|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$143.10
|
| Rate for Payer: BCN Commercial |
$143.10
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Advantage |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$309.58
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.41
|
| Rate for Payer: UHC Core |
$256.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$193.12
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
OP
|
$614.24
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$552.82 |
| Rate for Payer: Aetna Commercial |
$522.10
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$177.93
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$491.39
|
| Rate for Payer: Cash Price |
$491.39
|
| Rate for Payer: Cofinity Advantage |
$429.97
|
| Rate for Payer: Cofinity Commercial |
$528.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$552.82
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.10
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.68
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$522.10
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$386.97
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.26
|
| Rate for Payer: UHC Core |
$320.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$241.40
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
IP
|
$614.24
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.97 |
| Max. Negotiated Rate |
$552.82 |
| Rate for Payer: Aetna Commercial |
$522.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.26
|
| Rate for Payer: Cash Price |
$491.39
|
| Rate for Payer: Cofinity Advantage |
$429.97
|
| Rate for Payer: Cofinity Commercial |
$528.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.39
|
| Rate for Payer: Healthscope Commercial |
$552.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$522.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$460.68
|
| Rate for Payer: PHP Commercial |
$522.10
|
| Rate for Payer: Priority Health SBD |
$386.97
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
OP
|
$2,288.04
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$437.63
|
| Rate for Payer: BCN Commercial |
$437.63
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Advantage |
$1,601.63
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,441.47
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.23
|
| Rate for Payer: UHC Core |
$1,192.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$899.20
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
IP
|
$2,288.04
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,441.47 |
| Max. Negotiated Rate |
$2,059.24 |
| Rate for Payer: Healthscope Commercial |
$2,059.24
|
| Rate for Payer: Aetna Commercial |
$1,944.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,487.23
|
| Rate for Payer: Cash Price |
$1,830.43
|
| Rate for Payer: Cofinity Advantage |
$1,601.63
|
| Rate for Payer: Cofinity Commercial |
$1,967.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,830.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,944.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,716.03
|
| Rate for Payer: PHP Commercial |
$1,944.83
|
| Rate for Payer: Priority Health SBD |
$1,441.47
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
OP
|
$326.75
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$277.74
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$261.40
|
| Rate for Payer: Cash Price |
$261.40
|
| Rate for Payer: Cash Price |
$261.40
|
| Rate for Payer: Cofinity Advantage |
$228.72
|
| Rate for Payer: Cofinity Commercial |
$281.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$294.07
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| 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 |
$321.14
|
| 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 |
$277.74
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.06
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$277.74
|
| 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/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$205.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.39
|
| Rate for Payer: UHC Core |
$170.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$128.41
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
IP
|
$326.75
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.85 |
| Max. Negotiated Rate |
$294.07 |
| Rate for Payer: Aetna Commercial |
$277.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.39
|
| Rate for Payer: Cash Price |
$261.40
|
| Rate for Payer: Cofinity Advantage |
$228.72
|
| Rate for Payer: Cofinity Commercial |
$281.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.40
|
| Rate for Payer: Healthscope Commercial |
$294.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.06
|
| Rate for Payer: PHP Commercial |
$277.74
|
| Rate for Payer: Priority Health SBD |
$205.85
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
OP
|
$7,435.90
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Commercial |
$6,320.52
|
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,833.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,026.90
|
| Rate for Payer: BCN Commercial |
$3,026.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Cash Price |
$5,948.72
|
| Rate for Payer: Cash Price |
$5,948.72
|
| Rate for Payer: Cash Price |
$5,948.72
|
| Rate for Payer: Cofinity Advantage |
$5,205.13
|
| Rate for Payer: Cofinity Commercial |
$6,394.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,948.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Healthscope Commercial |
$6,692.31
|
| Rate for Payer: Mclaren Medicaid |
$2,899.76
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,320.52
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,576.93
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Commercial |
$6,320.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health SBD |
$4,684.62
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
IP
|
$7,435.90
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,684.62 |
| Max. Negotiated Rate |
$6,692.31 |
| Rate for Payer: Aetna Commercial |
$6,320.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,833.34
|
| Rate for Payer: Cash Price |
$5,948.72
|
| Rate for Payer: Cofinity Advantage |
$5,205.13
|
| Rate for Payer: Cofinity Commercial |
$6,394.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,948.72
|
| Rate for Payer: Healthscope Commercial |
$6,692.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,320.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,576.93
|
| Rate for Payer: PHP Commercial |
$6,320.52
|
| Rate for Payer: Priority Health SBD |
$4,684.62
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$327.51
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$278.38
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.86
|
| Rate for Payer: BCN Commercial |
$85.86
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$262.01
|
| Rate for Payer: Cash Price |
$262.01
|
| Rate for Payer: Cofinity Advantage |
$229.26
|
| Rate for Payer: Cofinity Commercial |
$281.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$294.76
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.38
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.63
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$278.38
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$206.33
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.88
|
| Rate for Payer: UHC Core |
$170.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$128.71
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC SPIROMETRY
|
Facility
|
IP
|
$327.51
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$206.33 |
| Max. Negotiated Rate |
$294.76 |
| Rate for Payer: Aetna Commercial |
$278.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.88
|
| Rate for Payer: Cash Price |
$262.01
|
| Rate for Payer: Cofinity Advantage |
$229.26
|
| Rate for Payer: Cofinity Commercial |
$281.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.01
|
| Rate for Payer: Healthscope Commercial |
$294.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.63
|
| Rate for Payer: PHP Commercial |
$278.38
|
| Rate for Payer: Priority Health SBD |
$206.33
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$577.64
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$128.81 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$490.99
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$128.81
|
| Rate for Payer: BCN Commercial |
$128.81
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$462.11
|
| Rate for Payer: Cash Price |
$462.11
|
| Rate for Payer: Cofinity Advantage |
$404.35
|
| Rate for Payer: Cofinity Commercial |
