|
HC XR SKULL LESS THAN 4 VW
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.26 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| Rate for Payer: ASR ASR |
$339.86
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
|
|
HC XR SKULL LESS THAN 4 VW
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$350.37 |
| Rate for Payer: Aetna Commercial |
$315.33
|
| 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 |
$339.86
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$271.64
|
| Rate for Payer: BCN Commercial |
$271.64
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$329.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$350.37
|
| Rate for Payer: Healthscope Whirlpool |
$339.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$315.33
|
| 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 |
$297.81
|
| 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 |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.59
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$112.47
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.33
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR SKULL MIN 4 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$360.18
|
| 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 |
$388.19
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$310.28
|
| Rate for Payer: BCN Commercial |
$310.28
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$376.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$400.20
|
| Rate for Payer: Healthscope Whirlpool |
$388.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$360.18
|
| 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 |
$340.17
|
| 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 |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$175.27
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.18
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR SKULL MIN 4 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.14 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$360.18
|
| Rate for Payer: ASR ASR |
$388.19
|
| Rate for Payer: BCBS Trust/PPO |
$310.28
|
| Rate for Payer: BCN Commercial |
$310.28
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$376.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Healthscope Commercial |
$400.20
|
| Rate for Payer: Healthscope Whirlpool |
$388.19
|
| Rate for Payer: Mclaren Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.18
|
|
|
HC XR SMALL BOWEL
|
Facility
|
OP
|
$600.55
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$600.55 |
| Rate for Payer: Aetna Commercial |
$540.50
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$582.53
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$465.61
|
| Rate for Payer: BCN Commercial |
$465.61
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$480.44
|
| Rate for Payer: Cash Price |
$480.44
|
| Rate for Payer: Cofinity Commercial |
$564.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$600.55
|
| Rate for Payer: Healthscope Whirlpool |
$582.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$540.50
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.47
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.95
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$233.56
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.48
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC XR SMALL BOWEL
|
Facility
|
IP
|
$600.55
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$420.38 |
| Max. Negotiated Rate |
$600.55 |
| Rate for Payer: Aetna Commercial |
$540.50
|
| Rate for Payer: ASR ASR |
$582.53
|
| Rate for Payer: BCBS Trust/PPO |
$465.61
|
| Rate for Payer: BCN Commercial |
$465.61
|
| Rate for Payer: Cash Price |
$480.44
|
| Rate for Payer: Cofinity Commercial |
$564.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$600.55
|
| Rate for Payer: Healthscope Whirlpool |
$582.53
|
| Rate for Payer: Mclaren Commercial |
$540.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$528.48
|
|
|
HC XR SMALL BOWEL.
|
Facility
|
OP
|
$278.77
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
32000331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.67 |
| Max. Negotiated Rate |
$278.77 |
| Rate for Payer: Aetna Commercial |
$250.89
|
| Rate for Payer: ASR ASR |
$270.41
|
| Rate for Payer: BCBS Complete |
$111.51
|
| Rate for Payer: BCBS Trust/PPO |
$216.13
|
| Rate for Payer: BCN Commercial |
$216.13
|
| Rate for Payer: Cash Price |
$223.02
|
| Rate for Payer: Cash Price |
$223.02
|
| Rate for Payer: Cofinity Commercial |
$262.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.02
|
| Rate for Payer: Healthscope Commercial |
$278.77
|
| Rate for Payer: Healthscope Whirlpool |
$270.41
|
| Rate for Payer: Mclaren Commercial |
$250.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.59
|
| Rate for Payer: Priority Health Narrow Network |
$71.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.32
|
|
|
HC XR SMALL BOWEL.
