|
HC VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
IP
|
$1,436.86
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100028
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$905.22 |
| Max. Negotiated Rate |
$1,293.17 |
| Rate for Payer: Aetna Commercial |
$1,221.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.96
|
| Rate for Payer: Cash Price |
$1,149.49
|
| Rate for Payer: Cofinity Advantage |
$1,005.80
|
| Rate for Payer: Cofinity Commercial |
$1,235.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.49
|
| Rate for Payer: Healthscope Commercial |
$1,293.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,077.64
|
| Rate for Payer: PHP Commercial |
$1,221.33
|
| Rate for Payer: Priority Health SBD |
$905.22
|
|
|
HC VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
OP
|
$884.98
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$796.48 |
| Rate for Payer: Aetna Commercial |
$752.23
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.24
|
| 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 |
$432.30
|
| Rate for Payer: BCN Commercial |
$432.30
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$707.98
|
| Rate for Payer: Cash Price |
$707.98
|
| Rate for Payer: Cofinity Advantage |
$619.49
|
| Rate for Payer: Cofinity Commercial |
$761.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$796.48
|
| 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 |
$752.23
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$663.74
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$752.23
|
| 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 |
$557.54
|
| 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) |
$575.24
|
| Rate for Payer: UHC Core |
$461.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$347.80
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
IP
|
$884.98
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$557.54 |
| Max. Negotiated Rate |
$796.48 |
| Rate for Payer: Aetna Commercial |
$752.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.24
|
| Rate for Payer: Cash Price |
$707.98
|
| Rate for Payer: Cofinity Advantage |
$619.49
|
| Rate for Payer: Cofinity Commercial |
$761.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.98
|
| Rate for Payer: Healthscope Commercial |
$796.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$752.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$663.74
|
| Rate for Payer: PHP Commercial |
$752.23
|
| Rate for Payer: Priority Health SBD |
$557.54
|
|
|
HC VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
OP
|
$1,041.15
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$937.03 |
| Rate for Payer: Aetna Commercial |
$884.98
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.75
|
| 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 |
$432.30
|
| Rate for Payer: BCN Commercial |
$432.30
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$832.92
|
| Rate for Payer: Cash Price |
$832.92
|
| Rate for Payer: Cofinity Advantage |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$895.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$937.03
|
| 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 |
$884.98
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.86
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$884.98
|
| 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 |
$655.92
|
| 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) |
$676.75
|
| Rate for Payer: UHC Core |
$542.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$409.17
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
IP
|
$1,041.15
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$655.92 |
| Max. Negotiated Rate |
$937.03 |
| Rate for Payer: Aetna Commercial |
$884.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.75
|
| Rate for Payer: Cash Price |
$832.92
|
| Rate for Payer: Cofinity Advantage |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$895.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.92
|
| Rate for Payer: Healthscope Commercial |
$937.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.86
|
| Rate for Payer: PHP Commercial |
$884.98
|
| Rate for Payer: Priority Health SBD |
$655.92
|
|
|
HC VENT CPS Y
|
Facility
|
OP
|
$31.21
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC Core |
$16.26
|
| Rate for Payer: UHC Exchange |
$12.27
|
|
|
HC VENT CPS Y
|
Facility
|
IP
|
$31.21
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
IP
|
$8,284.71
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,219.37 |
| Max. Negotiated Rate |
$7,456.24 |
| Rate for Payer: Aetna Commercial |
$7,042.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,385.06
|
| Rate for Payer: Cash Price |
$6,627.77
|
| Rate for Payer: Cofinity Advantage |
$5,799.30
|
| Rate for Payer: Cofinity Commercial |
$7,124.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,627.77
|
| Rate for Payer: Healthscope Commercial |
$7,456.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,042.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,213.53
|
| Rate for Payer: PHP Commercial |
$7,042.00
|
| Rate for Payer: Priority Health SBD |
$5,219.37
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
OP
|
$8,284.71
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$7,042.00
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,385.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,345.73
|
| Rate for Payer: BCN Commercial |
$2,345.73
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$6,627.77
|
| Rate for Payer: Cash Price |
$6,627.77
|
| Rate for Payer: Cash Price |
$6,627.77
|
| Rate for Payer: Cofinity Advantage |
$5,799.30
|
| Rate for Payer: Cofinity Commercial |
$7,124.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,627.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$7,456.24
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,042.00
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,213.53
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$7,042.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$5,219.37
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,385.06
|
| Rate for Payer: UHC Core |
$4,316.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,255.89
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
IP
|
$875.51
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$551.57 |
| Max. Negotiated Rate |
