|
HC CT SPINE CERVICAL WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$144.51
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Cofinity Commercial |
$1,110.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$999.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$130.98
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$999.31 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.03
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,110.34
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health SBD |
$999.31
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.74 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.94
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,511.93
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health SBD |
$1,360.74
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$239.94
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,511.93
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,360.74
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$199.08
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,221.32 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.10
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Cofinity Commercial |
$1,357.03
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health SBD |
$1,221.32
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$1,938.61
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$170.27 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$194.71
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,357.03
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,146.57
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Narrow Network |
$917.26
|
| Rate for Payer: Priority Health SBD |
$1,221.32
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$170.27
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$143.42
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Cofinity Commercial |
$1,110.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$999.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$129.99
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$999.31 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.03
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Cofinity Commercial |
$1,110.34
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health SBD |
$999.31
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,360.74 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.94
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,511.93
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health SBD |
$1,360.74
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$240.50
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Cofinity Commercial |
$1,511.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,360.74
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$199.41
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$1,938.61
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$195.82
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,357.03
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,221.32
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$171.25
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,221.32 |
| Max. Negotiated Rate |
$1,744.75 |
| Rate for Payer: Aetna Commercial |
$1,647.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.10
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,667.20
|
| Rate for Payer: Cofinity Commercial |
$1,357.03
|
| Rate for Payer: Healthscope Commercial |
$1,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PHP Commercial |
$1,647.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health SBD |
$1,221.32
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$144.51
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Cofinity Commercial |
$1,110.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$999.31
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$130.65
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$999.31 |
| Max. Negotiated Rate |
$1,427.58 |
| Rate for Payer: Aetna Commercial |
$1,348.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.03
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,110.34
|
| Rate for Payer: Cofinity Commercial |
$1,364.13
|
| Rate for Payer: Healthscope Commercial |
$1,427.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: PHP Commercial |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: Priority Health SBD |
$999.31
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$242.70
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Cofinity Commercial |
$1,511.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,360.74
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$200.39
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.74 |
| Max. Negotiated Rate |
$1,943.91 |
| Rate for Payer: Aetna Commercial |
$1,835.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.94
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$1,511.93
|
| Rate for Payer: Cofinity Commercial |
$1,857.51
|
| Rate for Payer: Healthscope Commercial |
$1,943.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: PHP Commercial |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: Priority Health SBD |
$1,360.74
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,799.28
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,619.35 |
| Rate for Payer: Aetna Commercial |
$1,529.39
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$371.77
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,439.42
|
| Rate for Payer: Cash Price |
$1,439.42
|
| Rate for Payer: Cofinity Commercial |
$1,547.38
|
| Rate for Payer: Cofinity Commercial |
$1,259.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,619.35
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,529.39
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,529.39
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.75
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$432.60
|
| Rate for Payer: Priority Health SBD |
$1,133.55
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$299.28
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
IP
|
$1,799.28
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,133.55 |
| Max. Negotiated Rate |
$1,619.35 |
| Rate for Payer: Aetna Commercial |
$1,529.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.53
|
| Rate for Payer: Cash Price |
$1,439.42
|
| Rate for Payer: Cofinity Commercial |
$1,259.50
|
| Rate for Payer: Cofinity Commercial |
$1,547.38
|
| Rate for Payer: Healthscope Commercial |
$1,619.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,529.39
|
| Rate for Payer: PHP Commercial |
$1,529.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.50
|
| Rate for Payer: Priority Health SBD |
$1,133.55
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
OP
|
$1,421.88
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,279.69 |
| Rate for Payer: Aetna Commercial |
$1,208.60
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$255.94
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cofinity Commercial |
$1,222.82
|
| Rate for Payer: Cofinity Commercial |
$995.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$1,279.69
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,208.60
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$1,208.60
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.74
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health Narrow Network |
$883.79
|
| Rate for Payer: Priority Health SBD |
$895.78
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$202.36
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
IP
|
$1,421.88
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$895.78 |
| Max. Negotiated Rate |
$1,279.69 |
| Rate for Payer: Aetna Commercial |
$1,208.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.22
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cofinity Commercial |
$995.32
|
| Rate for Payer: Cofinity Commercial |
$1,222.82
|
| Rate for Payer: Healthscope Commercial |
$1,279.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,208.60
|
| Rate for Payer: PHP Commercial |
$1,208.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.32
|
| Rate for Payer: Priority Health SBD |
$895.78
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
OP
|
$1,191.36
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,072.22 |
| Rate for Payer: Aetna Commercial |
$1,012.66
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$200.23
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$953.09
|
| Rate for Payer: Cash Price |
$953.09
|
| Rate for Payer: Cofinity Commercial |
$1,024.57
|
| Rate for Payer: Cofinity Commercial |
$833.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,072.22
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,012.66
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,012.66
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$750.56
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$162.41
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
IP
|
$1,191.36
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$750.56 |
| Max. Negotiated Rate |
$1,072.22 |
| Rate for Payer: Aetna Commercial |
$1,012.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.38
|
| Rate for Payer: Cash Price |
$953.09
|
| Rate for Payer: Cofinity Commercial |
$1,024.57
|
| Rate for Payer: Cofinity Commercial |
$833.95
|
| Rate for Payer: Healthscope Commercial |
$1,072.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,012.66
|
| Rate for Payer: PHP Commercial |
$1,012.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.95
|
| Rate for Payer: Priority Health SBD |
$750.56
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,657.70
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,491.93 |
| Rate for Payer: Aetna Commercial |
$1,409.04
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$334.82
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,326.16
|
| Rate for Payer: Cash Price |
$1,326.16
|
| Rate for Payer: Cofinity Commercial |
$1,160.39
|
| Rate for Payer: Cofinity Commercial |
$1,425.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,491.93
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,409.04
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,409.04
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,160.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.75
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$432.60
|
| Rate for Payer: Priority Health SBD |
$1,044.35
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$250.82
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,657.70
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,044.35 |
| Max. Negotiated Rate |
$1,491.93 |
| Rate for Payer: Aetna Commercial |
$1,409.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.50
|
| Rate for Payer: Cash Price |
$1,326.16
|
| Rate for Payer: Cofinity Commercial |
$1,160.39
|
| Rate for Payer: Cofinity Commercial |
$1,425.62
|
| Rate for Payer: Healthscope Commercial |
$1,491.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,409.04
|
| Rate for Payer: PHP Commercial |
$1,409.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,160.39
|
| Rate for Payer: Priority Health SBD |
$1,044.35
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
IP
|
$994.10
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$626.28 |
| Max. Negotiated Rate |
$894.69 |
| Rate for Payer: Aetna Commercial |
$844.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.16
|
| Rate for Payer: Cash Price |
$795.28
|
| Rate for Payer: Cofinity Commercial |
$695.87
|
| Rate for Payer: Cofinity Commercial |
$854.93
|
| Rate for Payer: Healthscope Commercial |
$894.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$844.98
|
| Rate for Payer: PHP Commercial |
$844.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.87
|
| Rate for Payer: Priority Health SBD |
$626.28
|
|
