|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$103.21
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$103.21 |
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$51.60
|
| Rate for Payer: ASR ASR |
$100.11
|
| Rate for Payer: ASR Commercial |
$100.11
|
| Rate for Payer: BCBS Complete |
$41.28
|
| Rate for Payer: BCBS Trust/PPO |
$84.52
|
| Rate for Payer: BCN Commercial |
$80.02
|
| Rate for Payer: Cash Price |
$82.57
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.57
|
| Rate for Payer: Healthscope Commercial |
$103.21
|
| Rate for Payer: Healthscope Whirlpool |
$100.11
|
| Rate for Payer: Mclaren Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.73
|
| Rate for Payer: Nomi Health Commercial |
$84.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.43
|
| Rate for Payer: Priority Health Narrow Network |
$72.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.82
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,655.64
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,446.59 |
| Max. Negotiated Rate |
$9,966.81 |
| Rate for Payer: Aetna Commercial |
$8,690.08
|
| Rate for Payer: Aetna Medicare |
$6,430.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,037.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,037.75
|
| Rate for Payer: ASR ASR |
$9,365.97
|
| Rate for Payer: ASR Commercial |
$9,365.97
|
| Rate for Payer: BCBS Complete |
$3,618.92
|
| Rate for Payer: BCBS MAPPO |
$6,430.20
|
| Rate for Payer: BCBS Trust/PPO |
$7,907.00
|
| Rate for Payer: BCN Commercial |
$7,486.02
|
| Rate for Payer: BCN Medicare Advantage |
$6,430.20
|
| Rate for Payer: Cash Price |
$7,724.51
|
| Rate for Payer: Cash Price |
$7,724.51
|
| Rate for Payer: Cofinity Commercial |
$9,076.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,724.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,430.20
|
| Rate for Payer: Healthscope Commercial |
$9,655.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,365.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,430.20
|
| Rate for Payer: Mclaren Commercial |
$8,690.08
|
| Rate for Payer: Mclaren Medicaid |
$3,446.59
|
| Rate for Payer: Mclaren Medicare |
$6,430.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,751.71
|
| Rate for Payer: Meridian Medicaid |
$3,618.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,394.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,207.29
|
| Rate for Payer: Nomi Health Commercial |
$7,917.62
|
| Rate for Payer: PACE Medicare |
$6,108.69
|
| Rate for Payer: PACE SWMI |
$6,430.20
|
| Rate for Payer: PHP Commercial |
$7,073.22
|
| Rate for Payer: PHP Medicaid |
$3,446.59
|
| Rate for Payer: PHP Medicare Advantage |
$6,430.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,446.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,276.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,460.27
|
| Rate for Payer: Priority Health Medicare |
$6,430.20
|
| Rate for Payer: Priority Health Narrow Network |
$6,768.60
|
| Rate for Payer: Railroad Medicare Medicare |
$6,430.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,496.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,430.20
|
| Rate for Payer: UHC Exchange |
$9,966.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,430.20
|
| Rate for Payer: UHCCP DNSP |
$6,430.20
|
| Rate for Payer: UHCCP Medicaid |
$3,446.59
|
| Rate for Payer: VA VA |
$6,430.20
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,655.64
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,276.17 |
| Max. Negotiated Rate |
$9,655.64 |
| Rate for Payer: Aetna Commercial |
$8,690.08
|
| Rate for Payer: ASR ASR |
$9,365.97
|
| Rate for Payer: ASR Commercial |
$9,365.97
|
| Rate for Payer: BCBS Trust/PPO |
$7,868.38
|
| Rate for Payer: BCN Commercial |
$7,486.02
|
| Rate for Payer: Cash Price |
$7,724.51
|
| Rate for Payer: Cofinity Commercial |
$9,076.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,724.51
|
| Rate for Payer: Healthscope Commercial |
$9,655.64
|
| Rate for Payer: Healthscope Whirlpool |
$9,365.97
|
| Rate for Payer: Mclaren Commercial |
$8,690.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,207.29
|
| Rate for Payer: Nomi Health Commercial |
$7,917.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,276.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,496.96
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,125.34
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$1,125.34 |
| Rate for Payer: Aetna Commercial |
$1,012.81
|
| Rate for Payer: Aetna Medicare |
$197.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: ASR ASR |
$1,091.58
|
| Rate for Payer: ASR Commercial |
$1,091.58
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$921.54
|
| Rate for Payer: BCN Commercial |
$872.48
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$900.27
|
| Rate for Payer: Cash Price |
$900.27
|
| Rate for Payer: Cofinity Commercial |
$1,057.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$1,125.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$197.10
|
| Rate for Payer: Mclaren Commercial |
$1,012.81
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.54
|
