|
HC XR PYELOGRAPHY IV
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,041.20 |
| Rate for Payer: Aetna Commercial |
$937.08
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,009.96
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$858.47
|
| Rate for Payer: BCN Commercial |
$858.47
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$978.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,009.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,041.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$937.08
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$610.12
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$488.10
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$916.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,015.00 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.36
|
| Rate for Payer: BCN Commercial |
$1,111.36
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,312.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.34
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
|
|
HC XR PYELOGRAPHY RETROGRADE
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
32000160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,115.83
|
| Rate for Payer: BCN Commercial |
$1,115.83
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,312.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,353.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,185.80
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$948.69
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC XR RIBS 2 VW
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165.85
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$132.68
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR RIBS 2 VW
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
32000027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
OP
|
$468.74
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$468.74 |
| Rate for Payer: Aetna Commercial |
$421.87
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$454.68
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$386.48
|
| Rate for Payer: BCN Commercial |
$386.48
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$440.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$454.68
|
| Rate for Payer: Healthscope Whirlpool |
$468.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$421.87
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.43
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$222.74
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR RIBS BIL INCL PA CHST
|
Facility
|
IP
|
$468.74
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
32000030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.56 |
| Max. Negotiated Rate |
$468.74 |
| Rate for Payer: Aetna Commercial |
$421.87
|
| Rate for Payer: ASR ASR |
$454.68
|
| Rate for Payer: BCBS Trust/PPO |
$384.93
|
| Rate for Payer: BCN Commercial |
$384.93
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$440.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$454.68
|
| Rate for Payer: Healthscope Whirlpool |
$468.74
|
| Rate for Payer: Mclaren Commercial |
$421.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.49
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
OP
|
$468.74
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$468.74 |
| Rate for Payer: Aetna Commercial |
$421.87
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$454.68
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$386.48
|
| Rate for Payer: BCN Commercial |
$386.48
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$440.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$454.68
|
| Rate for Payer: Healthscope Whirlpool |
$468.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$421.87
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.19
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$200.95
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR RIBS BIL MIN 3 VW
|
Facility
|
IP
|
$468.74
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
32000029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.56 |
| Max. Negotiated Rate |
$468.74 |
| Rate for Payer: Aetna Commercial |
$421.87
|
| Rate for Payer: ASR ASR |
$454.68
|
| Rate for Payer: BCBS Trust/PPO |
$384.93
|
| Rate for Payer: BCN Commercial |
$384.93
|
| Rate for Payer: Cash Price |
$374.99
|
| Rate for Payer: Cofinity Commercial |
$440.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.99
|
| Rate for Payer: Healthscope Commercial |
$454.68
|
| Rate for Payer: Healthscope Whirlpool |
$468.74
|
| Rate for Payer: Mclaren Commercial |
$421.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.43
|
| Rate for Payer: Nomi Health Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.49
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
OP
|
$416.36
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$343.29
|
| Rate for Payer: BCN Commercial |
$343.29
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.14
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$140.91
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR RIBS INC PA CHST
|
Facility
|
IP
|
$416.36
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
32000028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.27 |
| Max. Negotiated Rate |
$416.36 |
| Rate for Payer: Aetna Commercial |
$374.72
|
| Rate for Payer: ASR ASR |
$403.87
|
| Rate for Payer: BCBS Trust/PPO |
$341.91
|
| Rate for Payer: BCN Commercial |
$341.91
|
| Rate for Payer: Cash Price |
$333.09
|
| Rate for Payer: Cofinity Commercial |
$391.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.09
|
| Rate for Payer: Healthscope Commercial |
$403.87
|
| Rate for Payer: Healthscope Whirlpool |
$416.36
|
| Rate for Payer: Mclaren Commercial |
$374.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.91
|
| Rate for Payer: Nomi Health Commercial |
$341.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.40
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
OP
|
$192.54
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$192.54 |
| Rate for Payer: Aetna Commercial |
$173.29
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$186.76
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$158.75
|
| Rate for Payer: BCN Commercial |
$158.75
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$154.03
|
| Rate for Payer: Cash Price |
$154.03
|
| Rate for Payer: Cofinity Commercial |
$180.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$186.76
|
| Rate for Payer: Healthscope Whirlpool |
$192.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$173.29
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.66
|
| Rate for Payer: Nomi Health Commercial |
$157.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.41
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$163.42
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$130.74
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SACROILIAC JTS 3 VW OR LESS
|
Facility
|
IP
|
$192.54
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
32000050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.41 |
| Max. Negotiated Rate |
$192.54 |