$496.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$519.88
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.99
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.23
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$490.99
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$363.91
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.47
|
| Rate for Payer: UHC Core |
$300.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$227.01
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$577.64
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$363.91 |
| Max. Negotiated Rate |
$519.88 |
| Rate for Payer: Aetna Commercial |
$490.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.47
|
| Rate for Payer: Cash Price |
$462.11
|
| Rate for Payer: Cofinity Advantage |
$404.35
|
| Rate for Payer: Cofinity Commercial |
$496.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.11
|
| Rate for Payer: Healthscope Commercial |
$519.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$433.23
|
| Rate for Payer: PHP Commercial |
$490.99
|
| Rate for Payer: Priority Health SBD |
$363.91
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,284.95
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,642.21
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,785.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$4,474.49
|
| Rate for Payer: BCN Commercial |
$4,474.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cofinity Advantage |
$2,999.47
|
| Rate for Payer: Cofinity Commercial |
$3,685.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,427.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,856.45
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.21
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,213.71
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,642.21
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,699.52
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,785.22
|
| Rate for Payer: UHC Core |
$2,232.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$1,683.99
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,284.95
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,699.52 |
| Max. Negotiated Rate |
$3,856.45 |
| Rate for Payer: Aetna Commercial |
$3,642.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,785.22
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cofinity Advantage |
$2,999.47
|
| Rate for Payer: Cofinity Commercial |
$3,685.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,427.96
|
| Rate for Payer: Healthscope Commercial |
$3,856.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,213.71
|
| Rate for Payer: PHP Commercial |
$3,642.21
|
| Rate for Payer: Priority Health SBD |
$2,699.52
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$143.04
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$37.45
|
| Rate for Payer: BCN Commercial |
$37.45
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Advantage |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$90.12
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.98
|
| Rate for Payer: UHC Core |
$74.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$56.21
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$143.04
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$128.74 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.98
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Advantage |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: Priority Health SBD |
$90.12
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$143.04
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$55.37
|
| Rate for Payer: BCN Commercial |
$55.37
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Advantage |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$90.12
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.98
|
| Rate for Payer: UHC Core |
$74.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$56.21
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$143.04
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$128.74 |
| Rate for Payer: Aetna Commercial |
$121.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.98
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Advantage |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$123.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Healthscope Commercial |
$128.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PHP Commercial |
$121.58
|
| Rate for Payer: Priority Health SBD |
$90.12
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$404.91
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna Commercial |
$344.17
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$91.07
|
| Rate for Payer: BCN Commercial |
$91.07
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cofinity Advantage |
$283.44
|
| Rate for Payer: Cofinity Commercial |
$348.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$364.42
|
| Rate for Payer: Mclaren Medicaid |
$84.68
|
| 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 |
$170.02
|
| 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 |
$344.17
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.68
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$344.17
|
| 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/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health SBD |
$255.09
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.19
|
| Rate for Payer: UHC Core |
$210.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$159.13
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$404.91
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$364.42 |
| Rate for Payer: Aetna Commercial |
$344.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.19
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cofinity Advantage |
$283.44
|
| Rate for Payer: Cofinity Commercial |
$348.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.93
|
| Rate for Payer: Healthscope Commercial |
$364.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.68
|
| Rate for Payer: PHP Commercial |
$344.17
|
| Rate for Payer: Priority Health SBD |
$255.09
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$523.62 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$168.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$96.81
|
| Rate for Payer: BCN Commercial |
$96.81
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$84.68
|
| 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 |
$170.02
|
| 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 |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$485.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$309.85
|
| 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/Narrow Network |
$523.62
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: Priority Health Tiered Network |
$418.90
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.94
|
| Rate for Payer: UHC Core |
$189.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$143.26
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$229.65 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Advantage |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health SBD |
$229.65
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$563.37
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$354.92 |
| Max. Negotiated Rate |
$507.03 |
| Rate for Payer: Aetna Commercial |
$478.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.19
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cofinity Advantage |
$394.36
|
| Rate for Payer: Cofinity Commercial |
$484.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.70
|
| Rate for Payer: Healthscope Commercial |
$507.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.53
|
| Rate for Payer: PHP Commercial |
$478.86
|
| Rate for Payer: Priority Health SBD |
$354.92
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$563.37
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$507.03 |
| Rate for Payer: Aetna Commercial |
$478.86
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCN Commercial |
$68.67
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cofinity Advantage |
$394.36
|
| Rate for Payer: Cofinity Commercial |
$484.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$507.03
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.53
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$478.86
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$354.92
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.19
|
| Rate for Payer: UHC Core |
$293.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$221.40
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
