|
HC SPINE JACK
|
Facility
|
IP
|
$14,119.00
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,177.35 |
| Max. Negotiated Rate |
$14,119.00 |
| Rate for Payer: Aetna Commercial |
$12,707.10
|
| Rate for Payer: ASR ASR |
$13,695.43
|
| Rate for Payer: ASR Commercial |
$13,695.43
|
| Rate for Payer: BCBS Trust/PPO |
$11,505.57
|
| Rate for Payer: BCN Commercial |
$10,946.46
|
| Rate for Payer: Cash Price |
$11,295.20
|
| Rate for Payer: Cofinity Commercial |
$13,271.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,295.20
|
| Rate for Payer: Healthscope Commercial |
$14,119.00
|
| Rate for Payer: Healthscope Whirlpool |
$13,695.43
|
| Rate for Payer: Mclaren Commercial |
$12,707.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,001.15
|
| Rate for Payer: Nomi Health Commercial |
$11,577.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,177.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,424.72
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 1 VIEW
|
Facility
|
OP
|
$150.54
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
32000317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Aetna Commercial |
$135.49
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$146.02
|
| Rate for Payer: ASR Commercial |
$146.02
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$123.28
|
| Rate for Payer: BCN Commercial |
$116.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$120.43
|
| Rate for Payer: Cash Price |
$120.43
|
| Rate for Payer: Cofinity Commercial |
$141.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$150.54
|
| Rate for Payer: Healthscope Whirlpool |
$146.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$135.49
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.96
|
| Rate for Payer: Nomi Health Commercial |
$123.44
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.90
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$105.53
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 1 VIEW
|
Facility
|
IP
|
$150.54
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
32000317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.85 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Aetna Commercial |
$135.49
|
| Rate for Payer: ASR ASR |
$146.02
|
| Rate for Payer: ASR Commercial |
$146.02
|
| Rate for Payer: BCBS Trust/PPO |
$122.68
|
| Rate for Payer: BCN Commercial |
$116.71
|
| Rate for Payer: Cash Price |
$120.43
|
| Rate for Payer: Cofinity Commercial |
$141.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.43
|
| Rate for Payer: Healthscope Commercial |
$150.54
|
| Rate for Payer: Healthscope Whirlpool |
$146.02
|
| Rate for Payer: Mclaren Commercial |
$135.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.96
|
| Rate for Payer: Nomi Health Commercial |
$123.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.48
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 2 OR 3 VIEW
|
Facility
|
OP
|
$361.32
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
32000306
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$361.32 |
| Rate for Payer: Aetna Commercial |
$325.19
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$350.48
|
| Rate for Payer: ASR Commercial |
$350.48
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$295.88
|
| Rate for Payer: BCN Commercial |
$280.13
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$289.06
|
| Rate for Payer: Cash Price |
$289.06
|
| Rate for Payer: Cofinity Commercial |
$339.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$361.32
|
| Rate for Payer: Healthscope Whirlpool |
$350.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$325.19
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.12
|
| Rate for Payer: Nomi Health Commercial |
$296.28
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.59
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$253.29
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 2 OR 3 VIEW
|
Facility
|
IP
|
$361.32
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
32000306
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.86 |
| Max. Negotiated Rate |
$361.32 |
| Rate for Payer: Aetna Commercial |
$325.19
|
| Rate for Payer: ASR ASR |
$350.48
|
| Rate for Payer: ASR Commercial |
$350.48
|
| Rate for Payer: BCBS Trust/PPO |
$294.44
|
| Rate for Payer: BCN Commercial |
$280.13
|
| Rate for Payer: Cash Price |
$289.06
|
| Rate for Payer: Cofinity Commercial |
$339.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.06
|
| Rate for Payer: Healthscope Commercial |
$361.32
|
| Rate for Payer: Healthscope Whirlpool |
$350.48
|
| Rate for Payer: Mclaren Commercial |
$325.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.12
|
| Rate for Payer: Nomi Health Commercial |
$296.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.96
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$394.51
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.12
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$337.71
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$481.76 |
| Rate for Payer: Aetna Commercial |
$433.58
|
