|
HC VENOGRAM INTERNAL JUGULAR
|
Facility
|
OP
|
$5,018.21
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
32000319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$5,018.21 |
| Rate for Payer: Aetna Commercial |
$4,516.39
|
| 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 |
$4,867.66
|
| Rate for Payer: ASR Commercial |
$4,867.66
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,109.41
|
| Rate for Payer: BCN Commercial |
$3,890.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$4,014.57
|
| Rate for Payer: Cash Price |
$4,014.57
|
| Rate for Payer: Cofinity Commercial |
$4,717.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,014.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$5,018.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,867.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$4,516.39
|
| 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 |
$4,265.48
|
| Rate for Payer: Nomi Health Commercial |
$4,114.93
|
| 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 |
$3,261.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,396.96
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,517.77
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,416.02
|
| 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 VENOGRAM SUPERIOR SAGITTAL SINUS
|
Facility
|
OP
|
$2,442.36
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
32000320
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,587.53 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$2,198.12
|
| 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 |
$2,369.09
|
| Rate for Payer: ASR Commercial |
$2,369.09
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,000.05
|
| Rate for Payer: BCN Commercial |
$1,893.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$1,953.89
|
| Rate for Payer: Cash Price |
$1,953.89
|
| Rate for Payer: Cofinity Commercial |
$2,295.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,953.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$2,442.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,369.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$2,198.12
|
| 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 |
$2,076.01
|
| Rate for Payer: Nomi Health Commercial |
$2,002.74
|
| 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 |
$1,587.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,140.00
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,712.09
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,149.28
|
| 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 VENOGRAM SUPERIOR SAGITTAL SINUS
|
Facility
|
IP
|
$2,442.36
|
|
|
Service Code
|
CPT 75870
|
| Hospital Charge Code |
32000320
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,587.53 |
| Max. Negotiated Rate |
$2,442.36 |
| Rate for Payer: Aetna Commercial |
$2,198.12
|
| Rate for Payer: ASR ASR |
$2,369.09
|
| Rate for Payer: ASR Commercial |
$2,369.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,990.28
|
| Rate for Payer: BCN Commercial |
$1,893.56
|
| Rate for Payer: Cash Price |
$1,953.89
|
| Rate for Payer: Cofinity Commercial |
$2,295.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,953.89
|
| Rate for Payer: Healthscope Commercial |
$2,442.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,369.09
|
| Rate for Payer: Mclaren Commercial |
$2,198.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,076.01
|
| Rate for Payer: Nomi Health Commercial |
$2,002.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,149.28
|
|
|
HC VENOUS INSUFFICIENCY BIL
|
Facility
|
OP
|
$1,796.10
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92000033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,796.10 |
| Rate for Payer: Aetna Commercial |
$1,616.49
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,742.22
|
| Rate for Payer: ASR Commercial |
$1,742.22
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,470.83
|
| Rate for Payer: BCN Commercial |
$1,392.52
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,436.88
|
| Rate for Payer: Cash Price |
$1,436.88
|
| Rate for Payer: Cofinity Commercial |
$1,688.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,796.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,742.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,616.49
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.68
|
| Rate for Payer: Nomi Health Commercial |
$1,472.80
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.13
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$848.10
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC VENOUS INSUFFICIENCY BIL
|
Facility
|
IP
|
$1,796.10
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92000033
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,167.46 |
| Max. Negotiated Rate |
$1,796.10 |
| Rate for Payer: Aetna Commercial |
$1,616.49
|
| Rate for Payer: ASR ASR |
$1,742.22
|
| Rate for Payer: ASR Commercial |
$1,742.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.64
|
| Rate for Payer: BCN Commercial |
$1,392.52
|
| Rate for Payer: Cash Price |
$1,436.88
|
| Rate for Payer: Cofinity Commercial |
$1,688.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,436.88
|
| Rate for Payer: Healthscope Commercial |
$1,796.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,742.22
|
| Rate for Payer: Mclaren Commercial |
$1,616.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.68
|
| Rate for Payer: Nomi Health Commercial |
$1,472.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,580.57
|
|
|
HC VENOUS TRANSCATH THROMBOLYSIS
|
Facility
|
IP
|
$4,644.53
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
36100372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,018.94 |
| Max. Negotiated Rate |
$4,644.53 |
