commercial |
$8,863.88
|
| Rate for Payer: Mclaren Medicaid |
$6,350.08
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$3,487.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,371.44
|
| Rate for Payer: Nomi Health Commercial |
$8,075.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,386.56
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Commercial |
$6,985.09
|
| Rate for Payer: PHP Medicaid |
$3,403.64
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,629.47
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health Narrow Network |
$6,903.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,666.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Exchange |
$9,842.62
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP DNSP |
$6,350.08
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: VA VA |
$6,350.08
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,147.85
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$1,147.85 |
| Rate for Payer: Aetna Commercial |
$1,033.07
|
| Rate for Payer: Aetna Medicare |
$201.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: ASR ASR |
$1,113.41
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$946.40
|
| Rate for Payer: BCN Commercial |
$946.40
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cofinity Commercial |
$1,078.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$1,113.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,147.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$201.44
|
| Rate for Payer: Mclaren Commercial |
$1,033.07
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$110.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.67
|
| Rate for Payer: Nomi Health Commercial |
$941.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.89
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$221.58
|
| Rate for Payer: PHP Medicaid |
$107.97
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,005.75
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Narrow Network |
$804.64
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,010.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$312.23
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP DNSP |
$201.44
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,147.85
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.89 |
| Max. Negotiated Rate |
$1,147.85 |
| Rate for Payer: Aetna Commercial |
$1,033.07
|
| Rate for Payer: ASR ASR |
$1,113.41
|
| Rate for Payer: BCBS Trust/PPO |
$942.61
|
| Rate for Payer: BCN Commercial |
$942.61
|
| Rate for Payer: Cash Price |
$918.28
|
| Rate for Payer: Cofinity Commercial |
$1,078.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.28
|
| Rate for Payer: Healthscope Commercial |
$1,113.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,147.85
|
| Rate for Payer: Mclaren Commercial |
$1,033.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$975.67
|
| Rate for Payer: Nomi Health Commercial |
$941.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$860.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,010.11
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$566.15
|
| Rate for Payer: BCN Commercial |
$566.15
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$601.65
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$481.35
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.00 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Trust/PPO |
$563.89
|
| Rate for Payer: BCN Commercial |
$563.89
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.00 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Trust/PPO |
$563.89
|
| Rate for Payer: BCN Commercial |
$563.89
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$566.15
|
| Rate for Payer: BCN Commercial |
$566.15
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$601.65
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$481.35
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
OP
|
$686.66
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$566.15
|
| Rate for Payer: BCN Commercial |
$566.15
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$601.65
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$481.35
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
IP
|
$686.66
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.00 |
| Max. Negotiated Rate |
$686.66 |
| Rate for Payer: Aetna Commercial |
$617.99
|
| Rate for Payer: ASR ASR |
$666.06
|
| Rate for Payer: BCBS Trust/PPO |
$563.89
|
| Rate for Payer: BCN Commercial |
$563.89
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$645.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$666.06
|
| Rate for Payer: Healthscope Whirlpool |
$686.66
|
| Rate for Payer: Mclaren Commercial |
$617.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$604.26
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$741.19
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$741.19 |
| Rate for Payer: Aetna Commercial |
$667.07
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$718.95
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$611.11
|
| Rate for Payer: BCN Commercial |
$611.11
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Commercial |
$696.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$718.95
|
| Rate for Payer: Healthscope Whirlpool |
$741.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$667.07
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$607.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$649.43
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$519.57
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$741.19
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$555.89 |
| Max. Negotiated Rate |
$741.19 |
| Rate for Payer: Aetna Commercial |
$667.07
|
| Rate for Payer: ASR ASR |
$718.95
|
| Rate for Payer: BCBS Trust/PPO |
$608.67
|
| Rate for Payer: BCN Commercial |
$608.67
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Commercial |
$696.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$718.95
|
| Rate for Payer: Healthscope Whirlpool |
$741.19
|
| Rate for Payer: Mclaren Commercial |
$667.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Nomi Health Commercial |
$607.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.25
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$676.26
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$676.26 |
| Rate for Payer: Aetna Commercial |
$608.63
|
| Rate for Payer: ASR ASR |
$655.97
|
| Rate for Payer: BCBS Trust/PPO |
$555.34
|
| Rate for Payer: BCN Commercial |
$555.34
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Commercial |
$635.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Healthscope Commercial |
$655.97
|
| Rate for Payer: Healthscope Whirlpool |
$676.26
|
| Rate for Payer: Mclaren Commercial |
$608.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Nomi Health Commercial |
$554.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.11
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$676.26
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$676.26 |
| Rate for Payer: Aetna Commercial |
$608.63
|
| Rate for Payer: Aetna Medicare |
$236.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: ASR ASR |
$655.97
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$557.58
|
| Rate for Payer: BCN Commercial |
$557.58
