|
HC XR SINUS TRACT FISTULA ABSCESS
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$828.86 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.59
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$272.49
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC XR SKULL LESS THAN 4 VW
|
Facility
|
IP
|
$357.38
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| 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 XR SKULL LESS THAN 4 VW
|
Facility
|
OP
|
$357.38
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
32000017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$357.38 |
| Rate for Payer: Aetna Commercial |
$321.64
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$346.66
|
| Rate for Payer: ASR Commercial |
$346.66
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$292.66
|
| Rate for Payer: BCN Commercial |
$277.08
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$357.38
|
| Rate for Payer: Healthscope Whirlpool |
$346.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$321.64
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.77
|
| Rate for Payer: Nomi Health Commercial |
$293.05
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.14
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$250.52
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$314.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR SKULL MIN 4 VW
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.66
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$286.15
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR SKULL MIN 4 VW
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
32000018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
|
|
HC XR SMALL BOWEL
|
Facility
|
IP
|
$612.56
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$398.16 |
| Max. Negotiated Rate |
$612.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: ASR ASR |
$594.18
|
| Rate for Payer: ASR Commercial |
$594.18
|
| Rate for Payer: BCBS Trust/PPO |
$499.18
|
| Rate for Payer: BCN Commercial |
$474.92
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cofinity Commercial |
$575.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.05
|
| Rate for Payer: Healthscope Commercial |
$612.56
|
| Rate for Payer: Healthscope Whirlpool |
$594.18
|
| Rate for Payer: Mclaren Commercial |
$551.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.68
|
| Rate for Payer: Nomi Health Commercial |
$502.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.05
|
|
|
HC XR SMALL BOWEL
|
Facility
|
OP
|
$612.56
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$612.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$594.18
|
| Rate for Payer: ASR Commercial |
$594.18
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$501.63
|
| Rate for Payer: BCN Commercial |
$474.92
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cofinity Commercial |
$575.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$612.56
|
| Rate for Payer: Healthscope Whirlpool |
$594.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$551.30
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.68
|
| Rate for Payer: Nomi Health Commercial |
$502.30
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.73
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$429.40
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC XR SMALL BOWEL.
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
32000331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$231.72
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
HC XR SMALL BOWEL.
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
32000331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$232.85
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
HC XR SMALL BOWEL ENTEROCLYSIS TU
|
Facility
|
OP
|
$816.54
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$816.54 |
| Rate for Payer: Aetna Commercial |
$734.89
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$792.04
|
| Rate for Payer: ASR Commercial |
$792.04
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$668.66
|
| Rate for Payer: BCN Commercial |
$633.06
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$767.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$792.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$734.89
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.45
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$572.39
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC XR SMALL BOWEL ENTEROCLYSIS TU
|
Facility
|
IP
|
$816.54
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
32000145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$530.75 |
| Max. Negotiated Rate |
$816.54 |
| Rate for Payer: Aetna Commercial |
$734.89
|
| Rate for Payer: ASR ASR |
$792.04
|
| Rate for Payer: ASR Commercial |
$792.04
|
| Rate for Payer: BCBS Trust/PPO |
$665.40
|
| Rate for Payer: BCN Commercial |
$633.06
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$767.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Healthscope Commercial |
$816.54
|
| Rate for Payer: Healthscope Whirlpool |
$792.04
|
| Rate for Payer: Mclaren Commercial |
$734.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.56
|
|
|
HC XR SOFT TISSUE NECK
|
Facility
|
OP
|
$310.54
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
32000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$310.54 |
| Rate for Payer: Aetna Commercial |
$279.49
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$301.22
|
| Rate for Payer: ASR Commercial |
$301.22
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$254.30
|
| Rate for Payer: BCN Commercial |
$240.76
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$248.43
|
| Rate for Payer: Cash Price |
$248.43
|
| Rate for Payer: Cofinity Commercial |
$291.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$310.54
|
| Rate for Payer: Healthscope Whirlpool |
$301.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$279.49
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.96
|
| Rate for Payer: Nomi Health Commercial |
$254.64
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.10
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$217.69
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR SOFT TISSUE NECK
|
Facility
|
IP
|
$310.54
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
32000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.85 |
| Max. Negotiated Rate |
$310.54 |
| Rate for Payer: Aetna Commercial |
$279.49
|
| Rate for Payer: ASR ASR |
$301.22
|
| Rate for Payer: ASR Commercial |
$301.22
|
| Rate for Payer: BCBS Trust/PPO |
$253.06
|
| Rate for Payer: BCN Commercial |
$240.76
|
| Rate for Payer: Cash Price |
$248.43
|
| Rate for Payer: Cofinity Commercial |
$291.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.43
|
| Rate for Payer: Healthscope Commercial |
$310.54
|
| Rate for Payer: Healthscope Whirlpool |
$301.22
|
| Rate for Payer: Mclaren Commercial |
$279.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.96
|
| Rate for Payer: Nomi Health Commercial |
$254.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.28
|
|
|
HC XR SPECIMEN X-RAY
|
Facility
|
OP
|
$210.80
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.02 |
| Max. Negotiated Rate |
$828.86 |
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: Aetna Medicare |
$534.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: ASR ASR |
$204.48
|
| Rate for Payer: ASR Commercial |
$204.48
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCBS Trust/PPO |
$172.62
|
| Rate for Payer: BCN Commercial |
$163.43
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Cash Price |
$168.64
|
| Rate for Payer: Cash Price |
$168.64
|