| Rate for Payer: Aetna Commercial |
$4,180.08
|
| Rate for Payer: ASR ASR |
$4,505.19
|
| Rate for Payer: ASR Commercial |
$4,505.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,784.83
|
| Rate for Payer: BCN Commercial |
$3,600.90
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cofinity Commercial |
$4,365.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,715.62
|
| Rate for Payer: Healthscope Commercial |
$4,644.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,505.19
|
| Rate for Payer: Mclaren Commercial |
$4,180.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,947.85
|
| Rate for Payer: Nomi Health Commercial |
$3,808.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,087.19
|
|
|
HC VENOUS TRANSCATH THROMBOLYSIS
|
Facility
|
OP
|
$4,644.53
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
36100372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$719.99 |
| Max. Negotiated Rate |
$4,779.98 |
| Rate for Payer: Aetna Commercial |
$4,180.08
|
| 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 |
$4,505.19
|
| Rate for Payer: ASR Commercial |
$4,505.19
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,803.41
|
| Rate for Payer: BCN Commercial |
$3,600.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cofinity Commercial |
$4,365.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,715.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$4,644.53
|
| Rate for Payer: Healthscope Whirlpool |
$4,505.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$4,180.08
|
| 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 |
$3,947.85
|
| Rate for Payer: Nomi Health Commercial |
$3,808.51
|
| 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 |
$3,018.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.99
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$719.99
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,087.19
|
| 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 VENOUS ULTR IMAG BIL LOWER EXTREMITY
|
Facility
|
IP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100010
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$915.65 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.94
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
|
|
HC VENOUS ULTR IMAG BIL LOWER EXTREMITY
|
Facility
|
OP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100010
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.58
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.13
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$848.10
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
IP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100028
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$915.65 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.94
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
|
|
HC VENOUS ULTR IMAG BIL UPPER EXTREMITY
|
Facility
|
OP
|
$1,408.69
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
92100028
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$1,408.69 |
| Rate for Payer: Aetna Commercial |
$1,267.82
|
| Rate for Payer: Aetna Medicare |
$236.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: ASR ASR |
$1,366.43
|
| Rate for Payer: ASR Commercial |
$1,366.43
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.58
|
| Rate for Payer: BCN Commercial |
$1,092.16
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cash Price |
$1,126.95
|
| Rate for Payer: Cofinity Commercial |
$1,324.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,408.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,366.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$236.83
|
| Rate for Payer: Mclaren Commercial |
$1,267.82
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,197.39
|
| Rate for Payer: Nomi Health Commercial |
$1,155.13
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$260.51
|
| Rate for Payer: PHP Medicaid |
$126.94
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$915.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.13
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$848.10
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$367.09
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP DNSP |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$126.94
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
OP
|
$867.63
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$867.63 |
| Rate for Payer: Aetna Commercial |
$780.87
|
| 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 |
$841.60
|
| Rate for Payer: ASR Commercial |
$841.60
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$710.50
|
| Rate for Payer: BCN Commercial |
$672.67
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$815.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$867.63
|
| Rate for Payer: Healthscope Whirlpool |
$841.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$780.87
|
| 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 |
$737.49
|
| Rate for Payer: Nomi Health Commercial |
$711.46
|
| 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 |
$563.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.41
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$545.93
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$763.51
|
| 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 VENOUS ULTR IMAG UNILATERAL LOWER (R OR L)
|
Facility
|
IP
|
$867.63
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$563.96 |
| Max. Negotiated Rate |
$867.63 |
| Rate for Payer: Aetna Commercial |
$780.87
|
| Rate for Payer: ASR ASR |
$841.60
|
| Rate for Payer: ASR Commercial |
$841.60
|
| Rate for Payer: BCBS Trust/PPO |
$707.03
|
| Rate for Payer: BCN Commercial |
$672.67
|
