|
HC VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
IP
|
$1,000.73
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$700.51 |
| Max. Negotiated Rate |
$1,000.73 |
| Rate for Payer: Aetna Commercial |
$900.66
|
| Rate for Payer: ASR ASR |
$970.71
|
| Rate for Payer: BCBS Trust/PPO |
$775.87
|
| Rate for Payer: BCN Commercial |
$775.87
|
| Rate for Payer: Cash Price |
$800.58
|
| Rate for Payer: Cofinity Commercial |
$940.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.58
|
| Rate for Payer: Healthscope Commercial |
$1,000.73
|
| Rate for Payer: Healthscope Whirlpool |
$970.71
|
| Rate for Payer: Mclaren Commercial |
$900.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.64
|
|
|
HC VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
OP
|
$1,000.73
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,000.73 |
| Rate for Payer: Aetna Commercial |
$900.66
|
| 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 |
$970.71
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$775.87
|
| Rate for Payer: BCN Commercial |
$775.87
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$800.58
|
| Rate for Payer: Cash Price |
$800.58
|
| Rate for Payer: Cofinity Commercial |
$940.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,000.73
|
| Rate for Payer: Healthscope Whirlpool |
$970.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$900.66
|
| 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 |
$850.62
|
| 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 |
$700.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$637.77
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$510.22
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.64
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC VENT CPS Y
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
|
|
HC VENT CPS Y
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: ASR ASR |
$29.10
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$28.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$30.00
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Mclaren Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.30
|
| Rate for Payer: Priority Health Narrow Network |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.40
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
OP
|
$7,963.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,565.43 |
| Max. Negotiated Rate |
$7,963.00 |
| Rate for Payer: Aetna Commercial |
$7,166.70
|
| Rate for Payer: Aetna Medicare |
$2,861.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: ASR ASR |
$7,724.11
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,173.71
|
| Rate for Payer: BCN Commercial |
$6,173.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Cash Price |
$6,370.40
|
| Rate for Payer: Cash Price |
$6,370.40
|
| Rate for Payer: Cofinity Commercial |
$7,485.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,370.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Healthscope Commercial |
$7,963.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,724.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,861.84
|
| Rate for Payer: Mclaren Commercial |
$7,166.70
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,768.55
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Commercial |
$3,148.02
|
| Rate for Payer: PHP Medicaid |
$1,565.43
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,574.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,246.33
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$5,653.73
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,007.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
IP
|
$7,963.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,574.10 |
| Max. Negotiated Rate |
$7,963.00 |
| Rate for Payer: Aetna Commercial |
$7,166.70
|
| Rate for Payer: ASR ASR |
$7,724.11
|
| Rate for Payer: BCBS Trust/PPO |
$6,173.71
|
| Rate for Payer: BCN Commercial |
$6,173.71
|
| Rate for Payer: Cash Price |
$6,370.40
|
| Rate for Payer: Cofinity Commercial |
$7,485.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,370.40
|
| Rate for Payer: Healthscope Commercial |
$7,963.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,724.11
|
| Rate for Payer: Mclaren Commercial |
$7,166.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,574.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,007.44
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
OP
|
$841.51
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$841.51 |
| Rate for Payer: Aetna Commercial |
$757.36
|
| Rate for Payer: ASR ASR |
$816.26
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: BCBS Trust/PPO |
$652.42
|
| Rate for Payer: BCN Commercial |
$652.42
|
| Rate for Payer: Cash Price |
$673.21
|
| Rate for Payer: Cofinity Commercial |
$791.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.21
|
| Rate for Payer: Healthscope Commercial |
$841.51
|
| Rate for Payer: Healthscope Whirlpool |
$816.26
|
| Rate for Payer: Mclaren Commercial |
$757.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$715.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$765.77
|
| Rate for Payer: Priority Health Narrow Network |
$597.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.53
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
IP
|
$841.51
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.06 |
| Max. Negotiated Rate |
$841.51 |
| Rate for Payer: Aetna Commercial |
$757.36
|
| Rate for Payer: ASR ASR |
$816.26
|
| Rate for Payer: BCBS Trust/PPO |
$652.42
|
| Rate for Payer: BCN Commercial |
$652.42
|
| Rate for Payer: Cash Price |
$673.21
|
| Rate for Payer: Cofinity Commercial |
$791.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.21