| Rate for Payer: ASR ASR |
$467.31
|
| Rate for Payer: ASR Commercial |
$467.31
|
| Rate for Payer: BCBS Trust/PPO |
$392.59
|
| Rate for Payer: BCN Commercial |
$373.51
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$481.76
|
| Rate for Payer: Healthscope Whirlpool |
$467.31
|
| Rate for Payer: Mclaren Commercial |
$433.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.95
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
OP
|
$602.20
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$602.20 |
| Rate for Payer: Aetna Commercial |
$541.98
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$584.13
|
| Rate for Payer: ASR Commercial |
$584.13
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$493.14
|
| Rate for Payer: BCN Commercial |
$466.89
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$602.20
|
| Rate for Payer: Healthscope Whirlpool |
$584.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$541.98
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: Nomi Health Commercial |
$493.80
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.65
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$422.14
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL MIN 6 VIEW
|
Facility
|
IP
|
$602.20
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
32000308
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$391.43 |
| Max. Negotiated Rate |
$602.20 |
| Rate for Payer: Aetna Commercial |
$541.98
|
| Rate for Payer: ASR ASR |
$584.13
|
| Rate for Payer: ASR Commercial |
$584.13
|
| Rate for Payer: BCBS Trust/PPO |
$490.73
|
| Rate for Payer: BCN Commercial |
$466.89
|
| Rate for Payer: Cash Price |
$481.76
|
| Rate for Payer: Cofinity Commercial |
$566.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.76
|
| Rate for Payer: Healthscope Commercial |
$602.20
|
| Rate for Payer: Healthscope Whirlpool |
$584.13
|
| Rate for Payer: Mclaren Commercial |
$541.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.87
|
| Rate for Payer: Nomi Health Commercial |
$493.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$529.94
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
OP
|
$2,243.18
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$2,243.18 |
| Rate for Payer: Aetna Commercial |
$2,018.86
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,175.88
|
| Rate for Payer: ASR Commercial |
$2,175.88
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.94
|
| Rate for Payer: BCN Commercial |
$1,739.14
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$2,108.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$2,243.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,175.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$2,018.86
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,817.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,454.21
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC SPINE THORACIC W CON
|
Facility
|
IP
|
$2,243.18
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
61200008
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,458.07 |
| Max. Negotiated Rate |
$2,243.18 |
| Rate for Payer: Aetna Commercial |
$2,018.86
|
| Rate for Payer: ASR ASR |
$2,175.88
|
| Rate for Payer: ASR Commercial |
$2,175.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.97
|
| Rate for Payer: BCN Commercial |
$1,739.14
|
| Rate for Payer: Cash Price |
$1,794.54
|
| Rate for Payer: Cofinity Commercial |
$2,108.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.54
|
| Rate for Payer: Healthscope Commercial |
$2,243.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,175.88
|
| Rate for Payer: Mclaren Commercial |
$2,018.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.70
|
| Rate for Payer: Nomi Health Commercial |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.00
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
IP
|
$320.34
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.22 |
| Max. Negotiated Rate |
$320.34 |
| Rate for Payer: Aetna Commercial |
$288.31
|
| Rate for Payer: ASR ASR |
$310.73
|
| Rate for Payer: ASR Commercial |
$310.73
|
| Rate for Payer: BCBS Trust/PPO |
$261.05
|
| Rate for Payer: BCN Commercial |
$248.36
|
| Rate for Payer: Cash Price |
$256.27
|
| Rate for Payer: Cofinity Commercial |
$301.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.27
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Healthscope Whirlpool |
$310.73
|
| Rate for Payer: Mclaren Commercial |
$288.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.29
|
| Rate for Payer: Nomi Health Commercial |
$262.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.90
|
|
|
HC SP INJECTION TENDON SHEATH
|
Facility
|
OP
|
$320.34
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
36100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$288.31
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$310.73
|
| Rate for Payer: ASR Commercial |
$310.73
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$262.33
|
| Rate for Payer: BCN Commercial |
$248.36
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$256.27
|
