|
HC SPINAL/EPI INIT 30 MIN
|
Facility
|
OP
|
$428.17
|
|
| Hospital Charge Code |
37000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$171.27 |
| Max. Negotiated Rate |
$385.35 |
| Rate for Payer: Aetna Commercial |
$363.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.31
|
| Rate for Payer: BCBS Complete |
$171.27
|
| Rate for Payer: Cash Price |
$342.54
|
| Rate for Payer: Cofinity Commercial |
$299.72
|
| Rate for Payer: Cofinity Commercial |
$368.23
|
| Rate for Payer: Healthscope Commercial |
$385.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.94
|
| Rate for Payer: PHP Commercial |
$363.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.72
|
| Rate for Payer: Priority Health SBD |
$269.75
|
|
|
HC SPINAL/EPI INIT 30 MIN
|
Facility
|
IP
|
$428.17
|
|
| Hospital Charge Code |
37000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$269.75 |
| Max. Negotiated Rate |
$385.35 |
| Rate for Payer: Aetna Commercial |
$363.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.31
|
| Rate for Payer: Cash Price |
$342.54
|
| Rate for Payer: Cofinity Commercial |
$299.72
|
| Rate for Payer: Cofinity Commercial |
$368.23
|
| Rate for Payer: Healthscope Commercial |
$385.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.94
|
| Rate for Payer: PHP Commercial |
$363.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.72
|
| Rate for Payer: Priority Health SBD |
$269.75
|
|
|
HC SPINE JACK
|
Facility
|
OP
|
$14,119.00
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,969.89 |
| Max. Negotiated Rate |
$12,707.10 |
| Rate for Payer: Aetna Commercial |
$12,001.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,177.35
|
| Rate for Payer: BCBS Complete |
$5,647.60
|
| Rate for Payer: Cash Price |
$11,295.20
|
| Rate for Payer: Cofinity Commercial |
$12,142.34
|
| Rate for Payer: Cofinity Commercial |
$9,883.30
|
| Rate for Payer: Healthscope Commercial |
$12,707.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,001.15
|
| Rate for Payer: PHP Commercial |
$12,001.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,883.30
|
| Rate for Payer: Priority Health SBD |
$8,894.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,969.89
|
| Rate for Payer: UHC Exchange |
$5,788.79
|
|
|
HC SPINE JACK
|
Facility
|
IP
|
$14,119.00
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,894.97 |
| Max. Negotiated Rate |
$12,707.10 |
| Rate for Payer: Aetna Commercial |
$12,001.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,177.35
|
| Rate for Payer: Cash Price |
$11,295.20
|
| Rate for Payer: Cofinity Commercial |
$12,142.34
|
| Rate for Payer: Cofinity Commercial |
$9,883.30
|
| Rate for Payer: Healthscope Commercial |
$12,707.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,001.15
|
| Rate for Payer: PHP Commercial |
$12,001.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,883.30
|
| Rate for Payer: Priority Health SBD |
$8,894.97
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 1 VIEW
|
Facility
|
IP
|
$147.59
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
32000317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$132.83 |
| Rate for Payer: Aetna Commercial |
$125.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.93
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cofinity Commercial |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$126.93
|
| Rate for Payer: Healthscope Commercial |
$132.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.45
|
| Rate for Payer: PHP Commercial |
$125.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.31
|
| Rate for Payer: Priority Health SBD |
$92.98
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 1 VIEW
|
Facility
|
OP
|
$147.59
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
32000317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$125.45
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$50.20
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cofinity Commercial |
$126.93
|
| Rate for Payer: Cofinity Commercial |
$103.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$132.83
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.45
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$125.45
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$92.98
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$41.91
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 2 OR 3 VIEW
|
Facility
|
OP
|
$354.24
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
32000306
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$338.98 |
| Rate for Payer: Aetna Commercial |
$301.10
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$91.57
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$283.39
|
| Rate for Payer: Cash Price |
$283.39
|
| Rate for Payer: Cofinity Commercial |
$304.65
|
| Rate for Payer: Cofinity Commercial |
$247.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$318.82
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.10
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$301.10
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$223.17
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$69.09
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 2 OR 3 VIEW
|
Facility
|
IP
|
$354.24
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
32000306
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$318.82 |
| Rate for Payer: Aetna Commercial |
$301.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.26
|
| Rate for Payer: Cash Price |
$283.39
|
| Rate for Payer: Cofinity Commercial |
$247.97
|
| Rate for Payer: Cofinity Commercial |
$304.65
|