|
| Rate for Payer: Healthscope Commercial |
$841.51
|
| Rate for Payer: Healthscope Whirlpool |
$816.26
|
| Rate for Payer: Mclaren Commercial |
$757.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$715.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.53
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
OP
|
$5,002.91
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,573.80 |
| Max. Negotiated Rate |
$5,002.91 |
| Rate for Payer: Aetna Commercial |
$4,502.62
|
| Rate for Payer: Aetna Medicare |
$2,877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: ASR ASR |
$4,852.82
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,878.76
|
| Rate for Payer: BCN Commercial |
$3,878.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$4,002.33
|
| Rate for Payer: Cash Price |
$4,002.33
|
| Rate for Payer: Cofinity Commercial |
$4,702.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,002.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$5,002.91
|
| Rate for Payer: Healthscope Whirlpool |
$4,852.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,877.15
|
| Rate for Payer: Mclaren Commercial |
$4,502.62
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,252.47
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$3,164.86
|
| Rate for Payer: PHP Medicaid |
$1,573.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,502.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,552.65
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$3,552.07
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,402.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
IP
|
$5,002.91
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,502.04 |
| Max. Negotiated Rate |
$5,002.91 |
| Rate for Payer: Aetna Commercial |
$4,502.62
|
| Rate for Payer: ASR ASR |
$4,852.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,878.76
|
| Rate for Payer: BCN Commercial |
$3,878.76
|
| Rate for Payer: Cash Price |
$4,002.33
|
| Rate for Payer: Cofinity Commercial |
$4,702.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,002.33
|
| Rate for Payer: Healthscope Commercial |
$5,002.91
|
| Rate for Payer: Healthscope Whirlpool |
$4,852.82
|
| Rate for Payer: Mclaren Commercial |
$4,502.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,252.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,502.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,402.56
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
OP
|
$5,349.22
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,139.69 |
| Max. Negotiated Rate |
$5,349.22 |
| Rate for Payer: Aetna Commercial |
$4,814.30
|
| Rate for Payer: ASR ASR |
$5,188.74
|
| Rate for Payer: BCBS Complete |
$2,139.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,147.25
|
| Rate for Payer: BCN Commercial |
$4,147.25
|
| Rate for Payer: Cash Price |
$4,279.38
|
| Rate for Payer: Cofinity Commercial |
$5,028.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,279.38
|
| Rate for Payer: Healthscope Commercial |
$5,349.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,188.74
|
| Rate for Payer: Mclaren Commercial |
$4,814.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,546.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,744.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,867.79
|
| Rate for Payer: Priority Health Narrow Network |
$3,797.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,707.31
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
IP
|
$5,349.22
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,744.45 |
| Max. Negotiated Rate |
$5,349.22 |
| Rate for Payer: Aetna Commercial |
$4,814.30
|
| Rate for Payer: ASR ASR |
$5,188.74
|
| Rate for Payer: BCBS Trust/PPO |
$4,147.25
|
| Rate for Payer: BCN Commercial |
$4,147.25
|
| Rate for Payer: Cash Price |
$4,279.38
|
| Rate for Payer: Cofinity Commercial |
$5,028.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,279.38
|
| Rate for Payer: Healthscope Commercial |
$5,349.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,188.74
|
| Rate for Payer: Mclaren Commercial |
$4,814.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,546.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,744.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,707.31
|
|
|
HC VERPLSTY W WO BONE BX L S 1ST
|
Facility
|
OP
|
$4,321.70
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
36100464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,573.80 |
| Max. Negotiated Rate |
$4,321.70 |
| Rate for Payer: Aetna Commercial |
$3,889.53
|
| Rate for Payer: Aetna Medicare |
$2,877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: ASR ASR |
$4,192.05
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.61
|
| Rate for Payer: BCN Commercial |
$3,350.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$3,457.36
|
| Rate for Payer: Cash Price |
$3,457.36
|
| Rate for Payer: Cofinity Commercial |
$4,062.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,457.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$4,321.70
|
| Rate for Payer: Healthscope Whirlpool |
$4,192.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,877.15
|
| Rate for Payer: Mclaren Commercial |
$3,889.53
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,673.44
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$3,164.86
|
| Rate for Payer: PHP Medicaid |
$1,573.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,025.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,932.75
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$3,068.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,803.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
HC VERPLSTY W WO BONE BX L S 1ST
|