$787.96 |
| Rate for Payer: Aetna Commercial |
$744.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.08
|
| Rate for Payer: Cash Price |
$700.41
|
| Rate for Payer: Cofinity Advantage |
$612.86
|
| Rate for Payer: Cofinity Commercial |
$752.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.41
|
| Rate for Payer: Healthscope Commercial |
$787.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$656.63
|
| Rate for Payer: PHP Commercial |
$744.18
|
| Rate for Payer: Priority Health SBD |
$551.57
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
OP
|
$875.51
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$787.96 |
| Rate for Payer: Aetna Commercial |
$744.18
|
| Rate for Payer: Aetna Medicare |
$437.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.08
|
| Rate for Payer: BCBS Complete |
$350.20
|
| Rate for Payer: Cash Price |
$700.41
|
| Rate for Payer: Cofinity Advantage |
$612.86
|
| Rate for Payer: Cofinity Commercial |
$752.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.41
|
| Rate for Payer: Healthscope Commercial |
$787.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$656.63
|
| Rate for Payer: PHP Commercial |
$744.18
|
| Rate for Payer: Priority Health SBD |
$551.57
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
IP
|
$5,358.12
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,375.62 |
| Max. Negotiated Rate |
$4,822.31 |
| Rate for Payer: Aetna Commercial |
$4,554.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,482.78
|
| Rate for Payer: Cash Price |
$4,286.50
|
| Rate for Payer: Cofinity Advantage |
$3,750.68
|
| Rate for Payer: Cofinity Commercial |
$4,607.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,286.50
|
| Rate for Payer: Healthscope Commercial |
$4,822.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,554.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,018.59
|
| Rate for Payer: PHP Commercial |
$4,554.40
|
| Rate for Payer: Priority Health SBD |
$3,375.62
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
OP
|
$5,358.12
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$4,554.40
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,482.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,802.56
|
| Rate for Payer: BCN Commercial |
$1,802.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$4,286.50
|
| Rate for Payer: Cash Price |
$4,286.50
|
| Rate for Payer: Cash Price |
$4,286.50
|
| Rate for Payer: Cofinity Advantage |
$3,750.68
|
| Rate for Payer: Cofinity Commercial |
$4,607.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,286.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$4,822.31
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,554.40
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,018.59
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$4,554.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$3,375.62
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
IP
|
$5,729.01
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,609.28 |
| Max. Negotiated Rate |
$5,156.11 |
| Rate for Payer: Aetna Commercial |
$4,869.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,723.86
|
| Rate for Payer: Cash Price |
$4,583.21
|
| Rate for Payer: Cofinity Advantage |
$4,010.31
|
| Rate for Payer: Cofinity Commercial |
$4,926.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,583.21
|
| Rate for Payer: Healthscope Commercial |
$5,156.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,869.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,296.76
|
| Rate for Payer: PHP Commercial |
$4,869.66
|
| Rate for Payer: Priority Health SBD |
$3,609.28
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
OP
|
$5,729.01
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,291.60 |
| Max. Negotiated Rate |
$5,156.11 |
| Rate for Payer: Aetna Commercial |
$4,869.66
|
| Rate for Payer: Aetna Medicare |
$2,864.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,723.86
|
| Rate for Payer: BCBS Complete |
$2,291.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,524.45
|
| Rate for Payer: BCN Commercial |
$2,524.45
|
| Rate for Payer: Cash Price |
$4,583.21
|
| Rate for Payer: Cash Price |
$4,583.21
|
| Rate for Payer: Cofinity Advantage |
$4,010.31
|
| Rate for Payer: Cofinity Commercial |
$4,926.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,583.21
|
| Rate for Payer: Healthscope Commercial |
$5,156.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,583.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,869.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,296.76
|
| Rate for Payer: PHP Commercial |
$4,869.66
|
| Rate for Payer: Priority Health SBD |
$3,609.28
|
|
|
HC VERPLSTY W WO BONE BX L S 1ST
|
Facility
|
IP
|
$5,006.62
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
36100464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,154.17 |
| Max. Negotiated Rate |
$4,505.96 |
| Rate for Payer: Aetna Commercial |
$4,255.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,254.30
|
| Rate for Payer: Cash Price |
$4,005.30
|
| Rate for Payer: Cofinity Advantage |
$3,504.63
|
| Rate for Payer: Cofinity Commercial |
$4,305.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,005.30
|
| Rate for Payer: Healthscope Commercial |
$4,505.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,255.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,754.97
|
| Rate for Payer: PHP Commercial |
$4,255.63
|
| Rate for Payer: Priority Health SBD |
$3,154.17
|
|
|
HC VERPLSTY W WO BONE BX L S 1ST
|
Facility
|
OP
|
$5,006.62
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
36100464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$4,255.63
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,254.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,802.56
|
| Rate for Payer: BCN Commercial |
$1,802.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$4,005.30
|
| Rate for Payer: Cash Price |
$4,005.30
|
| Rate for Payer: Cash Price |
$4,005.30
|
| Rate for Payer: Cofinity Advantage |
$3,504.63
|
| Rate for Payer: Cofinity Commercial |
$4,305.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,005.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$4,505.96
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,255.63
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,754.97
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$4,255.63