| Rate for Payer: Nomi Health Commercial |
$922.78
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$216.81
|
| Rate for Payer: PHP Medicaid |
$105.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$986.02
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$788.86
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$305.50
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP DNSP |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,125.34
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$731.47 |
| Max. Negotiated Rate |
$1,125.34 |
| Rate for Payer: Aetna Commercial |
$1,012.81
|
| Rate for Payer: ASR ASR |
$1,091.58
|
| Rate for Payer: ASR Commercial |
$1,091.58
|
| Rate for Payer: BCBS Trust/PPO |
$917.04
|
| Rate for Payer: BCN Commercial |
$872.48
|
| Rate for Payer: Cash Price |
$900.27
|
| Rate for Payer: Cofinity Commercial |
$1,057.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.27
|
| Rate for Payer: Healthscope Commercial |
$1,125.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.58
|
| Rate for Payer: Mclaren Commercial |
$1,012.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.54
|
| Rate for Payer: Nomi Health Commercial |
$922.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.30
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$551.28
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$471.91
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC UNLISTED PROCEDURE FOREARM WRIST
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
76100410
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$551.28
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$471.91
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC UNLISTED PROCEDURE FOREARM WRIST
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
76100410
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC UNLISTED PROCEDURE HUMERUS ELBOW
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
76100409
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$551.28
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$471.91
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Trust/PPO |
$548.59
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
|
|
HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna Commercial |
$605.88
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$653.00
|
| Rate for Payer: ASR Commercial |
$653.00
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$551.28
|
| Rate for Payer: BCN Commercial |
$521.93
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$632.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$673.20
|
| Rate for Payer: Healthscope Whirlpool |
$653.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$605.88
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$589.86
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$471.91
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$726.66
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.33 |
| Max. Negotiated Rate |
$726.66 |
| Rate for Payer: Aetna Commercial |
$653.99
|
| Rate for Payer: ASR ASR |
$704.86
|
| Rate for Payer: ASR Commercial |
$704.86
|
| Rate for Payer: BCBS Trust/PPO |
$592.16
|
| Rate for Payer: BCN Commercial |
$563.38
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cofinity Commercial |
$683.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.33
|
| Rate for Payer: Healthscope Commercial |
$726.66
|
| Rate for Payer: Healthscope Whirlpool |
$704.86
|
| Rate for Payer: Mclaren Commercial |
$653.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.66
|
| Rate for Payer: Nomi Health Commercial |
$595.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.46
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$726.66
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$726.66 |
| Rate for Payer: Aetna Commercial |
$653.99
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$704.86
|
| Rate for Payer: ASR Commercial |
$704.86
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$595.06
|
| Rate for Payer: BCN Commercial |
$563.38
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cash Price |
$581.33
|
| Rate for Payer: Cofinity Commercial |
$683.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$726.66
|
| Rate for Payer: Healthscope Whirlpool |
$704.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$653.99
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.66
|
| Rate for Payer: Nomi Health Commercial |
$595.86
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.70
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$509.39
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$639.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.95 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: ASR Commercial |
$643.11
|
| Rate for Payer: BCBS Trust/PPO |
$540.28
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$543.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$596.70
|
| Rate for Payer: Aetna Medicare |
$227.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: ASR ASR |
$643.11
|
| Rate for Payer: ASR Commercial |
$643.11
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$542.93
|