| Rate for Payer: Healthscope Commercial |
$318.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.10
|
| Rate for Payer: PHP Commercial |
$301.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.97
|
| Rate for Payer: Priority Health SBD |
$223.17
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
IP
|
$472.31
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.56 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.00
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Cofinity Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health SBD |
$297.56
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
OP
|
$472.31
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$102.59
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$297.56
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
IP
|
$590.39
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.95 |
| Max. Negotiated Rate |
$531.35 |
| Rate for Payer: Aetna Commercial |
$501.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.75
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$507.74
|
| Rate for Payer: Cofinity Commercial |
$413.27
|
| Rate for Payer: Healthscope Commercial |
$531.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: PHP Commercial |
$501.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: Priority Health SBD |
$371.95
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
OP
|
$590.39
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$531.35 |
| Rate for Payer: Aetna Commercial |
$501.83
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$131.29
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$413.27
|
| Rate for Payer: Cofinity Commercial |
$507.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$531.35
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$501.83
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$371.95
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$96.92
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
OP
|
$2,199.20
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,979.28 |
| Rate for Payer: Aetna Commercial |
$1,869.32
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,429.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$331.51
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$1,891.31
|
| Rate for Payer: Cofinity Commercial |
$1,539.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,979.28
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,869.32
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,146.57
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Narrow Network |
$917.26
|
| Rate for Payer: Priority Health SBD |
$1,385.50
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$275.71
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
IP
|
$2,199.20
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,385.50 |
| Max. Negotiated Rate |
$1,979.28 |
| Rate for Payer: Aetna Commercial |
$1,869.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,429.48
|
| Rate for Payer: Cash Price |
$1,759.36
|
| Rate for Payer: Cofinity Commercial |
$1,539.44
|
| Rate for Payer: Cofinity Commercial |
$1,891.31
|
| Rate for Payer: Healthscope Commercial |
$1,979.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,869.32
|
| Rate for Payer: PHP Commercial |
$1,869.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.44
|
| Rate for Payer: Priority Health SBD |
$1,385.50
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
OP
|
$314.06
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$329.42 |
| Rate for Payer: Aetna Commercial |
$266.95
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$251.25
|
| Rate for Payer: Cash Price |
$251.25
|
| Rate for Payer: Cofinity Commercial |
$219.84
|
| Rate for Payer: Cofinity Commercial |
$270.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$282.65
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.95
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$266.95
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.84
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health SBD |
$197.86
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$37.98
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
IP
|
$314.06
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.86 |
| Max. Negotiated Rate |
$282.65 |
| Rate for Payer: Aetna Commercial |
$266.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.14
|
| Rate for Payer: Cash Price |
$251.25
|
| Rate for Payer: Cofinity Commercial |
$219.84
|
| Rate for Payer: Cofinity Commercial |
$270.09
|
| Rate for Payer: Healthscope Commercial |
$282.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.95
|
| Rate for Payer: PHP Commercial |
$266.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.84
|
| Rate for Payer: Priority Health SBD |
$197.86
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
IP
|
$7,147.16
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,502.71 |
| Max. Negotiated Rate |
$6,432.44 |
| Rate for Payer: Aetna Commercial |
$6,075.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,645.65
|
| Rate for Payer: Cash Price |
$5,717.73
|
| Rate for Payer: Cofinity Commercial |
$5,003.01
|
| Rate for Payer: Cofinity Commercial |
$6,146.56
|
| Rate for Payer: Healthscope Commercial |
$6,432.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.09
|
| Rate for Payer: PHP Commercial |
$6,075.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.01
|
| Rate for Payer: Priority Health SBD |
$4,502.71
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
OP
|
$7,147.16
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.22 |
