|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,284.95
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,856.45
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$4,156.40
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,532.94
|
| Rate for Payer: BCN Commercial |
$3,532.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cash Price |
$3,427.96
|
| Rate for Payer: Cofinity Commercial |
$4,027.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,427.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,156.40
|
| Rate for Payer: Healthscope Whirlpool |
$4,284.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,856.45
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,642.21
|
| Rate for Payer: Nomi Health Commercial |
$3,513.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,213.71
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,754.47
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,003.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,770.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$143.04
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$189.42 |
| Rate for Payer: Aetna Commercial |
$128.74
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$138.75
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$117.94
|
| Rate for Payer: BCN Commercial |
$117.94
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$134.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$138.75
|
| Rate for Payer: Healthscope Whirlpool |
$143.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$128.74
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$143.04
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.28 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$128.74
|
| Rate for Payer: ASR ASR |
$138.75
|
| Rate for Payer: BCBS Trust/PPO |
$117.46
|
| Rate for Payer: BCN Commercial |
$117.46
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$134.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Healthscope Commercial |
$138.75
|
| Rate for Payer: Healthscope Whirlpool |
$143.04
|
| Rate for Payer: Mclaren Commercial |
$128.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.88
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$143.04
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$128.74
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$138.75
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$117.94
|
| Rate for Payer: BCN Commercial |
$117.94
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$134.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$138.75
|
| Rate for Payer: Healthscope Whirlpool |
$143.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$128.74
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$143.04
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.28 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$128.74
|
| Rate for Payer: ASR ASR |
$138.75
|
| Rate for Payer: BCBS Trust/PPO |
$117.46
|
| Rate for Payer: BCN Commercial |
$117.46
|
| Rate for Payer: Cash Price |
$114.43
|
| Rate for Payer: Cofinity Commercial |
$134.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.43
|
| Rate for Payer: Healthscope Commercial |
$138.75
|
| Rate for Payer: Healthscope Whirlpool |
$143.04
|
| Rate for Payer: Mclaren Commercial |
$128.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.58
|
| Rate for Payer: Nomi Health Commercial |
$117.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.88
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$404.91
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$404.91 |
| Rate for Payer: Aetna Commercial |
$364.42
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$392.76
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$333.85
|
| Rate for Payer: BCN Commercial |
$333.85
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cofinity Commercial |
$380.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$392.76
|
| Rate for Payer: Healthscope Whirlpool |
$404.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$364.42
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.17
|
| Rate for Payer: Nomi Health Commercial |
$332.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.68
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$404.91
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$303.68 |
| Max. Negotiated Rate |
$404.91 |
| Rate for Payer: Aetna Commercial |
$364.42
|
| Rate for Payer: ASR ASR |
$392.76
|
| Rate for Payer: BCBS Trust/PPO |
$332.51
|
| Rate for Payer: BCN Commercial |
$332.51
|
| Rate for Payer: Cash Price |
$323.93
|
| Rate for Payer: Cofinity Commercial |
$380.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.93
|
| Rate for Payer: Healthscope Commercial |
$392.76
|
| Rate for Payer: Healthscope Whirlpool |
$404.91
|
| Rate for Payer: Mclaren Commercial |
$364.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.17
|
| Rate for Payer: Nomi Health Commercial |
$332.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.32
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$563.37
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$563.37 |
| Rate for Payer: Aetna Commercial |
$507.03
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$546.47
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$464.50
|
| Rate for Payer: BCN Commercial |
$464.50
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cofinity Commercial |
$529.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$546.47
|
| Rate for Payer: Healthscope Whirlpool |
$563.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$507.03
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Nomi Health Commercial |
$461.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.53
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$493.62
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$394.92
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$563.37