| Rate for Payer: Cash Price |
$256.27
|
| Rate for Payer: Cofinity Commercial |
$301.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$320.34
|
| Rate for Payer: Healthscope Whirlpool |
$310.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$288.31
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.29
|
| Rate for Payer: Nomi Health Commercial |
$262.68
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.07
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$323.26
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
OP
|
$7,290.10
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,838.87 |
| Max. Negotiated Rate |
$8,209.42 |
| Rate for Payer: Aetna Commercial |
$6,561.09
|
| Rate for Payer: Aetna Medicare |
$5,296.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: ASR ASR |
$7,071.40
|
| Rate for Payer: ASR Commercial |
$7,071.40
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,969.86
|
| Rate for Payer: BCN Commercial |
$5,652.01
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Cash Price |
$5,832.08
|
| Rate for Payer: Cash Price |
$5,832.08
|
| Rate for Payer: Cofinity Commercial |
$6,852.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Healthscope Commercial |
$7,290.10
|
| Rate for Payer: Healthscope Whirlpool |
$7,071.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,296.40
|
| Rate for Payer: Mclaren Commercial |
$6,561.09
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,196.58
|
| Rate for Payer: Nomi Health Commercial |
$5,977.88
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Commercial |
$5,826.04
|
| Rate for Payer: PHP Medicaid |
$2,838.87
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,387.59
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$5,110.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,415.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$8,209.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP DNSP |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
HC SP INSERTION IVC FILTER
|
Facility
|
IP
|
$7,290.10
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
36100351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,738.56 |
| Max. Negotiated Rate |
$7,290.10 |
| Rate for Payer: Aetna Commercial |
$6,561.09
|
| Rate for Payer: ASR ASR |
$7,071.40
|
| Rate for Payer: ASR Commercial |
$7,071.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,940.70
|
| Rate for Payer: BCN Commercial |
$5,652.01
|
| Rate for Payer: Cash Price |
$5,832.08
|
| Rate for Payer: Cofinity Commercial |
$6,852.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.08
|
| Rate for Payer: Healthscope Commercial |
$7,290.10
|
| Rate for Payer: Healthscope Whirlpool |
$7,071.40
|
| Rate for Payer: Mclaren Commercial |
$6,561.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,196.58
|
| Rate for Payer: Nomi Health Commercial |
$5,977.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,415.29
|
|
|
HC SPIROMETRY
|
Facility
|
IP
|
$321.09
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$208.71 |
| Max. Negotiated Rate |
$321.09 |
| Rate for Payer: Aetna Commercial |
$288.98
|
| Rate for Payer: ASR ASR |
$311.46
|
| Rate for Payer: ASR Commercial |
$311.46
|
| Rate for Payer: BCBS Trust/PPO |
$261.66
|
| Rate for Payer: BCN Commercial |
$248.94
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cofinity Commercial |
$301.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.87
|
| Rate for Payer: Healthscope Commercial |
$321.09
|
| Rate for Payer: Healthscope Whirlpool |
$311.46
|
| Rate for Payer: Mclaren Commercial |
$288.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.93
|
| Rate for Payer: Nomi Health Commercial |
$263.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.56
|
|
|
HC SPIROMETRY
|
Facility
|
OP
|
$321.09
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$321.09 |
| Rate for Payer: Aetna Commercial |
$288.98
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$311.46
|
| Rate for Payer: ASR Commercial |
$311.46
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$262.94
|
| Rate for Payer: BCN Commercial |
$248.94
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cash Price |
$256.87
|
| Rate for Payer: Cofinity Commercial |
$301.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$321.09
|
| Rate for Payer: Healthscope Whirlpool |
$311.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$288.98
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.93
|
| Rate for Payer: Nomi Health Commercial |
$263.29
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.52
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$121.22
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
OP
|
$566.31
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$566.31 |
| Rate for Payer: Aetna Commercial |
$509.68
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$549.32
|
| Rate for Payer: ASR Commercial |
$549.32
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$463.75
|
| Rate for Payer: BCN Commercial |
$439.06
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cofinity Commercial |