| Rate for Payer: BCN Commercial |
$514.02
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$623.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Healthscope Commercial |
$663.00
|
| Rate for Payer: Healthscope Whirlpool |
$643.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$227.52
|
| Rate for Payer: Mclaren Commercial |
$596.70
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$543.66
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Commercial |
$250.27
|
| Rate for Payer: PHP Medicaid |
$121.95
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.92
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$464.76
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$583.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Exchange |
$352.66
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP DNSP |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$121.95
|
| Rate for Payer: VA VA |
$227.52
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,904.37
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,887.84 |
| Max. Negotiated Rate |
$2,904.37 |
| Rate for Payer: Aetna Commercial |
$2,613.93
|
| Rate for Payer: ASR ASR |
$2,817.24
|
| Rate for Payer: ASR Commercial |
$2,817.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,366.77
|
| Rate for Payer: BCN Commercial |
$2,251.76
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cofinity Commercial |
$2,730.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.50
|
| Rate for Payer: Healthscope Commercial |
$2,904.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,817.24
|
| Rate for Payer: Mclaren Commercial |
$2,613.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,468.71
|
| Rate for Payer: Nomi Health Commercial |
$2,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,887.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,555.85
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,904.37
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$2,904.37 |
| Rate for Payer: Aetna Commercial |
$2,613.93
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$2,817.24
|
| Rate for Payer: ASR Commercial |
$2,817.24
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,378.39
|
| Rate for Payer: BCN Commercial |
$2,251.76
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cash Price |
$2,323.50
|
| Rate for Payer: Cofinity Commercial |
$2,730.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,323.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$2,904.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,817.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$2,613.93
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,468.71
|
| Rate for Payer: Nomi Health Commercial |
$2,381.58
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,887.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,544.81
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,035.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,555.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$456.97
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$456.97 |
| Rate for Payer: Aetna Commercial |
$411.27
|
| Rate for Payer: Aetna Medicare |
$235.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: ASR ASR |
$443.26
|
| Rate for Payer: ASR Commercial |
$443.26
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$374.21
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cofinity Commercial |
$429.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Healthscope Commercial |
$456.97
|
| Rate for Payer: Healthscope Whirlpool |
$443.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.03
|
| Rate for Payer: Mclaren Commercial |
$411.27
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.72
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Commercial |
$258.53
|
| Rate for Payer: PHP Medicaid |
$125.98
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$320.34
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$364.30
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP DNSP |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$456.97
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.03 |
| Max. Negotiated Rate |
$456.97 |
| Rate for Payer: Aetna Commercial |
$411.27
|
| Rate for Payer: ASR ASR |
$443.26
|
| Rate for Payer: ASR Commercial |
$443.26
|
| Rate for Payer: BCBS Trust/PPO |
$372.38
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: Cash Price |
$365.58
|
| Rate for Payer: Cofinity Commercial |
$429.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.58
|
| Rate for Payer: Healthscope Commercial |
$456.97
|
| Rate for Payer: Healthscope Whirlpool |
$443.26
|
| Rate for Payer: Mclaren Commercial |
$411.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.42
|
| Rate for Payer: Nomi Health Commercial |
$374.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$402.13
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$367.26
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.72 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$330.53
|
| Rate for Payer: ASR ASR |
$356.24
|
| Rate for Payer: ASR Commercial |
$356.24
|
| Rate for Payer: BCBS Trust/PPO |
$299.28