| Rate for Payer: Cofinity Commercial |
$198.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Healthscope Commercial |
$210.80
|
| Rate for Payer: Healthscope Whirlpool |
$204.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$534.75
|
| Rate for Payer: Mclaren Commercial |
$189.72
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.18
|
| Rate for Payer: Nomi Health Commercial |
$172.86
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Commercial |
$588.23
|
| Rate for Payer: PHP Medicaid |
$286.63
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.70
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Priority Health Narrow Network |
$147.77
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$828.86
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP DNSP |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
HC XR SPECIMEN X-RAY
|
Facility
|
IP
|
$210.80
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.02 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Aetna Commercial |
$189.72
|
| Rate for Payer: ASR ASR |
$204.48
|
| Rate for Payer: ASR Commercial |
$204.48
|
| Rate for Payer: BCBS Trust/PPO |
$171.78
|
| Rate for Payer: BCN Commercial |
$163.43
|
| Rate for Payer: Cash Price |
$168.64
|
| Rate for Payer: Cofinity Commercial |
$198.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.64
|
| Rate for Payer: Healthscope Commercial |
$210.80
|
| Rate for Payer: Healthscope Whirlpool |
$204.48
|
| Rate for Payer: Mclaren Commercial |
$189.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.18
|
| Rate for Payer: Nomi Health Commercial |
$172.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.50
|
|
|
HC XR SPINE CERV 6VW OR MORE
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$510.39 |
| Rate for Payer: Aetna Commercial |
$459.35
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$495.08
|
| Rate for Payer: ASR Commercial |
$495.08
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$417.96
|
| Rate for Payer: BCN Commercial |
$395.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$479.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$510.39
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$459.35
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.20
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$357.78
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR SPINE CERV 6VW OR MORE
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
32000037
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.75 |
| Max. Negotiated Rate |
$510.39 |
| Rate for Payer: Aetna Commercial |
$459.35
|
| Rate for Payer: ASR ASR |
$495.08
|
| Rate for Payer: ASR Commercial |
$495.08
|
| Rate for Payer: BCBS Trust/PPO |
$415.92
|
| Rate for Payer: BCN Commercial |
$395.71
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$479.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$510.39
|
| Rate for Payer: Healthscope Whirlpool |
$495.08
|
| Rate for Payer: Mclaren Commercial |
$459.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.14
|
|
|
HC XR SPINE CERVICAL 3VW OR LESS
|
Facility
|
IP
|
$377.89
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$377.89 |
| Rate for Payer: Aetna Commercial |
$340.10
|
| Rate for Payer: ASR ASR |
$366.55
|
| Rate for Payer: ASR Commercial |
$366.55
|
| Rate for Payer: BCBS Trust/PPO |
$307.94
|
| Rate for Payer: BCN Commercial |
$292.98
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$355.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Healthscope Commercial |
$377.89
|
| Rate for Payer: Healthscope Whirlpool |
$366.55
|
| Rate for Payer: Mclaren Commercial |
$340.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$309.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.54
|
|
|
HC XR SPINE CERVICAL 3VW OR LESS
|
Facility
|
OP
|
$377.89
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
32000035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$377.89 |
| Rate for Payer: Aetna Commercial |
$340.10
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$366.55
|
| Rate for Payer: ASR Commercial |
$366.55
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$309.45
|
| Rate for Payer: BCN Commercial |
$292.98
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$355.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$377.89
|
| Rate for Payer: Healthscope Whirlpool |
$366.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$340.10
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$309.87
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.11
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$264.90
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$332.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC XR SPINE CERVICAL 4 OR 5 VW
|
Facility
|
IP
|
$469.62
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.25 |
| Max. Negotiated Rate |
$469.62 |
| Rate for Payer: Aetna Commercial |
$422.66
|
| Rate for Payer: ASR ASR |
$455.53
|
| Rate for Payer: ASR Commercial |
$455.53
|
| Rate for Payer: BCBS Trust/PPO |
$382.69
|
| Rate for Payer: BCN Commercial |
$364.10
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Cofinity Commercial |
$441.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.70
|
| Rate for Payer: Healthscope Commercial |
$469.62
|
| Rate for Payer: Healthscope Whirlpool |
$455.53
|
| Rate for Payer: Mclaren Commercial |
$422.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.18
|
| Rate for Payer: Nomi Health Commercial |
$385.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.27
|
|
|
HC XR SPINE CERVICAL 4 OR 5 VW
|
Facility
|
OP
|
$469.62
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
32000036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$469.62 |
| Rate for Payer: Aetna Commercial |
$422.66
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$455.53
|
| Rate for Payer: ASR Commercial |
$455.53
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$384.57
|
| Rate for Payer: BCN Commercial |
$364.10
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Cash Price |
$375.70
|
| Rate for Payer: Cofinity Commercial |
$441.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$469.62
|
| Rate for Payer: Healthscope Whirlpool |
$455.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$422.66
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.18
|
| Rate for Payer: Nomi Health Commercial |
$385.09
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.48
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$329.20
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR SPINE LUMBAR 2 OR 3 VW
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
32000044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.66
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$286.15
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC XR SPINE LUMBAR 2 OR 3 VW
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
32000044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$367.38
|
| Rate for Payer: ASR ASR |
$395.95
|
| Rate for Payer: ASR Commercial |
$395.95
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$316.48
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$383.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Whirlpool |
$395.95
|
| Rate for Payer: Mclaren Commercial |
$367.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.22
|
|
|
HC XR SPINE LUMBAR BENDING ONLY 4
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC XR SPINE LUMBAR BENDING ONLY 4
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
32000047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.59
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$272.49
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