| Rate for Payer: Cash Price |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$815.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.10
|
| Rate for Payer: Healthscope Commercial |
$867.63
|
| Rate for Payer: Healthscope Whirlpool |
$841.60
|
| Rate for Payer: Mclaren Commercial |
$780.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$737.49
|
| Rate for Payer: Nomi Health Commercial |
$711.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$763.51
|
|
|
HC VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
OP
|
$1,020.74
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,020.74 |
| Rate for Payer: Aetna Commercial |
$918.67
|
| 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 |
$990.12
|
| Rate for Payer: ASR Commercial |
$990.12
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$835.88
|
| Rate for Payer: BCN Commercial |
$791.38
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$816.59
|
| Rate for Payer: Cash Price |
$816.59
|
| Rate for Payer: Cofinity Commercial |
$959.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,020.74
|
| Rate for Payer: Healthscope Whirlpool |
$990.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$918.67
|
| 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 |
$867.63
|
| Rate for Payer: Nomi Health Commercial |
$837.01
|
| 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 |
$663.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.41
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$545.93
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.25
|
| 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 VENOUS ULTR IMAG UNILATERAL UPPER (R OR L)
|
Facility
|
IP
|
$1,020.74
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$663.48 |
| Max. Negotiated Rate |
$1,020.74 |
| Rate for Payer: Aetna Commercial |
$918.67
|
| Rate for Payer: ASR ASR |
$990.12
|
| Rate for Payer: ASR Commercial |
$990.12
|
| Rate for Payer: BCBS Trust/PPO |
$831.80
|
| Rate for Payer: BCN Commercial |
$791.38
|
| Rate for Payer: Cash Price |
$816.59
|
| Rate for Payer: Cofinity Commercial |
$959.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.59
|
| Rate for Payer: Healthscope Commercial |
$1,020.74
|
| Rate for Payer: Healthscope Whirlpool |
$990.12
|
| Rate for Payer: Mclaren Commercial |
$918.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.63
|
| Rate for Payer: Nomi Health Commercial |
$837.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.25
|
|
|
HC VENT CPS Y
|
Facility
|
IP
|
$30.60
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$24.94
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC VENT CPS Y
|
Facility
|
OP
|
$30.60
|
|
| Hospital Charge Code |
27000058
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: ASR Commercial |
$29.68
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Healthscope Whirlpool |
$29.68
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
IP
|
$8,122.26
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,279.47 |
| Max. Negotiated Rate |
$8,122.26 |
| Rate for Payer: Aetna Commercial |
$7,310.03
|
| Rate for Payer: ASR ASR |
$7,878.59
|
| Rate for Payer: ASR Commercial |
$7,878.59
|
| Rate for Payer: BCBS Trust/PPO |
$6,618.83
|
| Rate for Payer: BCN Commercial |
$6,297.19
|
| Rate for Payer: Cash Price |
$6,497.81
|
| Rate for Payer: Cofinity Commercial |
$7,634.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,497.81
|
| Rate for Payer: Healthscope Commercial |
$8,122.26
|
| Rate for Payer: Healthscope Whirlpool |
$7,878.59
|
| Rate for Payer: Mclaren Commercial |
$7,310.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,903.92
|
| Rate for Payer: Nomi Health Commercial |
$6,660.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,279.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,147.59
|
|
|
HC VENT TUBE RMVL REQ GENERAL ANES
|
Facility
|
OP
|
$8,122.26
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,703.14 |
| Max. Negotiated Rate |
$8,122.26 |
| Rate for Payer: Aetna Commercial |
$7,310.03
|
| Rate for Payer: Aetna Medicare |
$3,177.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: ASR ASR |
$7,878.59
|
| Rate for Payer: ASR Commercial |
$7,878.59
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,651.32
|
| Rate for Payer: BCN Commercial |
$6,297.19
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$6,497.81
|
| Rate for Payer: Cash Price |
$6,497.81
|
| Rate for Payer: Cofinity Commercial |
$7,634.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,497.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$8,122.26
|
| Rate for Payer: Healthscope Whirlpool |
$7,878.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,177.50
|
| Rate for Payer: Mclaren Commercial |
$7,310.03
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,903.92
|
| Rate for Payer: Nomi Health Commercial |
$6,660.25
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$3,495.25
|
| Rate for Payer: PHP Medicaid |
$1,703.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,279.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,116.72
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$5,693.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,147.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$4,925.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP DNSP |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
IP
|
$858.34
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$557.92 |
| Max. Negotiated Rate |
$858.34 |
| Rate for Payer: Aetna Commercial |
$772.51
|
| Rate for Payer: ASR ASR |
$832.59
|
| Rate for Payer: ASR Commercial |
$832.59
|
| Rate for Payer: BCBS Trust/PPO |
$699.46
|
| Rate for Payer: BCN Commercial |
$665.47
|
| Rate for Payer: Cash Price |
$686.67
|
| Rate for Payer: Cofinity Commercial |
$806.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.67
