|
HC SPLINT LONG ARM
|
Facility
|
IP
|
$396.97
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$258.03 |
| Max. Negotiated Rate |
$396.97 |
| Rate for Payer: Aetna Commercial |
$357.27
|
| Rate for Payer: ASR ASR |
$385.06
|
| Rate for Payer: ASR Commercial |
$385.06
|
| Rate for Payer: BCBS Trust/PPO |
$323.49
|
| Rate for Payer: BCN Commercial |
$307.77
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cofinity Commercial |
$373.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.58
|
| Rate for Payer: Healthscope Commercial |
$396.97
|
| Rate for Payer: Healthscope Whirlpool |
$385.06
|
| Rate for Payer: Mclaren Commercial |
$357.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.42
|
| Rate for Payer: Nomi Health Commercial |
$325.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.33
|
|
|
HC SPLINT LONG ARM
|
Facility
|
OP
|
$396.97
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
70000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$396.97 |
| Rate for Payer: Aetna Commercial |
$357.27
|
| Rate for Payer: Aetna Medicare |
$154.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: ASR ASR |
$385.06
|
| Rate for Payer: ASR Commercial |
$385.06
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$325.08
|
| Rate for Payer: BCN Commercial |
$307.77
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cash Price |
$317.58
|
| Rate for Payer: Cofinity Commercial |
$373.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$396.97
|
| Rate for Payer: Healthscope Whirlpool |
$385.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$154.60
|
| Rate for Payer: Mclaren Commercial |
$357.27
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.42
|
| Rate for Payer: Nomi Health Commercial |
$325.52
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: PHP Medicaid |
$82.87
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.81
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$137.45
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP DNSP |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$82.87
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC SPLINT LONG LEG
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna Medicare |
$154.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$292.66
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$154.60
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: PHP Medicaid |
$82.87
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.81
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$137.45
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP DNSP |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$82.87
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC SPLINT LONG LEG
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
70000012
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$232.30 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.23
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cofinity Commercial |
$335.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.90
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
IP
|
$552.32
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$359.01 |
| Max. Negotiated Rate |
$552.32 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: ASR ASR |
$535.75
|
| Rate for Payer: ASR Commercial |
$535.75
|
| Rate for Payer: BCBS Trust/PPO |
$450.09
|
| Rate for Payer: BCN Commercial |
$428.21
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cofinity Commercial |
$519.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.86
|
| Rate for Payer: Healthscope Commercial |
$552.32
|
| Rate for Payer: Healthscope Whirlpool |
$535.75
|
| Rate for Payer: Mclaren Commercial |
$497.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.47
|
| Rate for Payer: Nomi Health Commercial |
$452.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.04
|
|
|
HC SPLINT SHORT ARM DYNAMIC
|
Facility
|
OP
|
$552.32
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$552.32 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| 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 |
$535.75
|
| Rate for Payer: ASR Commercial |
$535.75
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$452.29
|
| Rate for Payer: BCN Commercial |
$428.21
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cash Price |
$441.86
|
| Rate for Payer: Cofinity Commercial |
$519.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$552.32
|
| Rate for Payer: Healthscope Whirlpool |
$535.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$497.09
|
| 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 |
$469.47
|
| Rate for Payer: Nomi Health Commercial |
$452.90
|
| 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 |
$359.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.94
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$387.18
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.04
|
| 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 SHORT ARM STATIC
|
Facility
|
IP
|
$239.29
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$155.54 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| Rate for Payer: ASR ASR |
$232.11
|
| Rate for Payer: ASR Commercial |
$232.11
|
| Rate for Payer: BCBS Trust/PPO |
$195.00
|
| Rate for Payer: BCN Commercial |
$185.52
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$224.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$239.29
|
| Rate for Payer: Healthscope Whirlpool |
$232.11
|
| Rate for Payer: Mclaren Commercial |
$215.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.58
|
|
|
HC SPLINT SHORT ARM STATIC
|
Facility
|
OP
|
$239.29
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
43000002
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$215.36
|
| 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 |
$232.11