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$422.53 |
| Max. Negotiated Rate |
$563.37 |
| Rate for Payer: Aetna Commercial |
$507.03
|
| Rate for Payer: ASR ASR |
$546.47
|
| Rate for Payer: BCBS Trust/PPO |
$462.64
|
| Rate for Payer: BCN Commercial |
$462.64
|
| Rate for Payer: Cash Price |
$450.70
|
| Rate for Payer: Cofinity Commercial |
$529.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.70
|
| Rate for Payer: Healthscope Commercial |
$546.47
|
| Rate for Payer: Healthscope Whirlpool |
$563.37
|
| Rate for Payer: Mclaren Commercial |
$507.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.86
|
| Rate for Payer: Nomi Health Commercial |
$461.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.77
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$244.08
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$244.08 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$236.76
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$201.24
|
| Rate for Payer: BCN Commercial |
$201.24
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cofinity Commercial |
$229.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$236.76
|
| Rate for Payer: Healthscope Whirlpool |
$244.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$219.67
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.47
|
| Rate for Payer: Nomi Health Commercial |
$200.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.06
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
IP
|
$244.08
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$183.06 |
| Max. Negotiated Rate |
$244.08 |
| Rate for Payer: Aetna Commercial |
$219.67
|
| Rate for Payer: ASR ASR |
$236.76
|
| Rate for Payer: BCBS Trust/PPO |
$200.44
|
| Rate for Payer: BCN Commercial |
$200.44
|
| Rate for Payer: Cash Price |
$195.26
|
| Rate for Payer: Cofinity Commercial |
$229.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.26
|
| Rate for Payer: Healthscope Commercial |
$236.76
|
| Rate for Payer: Healthscope Whirlpool |
$244.08
|
| Rate for Payer: Mclaren Commercial |
$219.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.47
|
| Rate for Payer: Nomi Health Commercial |
$200.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.79
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
IP
|
$385.31
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$385.31 |
| Rate for Payer: Aetna Commercial |
$346.78
|
| Rate for Payer: ASR ASR |
$373.75
|
| Rate for Payer: BCBS Trust/PPO |
$316.42
|
| Rate for Payer: BCN Commercial |
$316.42
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cofinity Commercial |
$362.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.25
|
| Rate for Payer: Healthscope Commercial |
$373.75
|
| Rate for Payer: Healthscope Whirlpool |
$385.31
|
| Rate for Payer: Mclaren Commercial |
$346.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.51
|
| Rate for Payer: Nomi Health Commercial |
$315.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.07
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$385.31
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$385.31 |
| Rate for Payer: Aetna Commercial |
$346.78
|
| Rate for Payer: Aetna Medicare |
$161.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.40
|
| Rate for Payer: ASR ASR |
$373.75
|
| Rate for Payer: BCBS Complete |
$88.93
|
| Rate for Payer: BCBS MAPPO |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$317.69
|
| Rate for Payer: BCN Commercial |
$317.69
|
| Rate for Payer: BCN Medicare Advantage |
$161.92
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cofinity Commercial |
$362.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.92
|
| Rate for Payer: Healthscope Commercial |
$373.75
|
| Rate for Payer: Healthscope Whirlpool |
$385.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$161.92
|
| Rate for Payer: Mclaren Commercial |
$346.78
|
| Rate for Payer: Mclaren Medicaid |
$161.92
|
| Rate for Payer: Mclaren Medicare |
$161.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.02
|
| Rate for Payer: Meridian Medicaid |
$88.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.51
|
| Rate for Payer: Nomi Health Commercial |
$315.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.98
|
| Rate for Payer: PACE Medicare |
$153.82
|
| Rate for Payer: PACE SWMI |
$161.92
|
| Rate for Payer: PHP Commercial |
$178.11
|
| Rate for Payer: PHP Medicaid |
$86.79
|
| Rate for Payer: PHP Medicare Advantage |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.42
|
| Rate for Payer: Priority Health Medicare |
$161.92
|
| Rate for Payer: Priority Health Narrow Network |
$151.54
|
| Rate for Payer: Railroad Medicare Medicare |
$161.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.92
|
| Rate for Payer: UHC Exchange |
$250.98
|
| Rate for Payer: UHC Medicaid |
$84.68
|
| Rate for Payer: UHCCP DNSP |
$161.92
|
| Rate for Payer: UHCCP Medicaid |
$84.68
|
| Rate for Payer: VA VA |
$161.92
|
|
|
HC SPLINT SUPPLIES MISC
|
Facility
|
IP
|
$76.50
|
|
| Hospital Charge Code |
27200394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCN Commercial |
$62.82
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$74.20
|
| Rate for Payer: Healthscope Whirlpool |
$76.50
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC SPLINT SUPPLIES MISC
|
Facility
|
OP
|
$76.50
|
|
| Hospital Charge Code |
27200394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.30 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$28.30
|
| Rate for Payer: ASR ASR |
$74.20
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$63.07
|
| Rate for Payer: BCN Commercial |
$63.07
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$71.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$74.20
|
| Rate for Payer: Healthscope Whirlpool |
$76.50
|
| Rate for Payer: Mclaren Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.03
|
| Rate for Payer: Priority Health Narrow Network |