|
| Rate for Payer: Healthscope Commercial |
$858.34
|
| Rate for Payer: Healthscope Whirlpool |
$832.59
|
| Rate for Payer: Mclaren Commercial |
$772.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.59
|
| Rate for Payer: Nomi Health Commercial |
$703.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.34
|
|
|
HC VEN ULTRA IMAG INTRAOP
|
Facility
|
OP
|
$858.34
|
|
| Hospital Charge Code |
36000052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.34 |
| Max. Negotiated Rate |
$858.34 |
| Rate for Payer: Aetna Commercial |
$772.51
|
| Rate for Payer: Aetna Medicare |
$429.17
|
| Rate for Payer: ASR ASR |
$832.59
|
| Rate for Payer: ASR Commercial |
$832.59
|
| Rate for Payer: BCBS Complete |
$343.34
|
| Rate for Payer: BCBS Trust/PPO |
$702.89
|
| Rate for Payer: BCN Commercial |
$665.47
|
| Rate for Payer: Cash Price |
$686.67
|
| Rate for Payer: Cofinity Commercial |
$806.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.67
|
| Rate for Payer: Healthscope Commercial |
$858.34
|
| Rate for Payer: Healthscope Whirlpool |
$832.59
|
| Rate for Payer: Mclaren Commercial |
$772.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.59
|
| Rate for Payer: Nomi Health Commercial |
$703.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.08
|
| Rate for Payer: Priority Health Narrow Network |
$601.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.34
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
OP
|
$5,102.97
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,703.94 |
| Max. Negotiated Rate |
$5,102.97 |
| Rate for Payer: Aetna Commercial |
$4,592.67
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$4,949.88
|
| Rate for Payer: ASR Commercial |
$4,949.88
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,178.82
|
| Rate for Payer: BCN Commercial |
$3,956.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$4,082.38
|
| Rate for Payer: Cash Price |
$4,082.38
|
| Rate for Payer: Cofinity Commercial |
$4,796.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,082.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$5,102.97
|
| Rate for Payer: Healthscope Whirlpool |
$4,949.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$4,592.67
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,337.52
|
| Rate for Payer: Nomi Health Commercial |
$4,184.44
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,471.22
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$3,577.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,490.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
HC VERPLSTY W WO BONE BX C TH 1ST
|
Facility
|
IP
|
$5,102.97
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
36100465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,316.93 |
| Max. Negotiated Rate |
$5,102.97 |
| Rate for Payer: Aetna Commercial |
$4,592.67
|
| Rate for Payer: ASR ASR |
$4,949.88
|
| Rate for Payer: ASR Commercial |
$4,949.88
|
| Rate for Payer: BCBS Trust/PPO |
$4,158.41
|
| Rate for Payer: BCN Commercial |
$3,956.33
|
| Rate for Payer: Cash Price |
$4,082.38
|
| Rate for Payer: Cofinity Commercial |
$4,796.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,082.38
|
| Rate for Payer: Healthscope Commercial |
$5,102.97
|
| Rate for Payer: Healthscope Whirlpool |
$4,949.88
|
| Rate for Payer: Mclaren Commercial |
$4,592.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,337.52
|
| Rate for Payer: Nomi Health Commercial |
$4,184.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,316.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,490.61
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
OP
|
$5,456.20
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,182.48 |
| Max. Negotiated Rate |
$5,456.20 |
| Rate for Payer: Aetna Commercial |
$4,910.58
|
| Rate for Payer: Aetna Medicare |
$2,728.10
|
| Rate for Payer: ASR ASR |
$5,292.51
|
| Rate for Payer: ASR Commercial |
$5,292.51
|
| Rate for Payer: BCBS Complete |
$2,182.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,468.08
|
| Rate for Payer: BCN Commercial |
$4,230.19
|
| Rate for Payer: Cash Price |
$4,364.96
|
| Rate for Payer: Cofinity Commercial |
$5,128.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,364.96
|
| Rate for Payer: Healthscope Commercial |
$5,456.20
|
| Rate for Payer: Healthscope Whirlpool |
$5,292.51
|
| Rate for Payer: Mclaren Commercial |
$4,910.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,637.77
|
| Rate for Payer: Nomi Health Commercial |
$4,474.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,546.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,780.72
|
| Rate for Payer: Priority Health Narrow Network |
$3,824.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,801.46
|
|
|
HC VERPLSTY W WO BONE BX EA ADD
|
Facility
|
IP
|
$5,456.20
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
36100466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,546.53 |
| Max. Negotiated Rate |
$5,456.20 |
| Rate for Payer: Aetna Commercial |
$4,910.58
|
| Rate for Payer: ASR ASR |
$5,292.51
|
| Rate for Payer: ASR Commercial |
$5,292.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,446.26
|
| Rate for Payer: BCN Commercial |
$4,230.19
|
| Rate for Payer: Cash Price |
$4,364.96
|
| Rate for Payer: Cofinity Commercial |
$5,128.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,364.96
|
| Rate for Payer: Healthscope Commercial |
$5,456.20
|
| Rate for Payer: Healthscope Whirlpool |
$5,292.51
|
| Rate for Payer: Mclaren Commercial |
$4,910.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,637.77
|
| Rate for Payer: Nomi Health Commercial |
$4,474.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,546.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,801.46
|
|