|
| Rate for Payer: ASR Commercial |
$232.11
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$195.95
|
| Rate for Payer: BCN Commercial |
$185.52
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$224.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$239.29
|
| Rate for Payer: Healthscope Whirlpool |
$232.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$215.36
|
| 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 |
$203.40
|
| Rate for Payer: Nomi Health Commercial |
$196.22
|
| 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 |
$155.54
|
| 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 |
$210.58
|
| 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 SHORT LEG
|
Facility
|
IP
|
$377.75
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$245.54 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$339.98
|
| Rate for Payer: ASR ASR |
$366.42
|
| Rate for Payer: ASR Commercial |
$366.42
|
| Rate for Payer: BCBS Trust/PPO |
$307.83
|
| Rate for Payer: BCN Commercial |
$292.87
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cofinity Commercial |
$355.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.20
|
| Rate for Payer: Healthscope Commercial |
$377.75
|
| Rate for Payer: Healthscope Whirlpool |
$366.42
|
| Rate for Payer: Mclaren Commercial |
$339.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.09
|
| Rate for Payer: Nomi Health Commercial |
$309.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.42
|
|
|
HC SPLINT SHORT LEG
|
Facility
|
OP
|
$377.75
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
70000013
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$377.75 |
| Rate for Payer: Aetna Commercial |
$339.98
|
| Rate for Payer: Aetna Medicare |
$154.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: ASR ASR |
$366.42
|
| Rate for Payer: ASR Commercial |
$366.42
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$309.34
|
| Rate for Payer: BCN Commercial |
$292.87
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cash Price |
$302.20
|
| Rate for Payer: Cofinity Commercial |
$355.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Healthscope Commercial |
$377.75
|
| Rate for Payer: Healthscope Whirlpool |
$366.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$154.60
|
| Rate for Payer: Mclaren Commercial |
$339.98
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.09
|
| Rate for Payer: Nomi Health Commercial |
$309.76
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: PHP Medicaid |
$82.87
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.81
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$137.45
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP DNSP |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$82.87
|
| Rate for Payer: VA VA |
$154.60
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$97.10 |
| Rate for Payer: Aetna Commercial |
$87.39
|
| Rate for Payer: ASR ASR |
$94.19
|
| Rate for Payer: ASR Commercial |
$94.19
|
| Rate for Payer: BCBS Trust/PPO |
$79.13
|
| Rate for Payer: BCN Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$91.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$97.10
|
| Rate for Payer: Healthscope Whirlpool |
$94.19
|
| Rate for Payer: Mclaren Commercial |
$87.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.45
|
|
|
HC SPLITTING BLOOD/BLOOD PROD EA UNIT
|
Facility
|
OP
|
$97.10
|
|
|
Service Code
|
CPT 86985
|
| Hospital Charge Code |
39000029
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$87.39
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: ASR ASR |
$94.19
|
| Rate for Payer: ASR Commercial |
$94.19
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$79.52
|
| Rate for Payer: BCN Commercial |
$75.28
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$91.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$97.10
|
| Rate for Payer: Healthscope Whirlpool |
$94.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$87.39
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Medicaid |
$89.99
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.08
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$68.07
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP DNSP |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC SPORE CHECK
|
Facility
|
IP
|
$23.26
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$23.26 |
| Rate for Payer: Aetna Commercial |
$20.93
|
| Rate for Payer: ASR ASR |
$22.56
|
| Rate for Payer: ASR Commercial |
$22.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.95
|
| Rate for Payer: BCN Commercial |
$18.03
|
| Rate for Payer: Cash Price |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$21.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.61
|
| Rate for Payer: Healthscope Commercial |
$23.26
|
| Rate for Payer: Healthscope Whirlpool |
$22.56
|
| Rate for Payer: Mclaren Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.77
|
| Rate for Payer: Nomi Health Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.47
|
|
|
HC SPORE CHECK
|
Facility
|
OP
|
$23.26
|
|
| Hospital Charge Code |
30600180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$23.26 |
| Rate for Payer: Aetna Commercial |
$20.93
|
| Rate for Payer: Aetna Medicare |
$11.63
|
| Rate for Payer: ASR ASR |
$22.56
|
| Rate for Payer: ASR Commercial |
$22.56
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$19.05
|
| Rate for Payer: BCN Commercial |
$18.03
|
| Rate for Payer: Cash Price |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$21.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.61
|
| Rate for Payer: Healthscope Commercial |
$23.26
|
| Rate for Payer: Healthscope Whirlpool |
$22.56
|
| Rate for Payer: Mclaren Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.77
|
| Rate for Payer: Nomi Health Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.47