| Max. Negotiated Rate |
$14,847.89 |
| Rate for Payer: Aetna Commercial |
$6,075.09
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,645.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,294.87
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$5,717.73
|
| Rate for Payer: Cash Price |
$5,717.73
|
| Rate for Payer: Cofinity Commercial |
$6,146.56
|
| Rate for Payer: Cofinity Commercial |
$5,003.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$6,432.44
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.09
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$6,075.09
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,847.89
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$11,878.31
|
| Rate for Payer: Priority Health SBD |
$4,502.71
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.24
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$210.22
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$314.79
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$436.07 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$85.95
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$251.83
|
| Rate for Payer: Cash Price |
$251.83
|
| Rate for Payer: Cofinity Commercial |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$283.31
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.57
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$267.57
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$198.32
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC SPIROMETRY
|
Facility
|
IP
|
$314.79
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.32 |
| Max. Negotiated Rate |
$283.31 |
| Rate for Payer: Aetna Commercial |
$267.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.61
|
| Rate for Payer: Cash Price |
$251.83
|
| Rate for Payer: Cofinity Commercial |
$220.35
|
| Rate for Payer: Cofinity Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$283.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.57
|
| Rate for Payer: PHP Commercial |
$267.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health SBD |
$198.32
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$555.21
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$38.31 |
| Max. Negotiated Rate |
$499.69 |
| Rate for Payer: Aetna Commercial |
$471.93
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$130.49
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$444.17
|
| Rate for Payer: Cash Price |
$444.17
|
| Rate for Payer: Cofinity Commercial |
$477.48
|
| Rate for Payer: Cofinity Commercial |
$388.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$499.69
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.93
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$471.93
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.65
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$349.78
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$38.31
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$555.21
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$349.78 |
| Max. Negotiated Rate |
$499.69 |
| Rate for Payer: Aetna Commercial |
$471.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.89
|
| Rate for Payer: Cash Price |
$444.17
|
| Rate for Payer: Cofinity Commercial |
$388.65
|
| Rate for Payer: Cofinity Commercial |
$477.48
|
| Rate for Payer: Healthscope Commercial |
$499.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$471.93
|
| Rate for Payer: PHP Commercial |
$471.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.65
|
| Rate for Payer: Priority Health SBD |
$349.78
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,118.56
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,551.40 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,500.78
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,677.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,110.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,294.85
|
| Rate for Payer: Cash Price |
$3,294.85
|
| Rate for Payer: Cofinity Commercial |
$3,541.96
|
| Rate for Payer: Cofinity Commercial |
$2,882.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,706.70
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,500.78
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,500.78
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,882.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,594.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,118.56
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,594.69 |
| Max. Negotiated Rate |
$3,706.70 |
| Rate for Payer: Aetna Commercial |
$3,500.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,677.06
|
| Rate for Payer: Cash Price |
$3,294.85
|
| Rate for Payer: Cofinity Commercial |
$2,882.99
|
| Rate for Payer: Cofinity Commercial |
$3,541.96
|
| Rate for Payer: Healthscope Commercial |
$3,706.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,500.78
|
| Rate for Payer: PHP Commercial |
$3,500.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,882.99
|
| Rate for Payer: Priority Health SBD |
$2,594.69
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$137.49
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$123.74 |
| Rate for Payer: Aetna Commercial |
$116.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.37
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Cofinity Commercial |
$96.24
|
| Rate for Payer: Healthscope Commercial |
$123.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.87
|
| Rate for Payer: PHP Commercial |
$116.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.24
|
| Rate for Payer: Priority Health SBD |
$86.62
|
|