| Rate for Payer: Aetna Commercial |
$173.29
|
| Rate for Payer: ASR ASR |
$186.76
|
| Rate for Payer: BCBS Trust/PPO |
$158.11
|
| Rate for Payer: BCN Commercial |
$158.11
|
| Rate for Payer: Cash Price |
$154.03
|
| Rate for Payer: Cofinity Commercial |
$180.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.03
|
| Rate for Payer: Healthscope Commercial |
$186.76
|
| Rate for Payer: Healthscope Whirlpool |
$192.54
|
| Rate for Payer: Mclaren Commercial |
$173.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.66
|
| Rate for Payer: Nomi Health Commercial |
$157.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.44
|
|
|
HC XR SACROILIAC JTS 3 VW OR MORE
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC XR SACROILIAC JTS 3 VW OR MORE
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
32000051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$193.68
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$154.95
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SACRUM COCCYX MIN 2 VW
|
Facility
|
IP
|
$312.56
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$312.56 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: ASR ASR |
$303.18
|
| Rate for Payer: BCBS Trust/PPO |
$256.67
|
| Rate for Payer: BCN Commercial |
$256.67
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$293.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Healthscope Commercial |
$303.18
|
| Rate for Payer: Healthscope Whirlpool |
$312.56
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$256.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.05
|
|
|
HC XR SACRUM COCCYX MIN 2 VW
|
Facility
|
OP
|
$312.56
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
32000052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$312.56 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$303.18
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$257.71
|
| Rate for Payer: BCN Commercial |
$257.71
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cofinity Commercial |
$293.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$303.18
|
| Rate for Payer: Healthscope Whirlpool |
$312.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.68
|
| Rate for Payer: Nomi Health Commercial |
$256.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.42
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.64
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$131.71
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR SCAPULA
|
Facility
|
OP
|
$374.92
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$374.92 |
| Rate for Payer: Aetna Commercial |
$337.43
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$363.67
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$309.12
|
| Rate for Payer: BCN Commercial |
$309.12
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$299.94
|
| Rate for Payer: Cash Price |
$299.94
|
| Rate for Payer: Cofinity Commercial |
$352.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$363.67
|
| Rate for Payer: Healthscope Whirlpool |
$374.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$337.43
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.68
|
| Rate for Payer: Nomi Health Commercial |
$307.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.19
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$285.68
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$228.55
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SCAPULA
|
Facility
|
IP
|
$374.92
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.19 |
| Max. Negotiated Rate |
$374.92 |
| Rate for Payer: Aetna Commercial |
$337.43
|
| Rate for Payer: ASR ASR |
$363.67
|
| Rate for Payer: BCBS Trust/PPO |
$307.88
|
| Rate for Payer: BCN Commercial |
$307.88
|
| Rate for Payer: Cash Price |
$299.94
|
| Rate for Payer: Cofinity Commercial |
$352.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.94
|
| Rate for Payer: Healthscope Commercial |
$363.67
|
| Rate for Payer: Healthscope Whirlpool |
$374.92
|
| Rate for Payer: Mclaren Commercial |
$337.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.68
|
| Rate for Payer: Nomi Health Commercial |
$307.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.93
|
|
|
HC XR SCAPULA BILATERAL
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000337
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$256.31
|
| Rate for Payer: BCN Commercial |
$256.31
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC XR SCAPULA BILATERAL
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
32000337
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$257.34
|
| Rate for Payer: BCN Commercial |
$257.34
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$285.68
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$228.55
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC XR SELLA TURCICA
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$300.55
|
| Rate for Payer: BCN Commercial |
$300.55
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$134.98
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$107.98
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR SELLA TURCICA
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
32000016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Aetna Commercial |
$328.08
|
| Rate for Payer: ASR ASR |
$353.59
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$299.35
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$342.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$353.59
|
| Rate for Payer: Healthscope Whirlpool |
$364.53
|
| Rate for Payer: Mclaren Commercial |
$328.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.79
|
|
|
HC XR SHOULDER 1 VW
|
Facility
|
OP
|
$135.42
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$230.01 |
| Rate for Payer: Aetna Commercial |
$121.88
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$131.36
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$111.65
|
| Rate for Payer: BCN Commercial |
$111.65
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Commercial |
$127.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$131.36
|
| Rate for Payer: Healthscope Whirlpool |
$135.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$121.88
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$230.01
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$184.01
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC XR SHOULDER 1 VW
|
Facility
|
IP
|
$135.42
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
32000063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.56 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Aetna Commercial |
$121.88
|
| Rate for Payer: ASR ASR |
$131.36
|
| Rate for Payer: BCBS Trust/PPO |
$111.21
|
| Rate for Payer: BCN Commercial |
$111.21
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cofinity Commercial |
$127.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$131.36
|
| Rate for Payer: Healthscope Whirlpool |
$135.42
|
| Rate for Payer: Mclaren Commercial |
$121.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.11
|
| Rate for Payer: Nomi Health Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.17
|
|