|
|
|
HC SP REMOVAL IVC FILTER
|
Facility
|
OP
|
$4,707.35
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$4,236.62
|
| 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 |
$4,566.13
|
| Rate for Payer: ASR Commercial |
$4,566.13
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,854.85
|
| Rate for Payer: BCN Commercial |
$3,649.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,765.88
|
| Rate for Payer: Cash Price |
$3,765.88
|
| Rate for Payer: Cofinity Commercial |
$4,424.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,765.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$4,707.35
|
| Rate for Payer: Healthscope Whirlpool |
$4,566.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$4,236.62
|
| 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 |
$4,001.25
|
| Rate for Payer: Nomi Health Commercial |
$3,860.03
|
| 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 |
$3,059.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,124.58
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,299.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,142.47
|
| 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 SP REMOVAL IVC FILTER
|
Facility
|
IP
|
$4,707.35
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
36100353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,059.78 |
| Max. Negotiated Rate |
$4,707.35 |
| Rate for Payer: Aetna Commercial |
$4,236.62
|
| Rate for Payer: ASR ASR |
$4,566.13
|
| Rate for Payer: ASR Commercial |
$4,566.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,836.02
|
| Rate for Payer: BCN Commercial |
$3,649.61
|
| Rate for Payer: Cash Price |
$3,765.88
|
| Rate for Payer: Cofinity Commercial |
$4,424.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,765.88
|
| Rate for Payer: Healthscope Commercial |
$4,707.35
|
| Rate for Payer: Healthscope Whirlpool |
$4,566.13
|
| Rate for Payer: Mclaren Commercial |
$4,236.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,001.25
|
| Rate for Payer: Nomi Health Commercial |
$3,860.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,059.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,142.47
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
OP
|
$3,767.45
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,440.20 |
| Max. Negotiated Rate |
$4,164.76 |
| Rate for Payer: Aetna Commercial |
$3,390.70
|
| Rate for Payer: Aetna Medicare |
$2,686.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: ASR ASR |
$3,654.43
|
| Rate for Payer: ASR Commercial |
$3,654.43
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.16
|
| Rate for Payer: BCN Commercial |
$2,920.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Cash Price |
$3,013.96
|
| Rate for Payer: Cash Price |
$3,013.96
|
| Rate for Payer: Cofinity Commercial |
$3,541.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Healthscope Commercial |
$3,767.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,654.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,686.94
|
| Rate for Payer: Mclaren Commercial |
$3,390.70
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.33
|
| Rate for Payer: Nomi Health Commercial |
$3,089.31
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Commercial |
$2,955.63
|
| Rate for Payer: PHP Medicaid |
$1,440.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,301.04
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,640.98
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,315.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$4,164.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP DNSP |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
HC SP REPAIR ANAL FISTULA W FIBRN GL
|
Facility
|
IP
|
$3,767.45
|
|
|
Service Code
|
CPT 46706
|
| Hospital Charge Code |
36100316
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,448.84 |
| Max. Negotiated Rate |
$3,767.45 |
| Rate for Payer: Aetna Commercial |
$3,390.70
|
| Rate for Payer: ASR ASR |
$3,654.43
|
| Rate for Payer: ASR Commercial |
$3,654.43
|
| Rate for Payer: BCBS Trust/PPO |
$3,070.10
|
| Rate for Payer: BCN Commercial |
$2,920.90
|
| Rate for Payer: Cash Price |
$3,013.96
|
| Rate for Payer: Cofinity Commercial |
$3,541.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.96
|
| Rate for Payer: Healthscope Commercial |
$3,767.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,654.43
|
| Rate for Payer: Mclaren Commercial |
$3,390.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.33
|
| Rate for Payer: Nomi Health Commercial |
$3,089.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,315.36
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
IP
|
$4,279.41
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,781.62 |
| Max. Negotiated Rate |
$4,279.41 |
| Rate for Payer: Aetna Commercial |
$3,851.47
|
| Rate for Payer: ASR ASR |
$4,151.03
|
| Rate for Payer: ASR Commercial |
$4,151.03
|
| Rate for Payer: BCBS Trust/PPO |
$3,487.29
|
| Rate for Payer: BCN Commercial |
$3,317.83
|
| Rate for Payer: Cash Price |
$3,423.53
|
| Rate for Payer: Cofinity Commercial |
$4,022.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,423.53
|
| Rate for Payer: Healthscope Commercial |
$4,279.41
|
| Rate for Payer: Healthscope Whirlpool |
$4,151.03
|
| Rate for Payer: Mclaren Commercial |
$3,851.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,637.50
|
| Rate for Payer: Nomi Health Commercial |
$3,509.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,781.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,765.88
|
|
|
HC SP REPOSITION IVC FILTER
|
Facility
|
OP
|
$4,279.41
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
36100352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$3,851.47
|
| 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 |
$4,151.03
|