|
Facility
|
IP
|
$278.77
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
32000331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.14 |
| Max. Negotiated Rate |
$278.77 |
| Rate for Payer: Aetna Commercial |
$250.89
|
| Rate for Payer: ASR ASR |
$270.41
|
| Rate for Payer: BCBS Trust/PPO |
$216.13
|
| Rate for Payer: BCN Commercial |
$216.13
|
| Rate for Payer: Cash Price |
$223.02
|
| Rate for Payer: Cofinity Commercial |
$262.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.02
|
| Rate for Payer: Healthscope Commercial |
$278.77
|
| Rate for Payer: Healthscope Whirlpool |
$270.41
|
| Rate for Payer: Mclaren Commercial |
$250.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.32
|
|
|
HC XR SMALL BOWEL ENTEROCLYSIS TU
|
Facility
|
IP
|
$800.53
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$560.37 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$720.48
|
| Rate for Payer: ASR ASR |
$776.51
|
| Rate for Payer: BCBS Trust/PPO |
$620.65
|
| Rate for Payer: BCN Commercial |
$620.65
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.42
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Healthscope Whirlpool |
$776.51
|
| Rate for Payer: Mclaren Commercial |
$720.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.47
|
|
|
HC XR SMALL BOWEL ENTEROCLYSIS TU
|
Facility
|
OP
|
$800.53
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$800.53 |
| Rate for Payer: Aetna Commercial |
$720.48
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$776.51
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$620.65
|
| Rate for Payer: BCN Commercial |
$620.65
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$752.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$800.53
|
| Rate for Payer: Healthscope Whirlpool |
$776.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$720.48
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$728.48
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$568.38
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.47
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC XR SOFT TISSUE NECK
|
Facility
|
IP
|
$304.45
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
32000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$304.45 |
| Rate for Payer: Aetna Commercial |
$274.00
|
| Rate for Payer: ASR ASR |
$295.32
|
| Rate for Payer: BCBS Trust/PPO |
$236.04
|
| Rate for Payer: BCN Commercial |
$236.04
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cofinity Commercial |
$286.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.56
|
| Rate for Payer: Healthscope Commercial |
$304.45
|
| Rate for Payer: Healthscope Whirlpool |
$295.32
|
| Rate for Payer: Mclaren Commercial |
$274.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.92
|
|
|
HC XR SOFT TISSUE NECK
|
Facility
|
OP
|
$304.45
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
32000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$304.45 |
| Rate for Payer: Aetna Commercial |
$274.00
|
| 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 |
$295.32
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$236.04
|
| Rate for Payer: BCN Commercial |
$236.04
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cofinity Commercial |
$286.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$304.45
|
| Rate for Payer: Healthscope Whirlpool |
$295.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$274.00
|
| 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 |
$258.78
|
| 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 |
$213.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.54
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$79.63
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.92
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR SPECIMEN X-RAY
|
Facility
|
IP
|
$206.67
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.67 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: ASR ASR |
$200.47
|
| Rate for Payer: BCBS Trust/PPO |
$160.23
|
| Rate for Payer: BCN Commercial |
$160.23
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cofinity Commercial |
$194.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.34
|
| Rate for Payer: Healthscope Commercial |
$206.67
|
| Rate for Payer: Healthscope Whirlpool |
$200.47
|
| Rate for Payer: Mclaren Commercial |
$186.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.87
|
|
|
HC XR SPECIMEN X-RAY
|
Facility
|
OP
|
$206.67
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.13 |
| Max. Negotiated Rate |
$835.31 |
| Rate for Payer: Aetna Commercial |
$186.00
|
| Rate for Payer: Aetna Medicare |
$490.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$612.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$612.96
|
| Rate for Payer: ASR ASR |
$200.47
|
| Rate for Payer: BCBS Complete |
$281.67
|
| Rate for Payer: BCBS MAPPO |
$490.37
|
| Rate for Payer: BCBS Trust/PPO |
$160.23
|
| Rate for Payer: BCCCP Commercial |
$43.13
|
| Rate for Payer: BCN Commercial |
$160.23
|
| Rate for Payer: BCN Medicare Advantage |
$490.37
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cash Price |
$165.34
|
| Rate for Payer: Cofinity Commercial |
$194.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.37
|
| Rate for Payer: Healthscope Commercial |
$206.67
|
| Rate for Payer: Healthscope Whirlpool |
$200.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$490.37
|
| Rate for Payer: Mclaren Commercial |
$186.00
|
| Rate for Payer: Mclaren Medicaid |
$268.23
|
| Rate for Payer: Mclaren Medicare |
$490.37
|
| Rate for Payer: Meridian Medicaid |
$281.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.67
|
| Rate for Payer: PACE Medicare |
$465.85
|
| Rate for Payer: PACE SWMI |
$490.37
|
| Rate for Payer: PHP Commercial |
$539.41
|
| Rate for Payer: PHP Medicaid |
$268.23
|
| Rate for Payer: PHP Medicare Advantage |
$490.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.31
|
| Rate for Payer: Priority Health Medicare |
$490.37
|
| Rate for Payer: Priority Health Narrow Network |
$668.25
|
| Rate for Payer: Railroad Medicare Medicare |
$490.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.87
|
| Rate for Payer: UHC Medicare Advantage |
$505.08
|
| Rate for Payer: VA VA |
$490.37
|
|
|
HC XR SPINE CERV 6VW OR MORE
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$350.27 |
| Max. Negotiated Rate |
$500.38 |
| Rate for Payer: Aetna Commercial |
$450.34
|
| Rate for Payer: ASR ASR |
$485.37
|
| Rate for Payer: BCBS Trust/PPO |
$387.94
|
| Rate for Payer: BCN Commercial |
$387.94
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$470.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Healthscope Commercial |
$500.38
|
| Rate for Payer: Healthscope Whirlpool |
$485.37
|
| Rate for Payer: Mclaren Commercial |
$450.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.33
|
|
|
HC XR SPINE CERV 6VW OR MORE
