|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
IP
|
$212.16
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.49
|
| Rate for Payer: BCN Commercial |
$164.49
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cofinity Commercial |
$199.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.73
|
| Rate for Payer: Healthscope Commercial |
$212.16
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.70
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
OP
|
$254.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$90.51 |
| Max. Negotiated Rate |
$254.47 |
| Rate for Payer: Aetna Commercial |
$229.02
|
| Rate for Payer: ASR ASR |
$246.84
|
| Rate for Payer: BCBS Complete |
$101.79
|
| Rate for Payer: BCBS Trust/PPO |
$197.29
|
| Rate for Payer: BCN Commercial |
$197.29
|
| Rate for Payer: Cash Price |
$203.58
|
| Rate for Payer: Cash Price |
$203.58
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.58
|
| Rate for Payer: Healthscope Commercial |
$254.47
|
| Rate for Payer: Healthscope Whirlpool |
$246.84
|
| Rate for Payer: Mclaren Commercial |
$229.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.14
|
| Rate for Payer: Priority Health Narrow Network |
$90.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.93
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
IP
|
$254.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$178.13 |
| Max. Negotiated Rate |
$254.47 |
| Rate for Payer: Aetna Commercial |
$229.02
|
| Rate for Payer: ASR ASR |
$246.84
|
| Rate for Payer: BCBS Trust/PPO |
$197.29
|
| Rate for Payer: BCN Commercial |
$197.29
|
| Rate for Payer: Cash Price |
$203.58
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.58
|
| Rate for Payer: Healthscope Commercial |
$254.47
|
| Rate for Payer: Healthscope Whirlpool |
$246.84
|
| Rate for Payer: Mclaren Commercial |
$229.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.93
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
IP
|
$49.14
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$49.14 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: ASR ASR |
$47.67
|
| Rate for Payer: BCBS Trust/PPO |
$38.10
|
| Rate for Payer: BCN Commercial |
$38.10
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$46.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Healthscope Commercial |
$49.14
|
| Rate for Payer: Healthscope Whirlpool |
$47.67
|
| Rate for Payer: Mclaren Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.24
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
OP
|
$49.14
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$47.67
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$38.10
|
| Rate for Payer: BCN Commercial |
$38.10
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$46.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$49.14
|
| Rate for Payer: Healthscope Whirlpool |
$47.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$44.23
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.72
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$34.89
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.24
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
IP
|
$389.23
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$272.46 |
| Max. Negotiated Rate |
$389.23 |
| Rate for Payer: Aetna Commercial |
$350.31
|
| Rate for Payer: ASR ASR |
$377.55
|
| Rate for Payer: BCBS Trust/PPO |
$301.77
|
| Rate for Payer: BCN Commercial |
$301.77
|
| Rate for Payer: Cash Price |
$311.38
|
| Rate for Payer: Cofinity Commercial |
$365.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.38
|
| Rate for Payer: Healthscope Commercial |
$389.23
|
| Rate for Payer: Healthscope Whirlpool |
$377.55
|
| Rate for Payer: Mclaren Commercial |
$350.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.52
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
OP
|
$389.23
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$155.69 |
| Max. Negotiated Rate |
$389.23 |
| Rate for Payer: Aetna Commercial |
$350.31
|
| Rate for Payer: ASR ASR |
$377.55
|
| Rate for Payer: BCBS Complete |
$155.69
|
| Rate for Payer: BCBS Trust/PPO |
$301.77
|
| Rate for Payer: BCN Commercial |
$301.77
|
| Rate for Payer: Cash Price |
$311.38
|
| Rate for Payer: Cash Price |
$311.38
|
| Rate for Payer: Cofinity Commercial |
$365.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.38
|
| Rate for Payer: Healthscope Commercial |
$389.23
|
| Rate for Payer: Healthscope Whirlpool |
$377.55
|
| Rate for Payer: Mclaren Commercial |
$350.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.68
|
| Rate for Payer: Priority Health Narrow Network |
$209.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.52
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
OP
|
$280.23
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$280.23 |
| Rate for Payer: Aetna Commercial |
$252.21
|
| Rate for Payer: ASR ASR |
$271.82
|
| Rate for Payer: BCBS Complete |
$112.09
|
| Rate for Payer: BCBS Trust/PPO |
$217.26
|
| Rate for Payer: BCN Commercial |
$217.26
|
| Rate for Payer: Cash Price |
$224.18
|
| Rate for Payer: Cash Price |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$263.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.18
|
| Rate for Payer: Healthscope Commercial |
$280.23
|
| Rate for Payer: Healthscope Whirlpool |
$271.82
|
| Rate for Payer: Mclaren Commercial |
$252.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.95
|
| Rate for Payer: Priority Health Narrow Network |
$94.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.60
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
IP
|
$280.23
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.16 |
| Max. Negotiated Rate |
$280.23 |
| Rate for Payer: Aetna Commercial |
$252.21
|
| Rate for Payer: ASR ASR |
$271.82
|
| Rate for Payer: BCBS Trust/PPO |
$217.26
|
| Rate for Payer: BCN Commercial |
$217.26
|