| Rate for Payer: ASR Commercial |
$4,151.03
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,504.41
|
| Rate for Payer: BCN Commercial |
$3,317.83
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,423.53
|
| Rate for Payer: Cash Price |
$3,423.53
|
| Rate for Payer: Cofinity Commercial |
$4,022.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,423.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$4,279.41
|
| Rate for Payer: Healthscope Whirlpool |
$4,151.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$3,851.47
|
| 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 |
$3,637.50
|
| Rate for Payer: Nomi Health Commercial |
$3,509.12
|
| 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 |
$2,781.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,749.62
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$2,999.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,765.88
|
| 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 SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
OP
|
$696.30
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$696.30 |
| Rate for Payer: Aetna Commercial |
$626.67
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$675.41
|
| Rate for Payer: ASR Commercial |
$675.41
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$570.20
|
| Rate for Payer: BCN Commercial |
$539.84
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$557.04
|
| Rate for Payer: Cash Price |
$557.04
|
| Rate for Payer: Cofinity Commercial |
$654.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$696.30
|
| Rate for Payer: Healthscope Whirlpool |
$675.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$626.67
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.86
|
| Rate for Payer: Nomi Health Commercial |
$570.97
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.88
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$52.70
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SP UNLISTED PROC SKIN SUBCUT TISS
|
Facility
|
IP
|
$696.30
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
36100314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.60 |
| Max. Negotiated Rate |
$696.30 |
| Rate for Payer: Aetna Commercial |
$626.67
|
| Rate for Payer: ASR ASR |
$675.41
|
| Rate for Payer: ASR Commercial |
$675.41
|
| Rate for Payer: BCBS Trust/PPO |
$567.41
|
| Rate for Payer: BCN Commercial |
$539.84
|
| Rate for Payer: Cash Price |
$557.04
|
| Rate for Payer: Cofinity Commercial |
$654.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.04
|
| Rate for Payer: Healthscope Commercial |
$696.30
|
| Rate for Payer: Healthscope Whirlpool |
$675.41
|
| Rate for Payer: Mclaren Commercial |
$626.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.86
|
| Rate for Payer: Nomi Health Commercial |
$570.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.74
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
IP
|
$1,096.38
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$712.65 |
| Max. Negotiated Rate |
$1,096.38 |
| Rate for Payer: Aetna Commercial |
$986.74
|
| Rate for Payer: ASR ASR |
$1,063.49
|
| Rate for Payer: ASR Commercial |
$1,063.49
|
| Rate for Payer: BCBS Trust/PPO |
$893.44
|
| Rate for Payer: BCN Commercial |
$850.02
|
| Rate for Payer: Cash Price |
$877.10
|
| Rate for Payer: Cofinity Commercial |
$1,030.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.10
|
| Rate for Payer: Healthscope Commercial |
$1,096.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,063.49
|
| Rate for Payer: Mclaren Commercial |
$986.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$931.92
|
| Rate for Payer: Nomi Health Commercial |
$899.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$964.81
|
|
|
HC SP XR INJ ARTHROGRAM ANKLE
|
Facility
|
OP
|
$1,096.38
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
36100317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.55 |
| Max. Negotiated Rate |
$1,096.38 |
| Rate for Payer: Aetna Commercial |
$986.74
|
| Rate for Payer: Aetna Medicare |
$548.19
|
| Rate for Payer: ASR ASR |
$1,063.49
|
| Rate for Payer: ASR Commercial |
$1,063.49
|
| Rate for Payer: BCBS Complete |
$438.55
|
| Rate for Payer: BCBS Trust/PPO |
$897.83
|
| Rate for Payer: BCN Commercial |
$850.02
|
| Rate for Payer: Cash Price |
$877.10
|
| Rate for Payer: Cofinity Commercial |
$1,030.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.10
|
| Rate for Payer: Healthscope Commercial |
$1,096.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,063.49
|
| Rate for Payer: Mclaren Commercial |
$986.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$931.92
|
| Rate for Payer: Nomi Health Commercial |
$899.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$960.65
|
| Rate for Payer: Priority Health Narrow Network |
$768.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$964.81
|
|
|
HC SPYGLASS CHOLANGIOSCOPY
|
Facility
|
IP
|
$6,262.87
|
|
| Hospital Charge Code |
36000086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,070.87 |
| Max. Negotiated Rate |
$6,262.87 |
| Rate for Payer: Aetna Commercial |
$5,636.58
|
| Rate for Payer: ASR ASR |
$6,074.98
|
| Rate for Payer: ASR Commercial |
$6,074.98
|
| Rate for Payer: BCBS Trust/PPO |
$5,103.61
|
| Rate for Payer: BCN Commercial |
$4,855.60
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cofinity Commercial |
$5,887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,010.30
|
| Rate for Payer: Healthscope Commercial |
$6,262.87
|
| Rate for Payer: Healthscope Whirlpool |
$6,074.98
|
| Rate for Payer: Mclaren Commercial |
$5,636.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,323.44
|
| Rate for Payer: Nomi Health Commercial |
$5,135.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,070.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,511.33
|
|