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$500.38 |
| Rate for Payer: Aetna Commercial |
$450.34
|
| 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 |
$485.37
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$387.94
|
| Rate for Payer: BCN Commercial |
$387.94
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$470.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$500.38
|
| Rate for Payer: Healthscope Whirlpool |
$485.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$450.34
|
| 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 |
$425.32
|
| 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 |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$208.94
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.33
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR SPINE CERVICAL 3VW OR LESS
|
Facility
|
IP
|
$370.48
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.34 |
| Max. Negotiated Rate |
$370.48 |
| Rate for Payer: Aetna Commercial |
$333.43
|
| Rate for Payer: ASR ASR |
$359.37
|
| Rate for Payer: BCBS Trust/PPO |
$287.23
|
| Rate for Payer: BCN Commercial |
$287.23
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$348.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.38
|
| Rate for Payer: Healthscope Commercial |
$370.48
|
| Rate for Payer: Healthscope Whirlpool |
$359.37
|
| Rate for Payer: Mclaren Commercial |
$333.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.02
|
|
|
HC XR SPINE CERVICAL 3VW OR LESS
|
Facility
|
OP
|
$370.48
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$370.48 |
| Rate for Payer: Aetna Commercial |
$333.43
|
| 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 |
$359.37
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$287.23
|
| Rate for Payer: BCN Commercial |
$287.23
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$348.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$370.48
|
| Rate for Payer: Healthscope Whirlpool |
$359.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$333.43
|
| 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 |
$314.91
|
| 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 |
$259.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.56
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$111.65
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.02
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC XR SPINE CERVICAL 4 OR 5 VW
|
Facility
|
IP
|
$460.41
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.29 |
| Max. Negotiated Rate |
$460.41 |
| Rate for Payer: Aetna Commercial |
$414.37
|
| Rate for Payer: ASR ASR |
$446.60
|
| Rate for Payer: BCBS Trust/PPO |
$356.96
|
| Rate for Payer: BCN Commercial |
$356.96
|
| Rate for Payer: Cash Price |
$368.33
|
| Rate for Payer: Cofinity Commercial |
$432.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.33
|
| Rate for Payer: Healthscope Commercial |
$460.41
|
| Rate for Payer: Healthscope Whirlpool |
$446.60
|
| Rate for Payer: Mclaren Commercial |
$414.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.16
|
|
|
HC XR SPINE CERVICAL 4 OR 5 VW
|
Facility
|
OP
|
$460.41
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$460.41 |
| Rate for Payer: Aetna Commercial |
$414.37
|
| 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 |
$446.60
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$356.96
|
| Rate for Payer: BCN Commercial |
$356.96
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$368.33
|
| Rate for Payer: Cash Price |
$368.33
|
| Rate for Payer: Cofinity Commercial |
$432.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$460.41
|
| Rate for Payer: Healthscope Whirlpool |
$446.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$414.37
|
| 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 |
$391.35
|
| 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 |
$322.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.16
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$192.93
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.16
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR SPINE LUMBAR 2 OR 3 VW
|
Facility
|
OP
|
$400.20
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
32000044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$360.18
|
| 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 |
$388.19
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$310.28
|
| Rate for Payer: BCN Commercial |
$310.28
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$376.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$400.20
|
| Rate for Payer: Healthscope Whirlpool |
$388.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$360.18
|
| 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 |
$340.17
|
| 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 |
$280.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.51
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$110.01
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.18
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR SPINE LUMBAR 2 OR 3 VW
|
Facility
|
IP
|
$400.20
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
32000044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.14 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$360.18
|
| Rate for Payer: ASR ASR |
$388.19
|
| Rate for Payer: BCBS Trust/PPO |
$310.28
|
| Rate for Payer: BCN Commercial |
$310.28
|
| Rate for Payer: Cash Price |
$320.16
|
| Rate for Payer: Cofinity Commercial |
$376.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.16
|
| Rate for Payer: Healthscope Commercial |
$400.20
|
| Rate for Payer: Healthscope Whirlpool |
$388.19
|
| Rate for Payer: Mclaren Commercial |
$360.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.18
|
|
|
HC XR SPINE LUMBAR BENDING ONLY 4
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| 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 |
$369.66
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| 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 |
$323.93
|
| 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 |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.79
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$270.57
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC XR SPINE LUMBAR BENDING ONLY 4
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC XR SPINE LUMBAR MIN 4 VW
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
32000045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.34 |
| Max. Negotiated Rate |
$429.05 |
| Rate for Payer: Aetna Commercial |
$386.14
|
| Rate for Payer: ASR ASR |
$416.18
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$403.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Healthscope Commercial |
$429.05
|
| Rate for Payer: Healthscope Whirlpool |
$416.18
|
| Rate for Payer: Mclaren Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.56
|
|