| Rate for Payer: Cash Price |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$263.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.18
|
| Rate for Payer: Healthscope Commercial |
$280.23
|
| Rate for Payer: Healthscope Whirlpool |
$271.82
|
| Rate for Payer: Mclaren Commercial |
$252.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.60
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
OP
|
$15.75
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: ASR ASR |
$15.28
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Whirlpool |
$15.28
|
| Rate for Payer: Mclaren Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health Narrow Network |
$11.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.86
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
IP
|
$15.75
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$14.18
|
| Rate for Payer: ASR ASR |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$12.21
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Whirlpool |
$15.28
|
| Rate for Payer: Mclaren Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.86
|
|
|
HC SPINAL/EPI ADDL 15 MIN
|
Facility
|
IP
|
$156.58
|
|
| Hospital Charge Code |
37000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$156.58 |
| Rate for Payer: Aetna Commercial |
$140.92
|
| Rate for Payer: ASR ASR |
$151.88
|
| Rate for Payer: BCBS Trust/PPO |
$121.40
|
| Rate for Payer: BCN Commercial |
$121.40
|
| Rate for Payer: Cash Price |
$125.26
|
| Rate for Payer: Cofinity Commercial |
$147.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.26
|
| Rate for Payer: Healthscope Commercial |
$156.58
|
| Rate for Payer: Healthscope Whirlpool |
$151.88
|
| Rate for Payer: Mclaren Commercial |
$140.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.79
|
|
|
HC SPINAL/EPI ADDL 15 MIN
|
Facility
|
OP
|
$156.58
|
|
| Hospital Charge Code |
37000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$156.58 |
| Rate for Payer: Aetna Commercial |
$140.92
|
| Rate for Payer: ASR ASR |
$151.88
|
| Rate for Payer: BCBS Complete |
$62.63
|
| Rate for Payer: BCBS Trust/PPO |
$121.40
|
| Rate for Payer: BCN Commercial |
$121.40
|
| Rate for Payer: Cash Price |
$125.26
|
| Rate for Payer: Cofinity Commercial |
$147.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.26
|
| Rate for Payer: Healthscope Commercial |
$156.58
|
| Rate for Payer: Healthscope Whirlpool |
$151.88
|
| Rate for Payer: Mclaren Commercial |
$140.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.49
|
| Rate for Payer: Priority Health Narrow Network |
$111.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.79
|
|
|
HC SPINAL/EPI INIT 30 MIN
|
Facility
|
IP
|
$428.17
|
|
| Hospital Charge Code |
37000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$299.72 |
| Max. Negotiated Rate |
$428.17 |
| Rate for Payer: Aetna Commercial |
$385.35
|
| Rate for Payer: ASR ASR |
$415.32
|
| Rate for Payer: BCBS Trust/PPO |
$331.96
|
| Rate for Payer: BCN Commercial |
$331.96
|
| Rate for Payer: Cash Price |
$342.54
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.54
|
| Rate for Payer: Healthscope Commercial |
$428.17
|
| Rate for Payer: Healthscope Whirlpool |
$415.32
|
| Rate for Payer: Mclaren Commercial |
$385.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.79
|
|
|
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 |
$428.17 |
| Rate for Payer: Aetna Commercial |
$385.35
|
| Rate for Payer: ASR ASR |
$415.32
|
| Rate for Payer: BCBS Complete |
$171.27
|
| Rate for Payer: BCBS Trust/PPO |
$331.96
|
| Rate for Payer: BCN Commercial |
$331.96
|
| Rate for Payer: Cash Price |
$342.54
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.54
|
| Rate for Payer: Healthscope Commercial |
$428.17
|
| Rate for Payer: Healthscope Whirlpool |
$415.32
|
| Rate for Payer: Mclaren Commercial |
$385.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.63
|
| Rate for Payer: Priority Health Narrow Network |
$304.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.79
|
|
|
HC SPINE JACK
|
Facility
|
OP
|
$14,119.00
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,647.60 |
| Max. Negotiated Rate |
$14,119.00 |
| Rate for Payer: Aetna Commercial |
$12,707.10
|
| Rate for Payer: ASR ASR |
$13,695.43
|
| Rate for Payer: BCBS Complete |
$5,647.60
|
| Rate for Payer: BCBS Trust/PPO |
$10,946.46
|
| Rate for Payer: BCN Commercial |
$10,946.46
|
| Rate for Payer: Cash Price |
$11,295.20
|
| Rate for Payer: Cofinity Commercial |
$13,271.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,295.20
|
| Rate for Payer: Healthscope Commercial |
$14,119.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,695.43
|
| Rate for Payer: Mclaren Commercial |
$12,707.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,001.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,883.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,848.29
|
| Rate for Payer: Priority Health Narrow Network |
$10,024.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,424.72
|
|
|
HC SPINE JACK
|
Facility
|
IP
|
$14,119.00
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,883.30 |
| Max. Negotiated Rate |
$14,119.00 |
| Rate for Payer: Aetna Commercial |
$12,707.10
|
| Rate for Payer: ASR ASR |
$13,695.43
|
| Rate for Payer: BCBS Trust/PPO |
$10,946.46
|
| Rate for Payer: BCN Commercial |
$10,946.46
|
| Rate for Payer: Cash Price |
$11,295.20
|
| Rate for Payer: Cofinity Commercial |
$13,271.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,295.20
|
| Rate for Payer: Healthscope Commercial |
$14,119.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,695.43
|
| Rate for Payer: Mclaren Commercial |
$12,707.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,001.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,883.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,424.72
|
|
|
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 |