|
| Rate for Payer: BCN Commercial |
$284.74
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cofinity Commercial |
$345.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.81
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Healthscope Whirlpool |
$356.24
|
| Rate for Payer: Mclaren Commercial |
$330.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.17
|
| Rate for Payer: Nomi Health Commercial |
$301.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.19
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$367.26
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$367.26 |
| Rate for Payer: Aetna Commercial |
$330.53
|
| Rate for Payer: Aetna Medicare |
$154.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: ASR ASR |
$356.24
|
| Rate for Payer: ASR Commercial |
$356.24
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$300.75
|
| Rate for Payer: BCN Commercial |
$284.74
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cash Price |
$293.81
|
| Rate for Payer: Cofinity Commercial |
$345.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$367.26
|
| Rate for Payer: Healthscope Whirlpool |
$356.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$154.60
|
| Rate for Payer: Mclaren Commercial |
$330.53
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.17
|
| Rate for Payer: Nomi Health Commercial |
$301.15
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: PHP Medicaid |
$82.87
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.09
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$135.27
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$323.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP DNSP |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$82.87
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$9,022.12
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,864.38 |
| Max. Negotiated Rate |
$9,022.12 |
| Rate for Payer: Aetna Commercial |
$8,119.91
|
| Rate for Payer: ASR ASR |
$8,751.46
|
| Rate for Payer: ASR Commercial |
$8,751.46
|
| Rate for Payer: BCBS Trust/PPO |
$7,352.13
|
| Rate for Payer: BCN Commercial |
$6,994.85
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cofinity Commercial |
$8,480.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,217.70
|
| Rate for Payer: Healthscope Commercial |
$9,022.12
|
| Rate for Payer: Healthscope Whirlpool |
$8,751.46
|
| Rate for Payer: Mclaren Commercial |
$8,119.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,668.80
|
| Rate for Payer: Nomi Health Commercial |
$7,398.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,864.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,939.47
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$9,022.12
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,495.99 |
| Max. Negotiated Rate |
$15,893.27 |
| Rate for Payer: Aetna Commercial |
$8,119.91
|
| Rate for Payer: Aetna Medicare |
$10,253.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,817.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,817.15
|
| Rate for Payer: ASR ASR |
$8,751.46
|
| Rate for Payer: ASR Commercial |
$8,751.46
|
| Rate for Payer: BCBS Complete |
$5,770.79
|
| Rate for Payer: BCBS MAPPO |
$10,253.72
|
| Rate for Payer: BCBS Trust/PPO |
$7,388.21
|
| Rate for Payer: BCN Commercial |
$6,994.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,253.72
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cash Price |
$7,217.70
|
| Rate for Payer: Cofinity Commercial |
$8,480.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,217.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,253.72
|
| Rate for Payer: Healthscope Commercial |
$9,022.12
|
| Rate for Payer: Healthscope Whirlpool |
$8,751.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,253.72
|
| Rate for Payer: Mclaren Commercial |
$8,119.91
|
| Rate for Payer: Mclaren Medicaid |
$5,495.99
|
| Rate for Payer: Mclaren Medicare |
$10,253.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,766.41
|
| Rate for Payer: Meridian Medicaid |
$5,770.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,791.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,668.80
|
| Rate for Payer: Nomi Health Commercial |
$7,398.14
|
| Rate for Payer: PACE Medicare |
$9,741.03
|
| Rate for Payer: PACE SWMI |
$10,253.72
|
| Rate for Payer: PHP Commercial |
$11,279.09
|
| Rate for Payer: PHP Medicaid |
$5,495.99
|
| Rate for Payer: PHP Medicare Advantage |
$10,253.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,495.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,864.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,905.18
|
| Rate for Payer: Priority Health Medicare |
$10,253.72
|
| Rate for Payer: Priority Health Narrow Network |
$6,324.51
|
| Rate for Payer: Railroad Medicare Medicare |
$10,253.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,939.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,253.72
|
| Rate for Payer: UHC Exchange |
$15,893.27
|
| Rate for Payer: UHC Medicare Advantage |
$10,253.72
|
| Rate for Payer: UHCCP DNSP |
$10,253.72
|
| Rate for Payer: UHCCP Medicaid |
$5,495.99
|
| Rate for Payer: VA VA |
$10,253.72
|
|