$53.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.32
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$96.07
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$81.66
|
| Rate for Payer: BCN Commercial |
$81.66
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$93.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$96.07
|
| Rate for Payer: Healthscope Whirlpool |
$99.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$89.14
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$81.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.78
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$69.43
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: ASR ASR |
$96.07
|
| Rate for Payer: BCBS Trust/PPO |
$81.33
|
| Rate for Payer: BCN Commercial |
$81.33
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$93.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$96.07
|
| Rate for Payer: Healthscope Whirlpool |
$99.04
|
| Rate for Payer: Mclaren Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$81.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.16
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$23.73
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.49
|
| Rate for Payer: BCN Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$23.02
|
| Rate for Payer: Healthscope Whirlpool |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$23.73
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$19.57
|
| Rate for Payer: BCN Commercial |
$19.57
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$23.02
|
| Rate for Payer: Healthscope Whirlpool |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.79
|
| Rate for Payer: Priority Health Narrow Network |
$16.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,942.72
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,942.72 |
| Rate for Payer: Aetna Commercial |
$4,448.45
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$4,794.44
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$4,075.27
|
| Rate for Payer: BCN Commercial |
$4,075.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cofinity Commercial |
$4,646.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,794.44
|
| Rate for Payer: Healthscope Whirlpool |
$4,942.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$4,448.45
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.31
|
| Rate for Payer: Nomi Health Commercial |
$4,053.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.04
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,330.81
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,464.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,349.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
IP
|
$4,942.72
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,707.04 |
| Max. Negotiated Rate |
$4,942.72 |
| Rate for Payer: Aetna Commercial |
$4,448.45
|
| Rate for Payer: ASR ASR |
$4,794.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,058.96
|
| Rate for Payer: BCN Commercial |
$4,058.96
|
| Rate for Payer: Cash Price |
$3,954.18
|
| Rate for Payer: Cofinity Commercial |
$4,646.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,954.18
|
| Rate for Payer: Healthscope Commercial |
$4,794.44
|
| Rate for Payer: Healthscope Whirlpool |
$4,942.72
|
| Rate for Payer: Mclaren Commercial |
$4,448.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,201.31
|
| Rate for Payer: Nomi Health Commercial |
$4,053.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,707.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,349.59
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
OP
|
$3,842.80
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$4,286.80 |
| Rate for Payer: Aetna Commercial |
$3,458.52
|
| Rate for Payer: Aetna Medicare |
$2,765.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: ASR ASR |
$3,727.52
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,168.39
|
| Rate for Payer: BCN Commercial |
$3,168.39
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cofinity Commercial |
$3,612.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Healthscope Commercial |
$3,727.52
|
| Rate for Payer: Healthscope Whirlpool |
$3,842.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,765.68
|
| Rate for Payer: Mclaren Commercial |
$3,458.52
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$1,518.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.38
|
| Rate for Payer: Nomi Health Commercial |
$3,151.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,882.10
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Commercial |
$3,042.25
|
| Rate for Payer: PHP Medicaid |
$1,482.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,367.06
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,693.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,381.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Exchange |
$4,286.80
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP DNSP |
$2,765.68
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
IP
|
$3,842.80
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,882.10 |
| Max. Negotiated Rate |
$3,842.80 |
| Rate for Payer: Aetna Commercial |
$3,458.52
|
| Rate for Payer: ASR ASR |
$3,727.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,155.71
|
| Rate for Payer: BCN Commercial |
$3,155.71
|
| Rate for Payer: Cash Price |
$3,074.24
|
| Rate for Payer: Cofinity Commercial |
$3,612.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,074.24
|
| Rate for Payer: Healthscope Commercial |
$3,727.52
|
| Rate for Payer: Healthscope Whirlpool |
$3,842.80
|
| Rate for Payer: Mclaren Commercial |
$3,458.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,266.38
|
| Rate for Payer: Nomi Health Commercial |
$3,151.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,882.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,381.66
|
|