Facility
|
IP
|
$4,321.70
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
36100464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,025.19 |
| Max. Negotiated Rate |
$4,321.70 |
| Rate for Payer: Aetna Commercial |
$3,889.53
|
| Rate for Payer: ASR ASR |
$4,192.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.61
|
| Rate for Payer: BCN Commercial |
$3,350.61
|
| Rate for Payer: Cash Price |
$3,457.36
|
| Rate for Payer: Cofinity Commercial |
$4,062.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,457.36
|
| Rate for Payer: Healthscope Commercial |
$4,321.70
|
| Rate for Payer: Healthscope Whirlpool |
$4,192.05
|
| Rate for Payer: Mclaren Commercial |
$3,889.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,673.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,025.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,803.10
|
|
|
HC VERSACROSS KIT
|
Facility
|
OP
|
$3,570.00
|
|
| Hospital Charge Code |
27200346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$3,213.00
|
| Rate for Payer: ASR ASR |
$3,462.90
|
| Rate for Payer: BCBS Complete |
$1,428.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,767.82
|
| Rate for Payer: BCN Commercial |
$2,767.82
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$3,355.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.00
|
| Rate for Payer: Healthscope Commercial |
$3,570.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,462.90
|
| Rate for Payer: Mclaren Commercial |
$3,213.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,034.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,499.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,248.70
|
| Rate for Payer: Priority Health Narrow Network |
$2,534.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,141.60
|
|
|
HC VERSACROSS KIT
|
Facility
|
IP
|
$3,570.00
|
|
| Hospital Charge Code |
27200346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,499.00 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: Aetna Commercial |
$3,213.00
|
| Rate for Payer: ASR ASR |
$3,462.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,767.82
|
| Rate for Payer: BCN Commercial |
$2,767.82
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$3,355.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.00
|
| Rate for Payer: Healthscope Commercial |
$3,570.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,462.90
|
| Rate for Payer: Mclaren Commercial |
$3,213.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,034.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,499.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,141.60
|
|
|
HC VERT AUG W MECH DEV EA ADD
|
Facility
|
IP
|
$11,379.21
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
36100469
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,965.45 |
| Max. Negotiated Rate |
$11,379.21 |
| Rate for Payer: Aetna Commercial |
$10,241.29
|
| Rate for Payer: ASR ASR |
$11,037.83
|
| Rate for Payer: BCBS Trust/PPO |
$8,822.30
|
| Rate for Payer: BCN Commercial |
$8,822.30
|
| Rate for Payer: Cash Price |
$9,103.37
|
| Rate for Payer: Cofinity Commercial |
$10,696.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,103.37
|
| Rate for Payer: Healthscope Commercial |
$11,379.21
|
| Rate for Payer: Healthscope Whirlpool |
$11,037.83
|
| Rate for Payer: Mclaren Commercial |
$10,241.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,672.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,965.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,013.70
|
|
|
HC VERT AUG W MECH DEV EA ADD
|
Facility
|
OP
|
$11,379.21
|
|
|
Service Code
|
CPT 22515
|
| Hospital Charge Code |
36100469
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,551.68 |
| Max. Negotiated Rate |
$11,379.21 |
| Rate for Payer: Aetna Commercial |
$10,241.29
|
| Rate for Payer: ASR ASR |
$11,037.83
|
| Rate for Payer: BCBS Complete |
$4,551.68
|
| Rate for Payer: BCBS Trust/PPO |
$8,822.30
|
| Rate for Payer: BCN Commercial |
$8,822.30
|
| Rate for Payer: Cash Price |
$9,103.37
|
| Rate for Payer: Cofinity Commercial |
$10,696.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,103.37
|
| Rate for Payer: Healthscope Commercial |
$11,379.21
|
| Rate for Payer: Healthscope Whirlpool |
$11,037.83
|
| Rate for Payer: Mclaren Commercial |
$10,241.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,672.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,965.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,355.08
|
| Rate for Payer: Priority Health Narrow Network |
$8,079.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,013.70
|
|
|
HC VERT AUG W MECH DEV LUMB 1ST
|
Facility
|
OP
|
$10,344.74
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36100468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,478.42 |
| Max. Negotiated Rate |
$10,344.74 |
| Rate for Payer: Aetna Commercial |
$9,310.27
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$10,034.40
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,020.28
|
| Rate for Payer: BCN Commercial |
$8,020.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$8,275.79
|
| Rate for Payer: Cash Price |
$8,275.79
|
| Rate for Payer: Cofinity Commercial |
$9,724.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,275.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$10,344.74
|
| Rate for Payer: Healthscope Whirlpool |
$10,034.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$9,310.27
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,793.03
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,241.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,413.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$7,344.77
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,103.37