$44.18 |
| Max. Negotiated Rate |
$147.59 |
| Rate for Payer: Aetna Commercial |
$132.83
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$143.16
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.43
|
| Rate for Payer: BCN Commercial |
$114.43
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cofinity Commercial |
$138.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$147.59
|
| Rate for Payer: Healthscope Whirlpool |
$143.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$132.83
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.45
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.31
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$104.79
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.88
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
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 |
$103.31 |
| Max. Negotiated Rate |
$147.59 |
| Rate for Payer: Aetna Commercial |
$132.83
|
| Rate for Payer: ASR ASR |
$143.16
|
| Rate for Payer: BCBS Trust/PPO |
$114.43
|
| Rate for Payer: BCN Commercial |
$114.43
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cofinity Commercial |
$138.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.07
|
| Rate for Payer: Healthscope Commercial |
$147.59
|
| Rate for Payer: Healthscope Whirlpool |
$143.16
|
| Rate for Payer: Mclaren Commercial |
$132.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.88
|
|
|
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 |
$53.45 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Aetna Commercial |
$318.82
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$343.61
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$274.64
|
| Rate for Payer: BCN Commercial |
$274.64
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$283.39
|
| Rate for Payer: Cash Price |
$283.39
|
| Rate for Payer: Cofinity Commercial |
$332.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$354.24
|
| Rate for Payer: Healthscope Whirlpool |
$343.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$318.82
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.10
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.36
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$251.51
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.73
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
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 |
$247.97 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Aetna Commercial |
$318.82
|
| Rate for Payer: ASR ASR |
$343.61
|
| Rate for Payer: BCBS Trust/PPO |
$274.64
|
| Rate for Payer: BCN Commercial |
$274.64
|
| Rate for Payer: Cash Price |
$283.39
|
| Rate for Payer: Cofinity Commercial |
$332.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.39
|
| Rate for Payer: Healthscope Commercial |
$354.24
|
| Rate for Payer: Healthscope Whirlpool |
$343.61
|
| Rate for Payer: Mclaren Commercial |
$318.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.73
|
|
|
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 |
$53.45 |
| Max. Negotiated Rate |
$472.31 |
| Rate for Payer: Aetna Commercial |
$425.08
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$458.14
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$366.18
|
| Rate for Payer: BCN Commercial |
$366.18
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$443.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$472.31
|
| Rate for Payer: Healthscope Whirlpool |
$458.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$425.08
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.80
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$335.34
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.63
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
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 |
$330.62 |
| Max. Negotiated Rate |
$472.31 |
| Rate for Payer: Aetna Commercial |
$425.08
|
| Rate for Payer: ASR ASR |
$458.14
|
| Rate for Payer: BCBS Trust/PPO |
$366.18
|
| Rate for Payer: BCN Commercial |
$366.18
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$443.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Healthscope Commercial |
$472.31
|
| Rate for Payer: Healthscope Whirlpool |
$458.14
|
| Rate for Payer: Mclaren Commercial |
$425.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.63
|
|
|
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 |
$413.27 |
| Max. Negotiated Rate |
$590.39 |
| Rate for Payer: Aetna Commercial |
$531.35
|
| Rate for Payer: ASR ASR |
$572.68
|
| Rate for Payer: BCBS Trust/PPO |
$457.73
|
| Rate for Payer: BCN Commercial |
$457.73
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$554.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.31
|
| Rate for Payer: Healthscope Commercial |
$590.39
|
| Rate for Payer: Healthscope Whirlpool |
$572.68
|
| Rate for Payer: Mclaren Commercial |
$531.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.54
|
|
|
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 |
$53.45 |
| Max. Negotiated Rate |
$590.39 |
| Rate for Payer: Aetna Commercial |
$531.35
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$572.68
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$457.73
|
| Rate for Payer: BCN Commercial |
$457.73
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cash Price |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$554.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$590.39
|
| Rate for Payer: Healthscope Whirlpool |
$572.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$531.35
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$501.83
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$413.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$537.25
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$419.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.54
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