$532.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$566.31
|
| Rate for Payer: Healthscope Whirlpool |
$549.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$509.68
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.36
|
| Rate for Payer: Nomi Health Commercial |
$464.37
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.66
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$328.53
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC SPIROMETRY W/DRUG
|
Facility
|
IP
|
$566.31
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
46000002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$368.10 |
| Max. Negotiated Rate |
$566.31 |
| Rate for Payer: Aetna Commercial |
$509.68
|
| Rate for Payer: ASR ASR |
$549.32
|
| Rate for Payer: ASR Commercial |
$549.32
|
| Rate for Payer: BCBS Trust/PPO |
$461.49
|
| Rate for Payer: BCN Commercial |
$439.06
|
| Rate for Payer: Cash Price |
$453.05
|
| Rate for Payer: Cofinity Commercial |
$532.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.05
|
| Rate for Payer: Healthscope Commercial |
$566.31
|
| Rate for Payer: Healthscope Whirlpool |
$549.32
|
| Rate for Payer: Mclaren Commercial |
$509.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.36
|
| Rate for Payer: Nomi Health Commercial |
$464.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.35
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,200.93
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,780.84
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$4,074.90
|
| Rate for Payer: ASR Commercial |
$4,074.90
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,440.14
|
| Rate for Payer: BCN Commercial |
$3,256.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cofinity Commercial |
$3,948.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,360.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$4,200.93
|
| Rate for Payer: Healthscope Whirlpool |
$4,074.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,780.84
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,570.79
|
| Rate for Payer: Nomi Health Commercial |
$3,444.76
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,730.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,680.85
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,944.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,696.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,200.93
|
|
|
Service Code
|
CPT 75810
|
| Hospital Charge Code |
32000318
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,730.60 |
| Max. Negotiated Rate |
$4,200.93 |
| Rate for Payer: Aetna Commercial |
$3,780.84
|
| Rate for Payer: ASR ASR |
$4,074.90
|
| Rate for Payer: ASR Commercial |
$4,074.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,423.34
|
| Rate for Payer: BCN Commercial |
$3,256.98
|
| Rate for Payer: Cash Price |
$3,360.74
|
| Rate for Payer: Cofinity Commercial |
$3,948.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,360.74
|
| Rate for Payer: Healthscope Commercial |
$4,200.93
|
| Rate for Payer: Healthscope Whirlpool |
$4,074.90
|
| Rate for Payer: Mclaren Commercial |
$3,780.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,570.79
|
| Rate for Payer: Nomi Health Commercial |
$3,444.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,730.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,696.82
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$171.81 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Medicare |
$58.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$114.84
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.20
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: PHP Medicaid |
$31.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.81
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$137.45
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP DNSP |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
HC SPLINT FINGER DYNAMIC
|
Facility
|
IP
|
$140.24
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$140.24 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
OP
|
$140.24
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$114.84
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.81
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$137.45
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC SPLINT FINGER STATIC
|
Facility
|
IP
|
$140.24
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.16 |
| Max. Negotiated Rate |
$140.24 |
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: ASR ASR |
$136.03
|
| Rate for Payer: ASR Commercial |
$136.03
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$108.73
|
| Rate for Payer: Cash Price |
$112.19
|
| Rate for Payer: Cofinity Commercial |
$131.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.19
|
| Rate for Payer: Healthscope Commercial |
$140.24
|
| Rate for Payer: Healthscope Whirlpool |
$136.03
|
| Rate for Payer: Mclaren Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.20
|
| Rate for Payer: Nomi Health Commercial |
$115.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.41
|
|