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
HC VERT AUG W MECH DEV LUMB 1ST
|
Facility
|
IP
|
$10,344.74
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
36100468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,241.32 |
| Max. Negotiated Rate |
$10,344.74 |
| Rate for Payer: Aetna Commercial |
$9,310.27
|
| Rate for Payer: ASR ASR |
$10,034.40
|
| Rate for Payer: BCBS Trust/PPO |
$8,020.28
|
| Rate for Payer: BCN Commercial |
$8,020.28
|
| Rate for Payer: Cash Price |
$8,275.79
|
| Rate for Payer: Cofinity Commercial |
$9,724.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,275.79
|
| Rate for Payer: Healthscope Commercial |
$10,344.74
|
| Rate for Payer: Healthscope Whirlpool |
$10,034.40
|
| Rate for Payer: Mclaren Commercial |
$9,310.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,793.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,241.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,103.37
|
|
|
HC VERT AUG W MECH DEV THOR 1ST
|
Facility
|
IP
|
$10,344.74
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36100467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,241.32 |
| Max. Negotiated Rate |
$10,344.74 |
| Rate for Payer: Aetna Commercial |
$9,310.27
|
| Rate for Payer: ASR ASR |
$10,034.40
|
| Rate for Payer: BCBS Trust/PPO |
$8,020.28
|
| Rate for Payer: BCN Commercial |
$8,020.28
|
| Rate for Payer: Cash Price |
$8,275.79
|
| Rate for Payer: Cofinity Commercial |
$9,724.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,275.79
|
| Rate for Payer: Healthscope Commercial |
$10,344.74
|
| Rate for Payer: Healthscope Whirlpool |
$10,034.40
|
| Rate for Payer: Mclaren Commercial |
$9,310.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,793.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,241.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,103.37
|
|
|
HC VERT AUG W MECH DEV THOR 1ST
|
Facility
|
OP
|
$10,344.74
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
36100467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,478.42 |
| Max. Negotiated Rate |
$10,344.74 |
| Rate for Payer: Aetna Commercial |
$9,310.27
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$10,034.40
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,020.28
|
| Rate for Payer: BCN Commercial |
$8,020.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$8,275.79
|
| Rate for Payer: Cash Price |
$8,275.79
|
| Rate for Payer: Cofinity Commercial |
$9,724.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,275.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$10,344.74
|
| Rate for Payer: Healthscope Whirlpool |
$10,034.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$9,310.27
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,793.03
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,241.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,413.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$7,344.77
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,103.37
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
IP
|
$1,226.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.54 |
| Max. Negotiated Rate |
$1,226.49 |
| Rate for Payer: Aetna Commercial |
$1,103.84
|
| Rate for Payer: ASR ASR |
$1,189.70
|
| Rate for Payer: BCBS Trust/PPO |
$950.90
|
| Rate for Payer: BCN Commercial |
$950.90
|
| Rate for Payer: Cash Price |
$981.19
|
| Rate for Payer: Cofinity Commercial |
$1,152.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.19
|
| Rate for Payer: Healthscope Commercial |
$1,226.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.70
|
| Rate for Payer: Mclaren Commercial |
$1,103.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,042.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,079.31
|
|
|
HC VERTEBROPLASTY CEMENT
|
Facility
|
OP
|
$1,226.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,226.49 |
| Rate for Payer: Aetna Commercial |
$1,103.84
|
| Rate for Payer: ASR ASR |
$1,189.70
|
| Rate for Payer: BCBS Complete |
$490.60
|
| Rate for Payer: BCBS Trust/PPO |
$950.90
|
| Rate for Payer: BCN Commercial |
$950.90
|
| Rate for Payer: Cash Price |
$981.19
|
| Rate for Payer: Cofinity Commercial |
$1,152.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.19
|
| Rate for Payer: Healthscope Commercial |
$1,226.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,189.70
|
| Rate for Payer: Mclaren Commercial |
$1,103.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,042.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$858.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.11
|
| Rate for Payer: Priority Health Narrow Network |
$870.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,079.31
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$6,140.04
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,478.42 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$5,526.04
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$5,955.84
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,760.37
|
| Rate for Payer: BCN Commercial |
$4,760.37
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$4,912.03
|
| Rate for Payer: Cash Price |
$4,912.03
|
| Rate for Payer: Cofinity Commercial |
$5,771.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$6,140.04
|
| Rate for Payer: Healthscope Whirlpool |
$5,955.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$5,526.04
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.03
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,587.44
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$4,359.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,403.24
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