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cash Price |
$541.01
|
| Rate for Payer: Cofinity Commercial |
$635.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$655.97
|
| Rate for Payer: Healthscope Whirlpool |
$676.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.00
|
| Rate for Payer: Mclaren Commercial |
$608.63
|
| Rate for Payer: Mclaren Medicaid |
$236.00
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$129.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.82
|
| Rate for Payer: Nomi Health Commercial |
$554.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.19
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$259.60
|
| Rate for Payer: PHP Medicaid |
$126.50
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$592.54
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health Narrow Network |
$474.06
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Exchange |
$365.80
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP DNSP |
$236.00
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,962.46
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,221.84 |
| Max. Negotiated Rate |
$2,962.46 |
| Rate for Payer: Aetna Commercial |
$2,666.21
|
| Rate for Payer: ASR ASR |
$2,873.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,432.77
|
| Rate for Payer: BCN Commercial |
$2,432.77
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cofinity Commercial |
$2,784.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,369.97
|
| Rate for Payer: Healthscope Commercial |
$2,873.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,962.46
|
| Rate for Payer: Mclaren Commercial |
$2,666.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.09
|
| Rate for Payer: Nomi Health Commercial |
$2,429.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,221.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,606.96
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,962.46
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$2,962.46 |
| Rate for Payer: Aetna Commercial |
$2,666.21
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$2,873.59
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,442.55
|
| Rate for Payer: BCN Commercial |
$2,442.55
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cash Price |
$2,369.97
|
| Rate for Payer: Cofinity Commercial |
$2,784.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,369.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$2,873.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,962.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$2,666.21
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,518.09
|
| Rate for Payer: Nomi Health Commercial |
$2,429.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,221.84
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,595.71
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,076.68
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,606.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$466.11
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$466.11 |
| Rate for Payer: Aetna Commercial |
$419.50
|
| Rate for Payer: Aetna Medicare |
$245.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: ASR ASR |
$452.13
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$384.31
|
| Rate for Payer: BCN Commercial |
$384.31
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cofinity Commercial |
$438.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Healthscope Commercial |
$452.13
|
| Rate for Payer: Healthscope Whirlpool |
$466.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$245.78
|
| Rate for Payer: Mclaren Commercial |
$419.50
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$134.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$382.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.58
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Commercial |
$270.36
|
| Rate for Payer: PHP Medicaid |
$131.74
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$408.41
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Narrow Network |
$326.74
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Exchange |
$380.96
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP DNSP |
$245.78
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$466.11
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.58 |
| Max. Negotiated Rate |
$466.11 |
| Rate for Payer: Aetna Commercial |
$419.50
|
| Rate for Payer: ASR ASR |
$452.13
|
| Rate for Payer: BCBS Trust/PPO |
$382.77
|
| Rate for Payer: BCN Commercial |
$382.77
|
| Rate for Payer: Cash Price |
$372.89
|
| Rate for Payer: Cofinity Commercial |
$438.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.89
|
| Rate for Payer: Healthscope Commercial |
$452.13
|
| Rate for Payer: Healthscope Whirlpool |
$466.11
|
| Rate for Payer: Mclaren Commercial |
$419.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.19
|
| Rate for Payer: Nomi Health Commercial |
$382.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.18
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$374.61
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$374.61 |
| Rate for Payer: Aetna Commercial |
$337.15
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$363.37
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$308.87
|
| Rate for Payer: BCN Commercial |
$308.87
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Healthscope Whirlpool |
$374.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$337.15
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.42
|
| Rate for Payer: Nomi Health Commercial |
$307.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.96
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$186.42
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$149.13
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$374.61
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.96 |
| Max. Negotiated Rate |
$374.61 |
| Rate for Payer: Aetna Commercial |
$337.15
|
| Rate for Payer: ASR ASR |
$363.37
|
| Rate for Payer: BCBS Trust/PPO |
$307.63
|
| Rate for Payer: BCN Commercial |
$307.63
|
| Rate for Payer: Cash Price |
$299.69
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.69
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Healthscope Whirlpool |
$374.61
|
| Rate for Payer: Mclaren Commercial |
$337.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.42
|
| Rate for Payer: Nomi Health Commercial |
$307.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.66
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$9,202.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,901.92 |
| Max. Negotiated Rate |
$9,202.56 |
| Rate for Payer: Aetna Commercial |
$8,282.30
|
| Rate for Payer: ASR ASR |
$8,926.48
|
| Rate for Payer: BCBS Trust/PPO |
$7,557.14
|
| Rate for Payer: BCN Commercial |
$7,557.14
|
| Rate for Payer: Cash Price |
$7,362.05
|
| Rate for Payer: Cofinity Commercial |
$8,650.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,362.05
|
| Rate for Payer: Healthscope Commercial |
$8,926.48
|
| Rate for Payer: Healthscope Whirlpool |
$9,202.56
|
| Rate for Payer: Mclaren Commercial |
$8,282.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,822.18
|
| Rate for Payer: Nomi Health Commercial |
$7,546.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,901.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,098.25
|
|