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$3,154.17
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC VERSACROSS KIT
|
Facility
|
IP
|
$3,714.23
|
|
| Hospital Charge Code |
27200346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,339.96 |
| Max. Negotiated Rate |
$3,342.81 |
| Rate for Payer: Aetna Commercial |
$3,157.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,414.25
|
| Rate for Payer: Cash Price |
$2,971.38
|
| Rate for Payer: Cofinity Advantage |
$2,599.96
|
| Rate for Payer: Cofinity Commercial |
$3,194.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,971.38
|
| Rate for Payer: Healthscope Commercial |
$3,342.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,157.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,785.67
|
| Rate for Payer: PHP Commercial |
$3,157.10
|
| Rate for Payer: Priority Health SBD |
$2,339.96
|
|
|
HC VERSACROSS KIT
|
Facility
|
OP
|
$3,714.23
|
|
| Hospital Charge Code |
27200346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,459.69 |
| Max. Negotiated Rate |
$3,342.81 |
| Rate for Payer: Aetna Commercial |
$3,157.10
|
| Rate for Payer: Aetna Medicare |
$1,857.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,414.25
|
| Rate for Payer: BCBS Complete |
$1,485.69
|
| Rate for Payer: Cash Price |
$2,971.38
|
| Rate for Payer: Cofinity Advantage |
$2,599.96
|
| Rate for Payer: Cofinity Commercial |
$3,194.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,971.38
|
| Rate for Payer: Healthscope Commercial |
$3,342.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,971.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,157.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,785.67
|
| Rate for Payer: PHP Commercial |
$3,157.10
|
| Rate for Payer: Priority Health SBD |
$2,339.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,414.25
|
| Rate for Payer: UHC Core |
$1,935.11
|
| Rate for Payer: UHC Exchange |
$1,459.69
|
|
|
HC VERSAPAP SUPPLY
|
Facility
|
OP
|
$61.20
|
|
| Hospital Charge Code |
27000711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Advantage |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.90
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.78
|
| Rate for Payer: UHC Core |
$31.89
|
| Rate for Payer: UHC Exchange |
$24.05
|
|
|
HC VERSAPAP SUPPLY
|
Facility
|
IP
|
$61.20
|
|
| Hospital Charge Code |
27000711
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Advantage |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.90
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC VERT AUG W MECH DEV EA ADD
|
Facility
|
IP
|
$11,838.93
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
36100469
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,458.53 |
| Max. Negotiated Rate |
$10,655.04 |
| Rate for Payer: Aetna Commercial |
$10,063.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,695.30
|
| Rate for Payer: Cash Price |
$9,471.14
|
| Rate for Payer: Cofinity Advantage |
$8,287.25
|
| Rate for Payer: Cofinity Commercial |
$10,181.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,471.14
|
| Rate for Payer: Healthscope Commercial |
$10,655.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,063.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,879.20
|
| Rate for Payer: PHP Commercial |
$10,063.09
|
| Rate for Payer: Priority Health SBD |
$7,458.53
|
|
|
HC VERT AUG W MECH DEV EA ADD
|
Facility
|
OP
|
$11,838.93
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
36100469
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,735.57 |
| Max. Negotiated Rate |
$10,655.04 |
| Rate for Payer: Aetna Commercial |
$10,063.09
|
| Rate for Payer: Aetna Medicare |
$5,919.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,695.30
|
| Rate for Payer: BCBS Complete |
$4,735.57
|
| Rate for Payer: BCBS Trust/PPO |
$8,732.16
|
| Rate for Payer: BCN Commercial |
$8,732.16
|
| Rate for Payer: Cash Price |
$9,471.14
|
| Rate for Payer: Cash Price |
$9,471.14
|
| Rate for Payer: Cofinity Advantage |
$8,287.25
|
| Rate for Payer: Cofinity Commercial |
$10,181.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,471.14
|
| Rate for Payer: Healthscope Commercial |
$10,655.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,471.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,063.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,879.20
|
| Rate for Payer: PHP Commercial |
$10,063.09
|
| Rate for Payer: Priority Health SBD |
$7,458.53
|
|
|
HC VERT AUG W MECH DEV LUMB 1ST
|
Facility
|
IP
|
$11,830.21
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36100468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,453.03 |
| Max. Negotiated Rate |
$10,647.19 |
| Rate for Payer: Aetna Commercial |
$10,055.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,689.64
|
| Rate for Payer: Cash Price |
$9,464.17
|
| Rate for Payer: Cofinity Advantage |
$8,281.15
|
| Rate for Payer: Cofinity Commercial |
$10,173.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,464.17
|
| Rate for Payer: Healthscope Commercial |
$10,647.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,055.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,872.66
|
| Rate for Payer: PHP Commercial |
$10,055.68
|
| Rate for Payer: Priority Health SBD |
$7,453.03
|
|
|
HC VERT AUG W MECH DEV LUMB 1ST
|
Facility
|
OP
|
$11,830.21
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36100468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Commercial |
$10,055.68
|
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,689.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,259.30
|
| Rate for Payer: BCN Commercial |
$4,259.30
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Cash Price |
$9,464.17
|
| Rate for Payer: Cash Price |
$9,464.17
|
| Rate for Payer: Cash Price |
$9,464.17
|
| Rate for Payer: Cofinity Advantage |
$8,281.15
|
| Rate for Payer: Cofinity Commercial |
$10,173.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,464.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Healthscope Commercial |
$10,647.19
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,055.68
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,872.66
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Commercial |
$10,055.68
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health SBD |
$7,453.03
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
