|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
IP
|
$3,753.17
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,364.50 |
| Max. Negotiated Rate |
$3,377.85 |
| Rate for Payer: Aetna Commercial |
$3,190.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.56
|
| Rate for Payer: Cash Price |
$3,002.54
|
| Rate for Payer: Cofinity Advantage |
$2,627.22
|
| Rate for Payer: Cofinity Commercial |
$3,227.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.54
|
| Rate for Payer: Healthscope Commercial |
$3,377.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,814.88
|
| Rate for Payer: PHP Commercial |
$3,190.19
|
| Rate for Payer: Priority Health SBD |
$2,364.50
|
|
|
HC CSF LACTATE
|
Facility
|
OP
|
$22.29
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.34
|
| Rate for Payer: BCN Commercial |
$12.34
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Mclaren Medicaid |
$6.05
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.72
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.57
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: Priority Health Tiered Network |
$9.26
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.36
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.57
|
| Rate for Payer: UHC Exchange |
$17.36
|
| Rate for Payer: UHC Medicaid |
$6.05
|
| Rate for Payer: UHCCP Medicaid |
$6.05
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC CSF LACTATE
|
Facility
|
IP
|
$22.29
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.72
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.04
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC CSU R&B
|
Facility
|
IP
|
$7,454.86
|
|
| Hospital Charge Code |
21000002
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$4,696.56 |
| Max. Negotiated Rate |
$6,709.37 |
| Rate for Payer: Aetna Commercial |
$6,336.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,845.66
|
| Rate for Payer: Cash Price |
$5,963.89
|
| Rate for Payer: Cofinity Advantage |
$5,218.40
|
| Rate for Payer: Cofinity Commercial |
$6,411.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,963.89
|
| Rate for Payer: Healthscope Commercial |
$6,709.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,336.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,591.15
|
| Rate for Payer: PHP Commercial |
$6,336.63
|
| Rate for Payer: Priority Health SBD |
$4,696.56
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
IP
|
$3,783.83
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,383.81 |
| Max. Negotiated Rate |
$3,405.45 |
| Rate for Payer: Aetna Commercial |
$3,216.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,459.49
|
| Rate for Payer: Cash Price |
$3,027.06
|
| Rate for Payer: Cofinity Advantage |
$2,648.68
|
| Rate for Payer: Cofinity Commercial |
$3,254.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,027.06
|
| Rate for Payer: Healthscope Commercial |
$3,405.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,216.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,837.87
|
| Rate for Payer: PHP Commercial |
$3,216.26
|
| Rate for Payer: Priority Health SBD |
$2,383.81
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
OP
|
$3,783.83
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$3,405.45 |
| Rate for Payer: Aetna Commercial |
$3,216.26
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,459.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$500.47
|
| Rate for Payer: BCN Commercial |
$500.47
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$3,027.06
|
| Rate for Payer: Cash Price |
$3,027.06
|
| Rate for Payer: Cofinity Advantage |
$2,648.68
|
| Rate for Payer: Cofinity Commercial |
$3,254.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,027.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$3,405.45
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$3,216.26
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,837.87
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$3,216.26
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,383.81
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,459.49
|
| Rate for Payer: UHC Core |
$1,971.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,487.05
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
OP
|
$2,552.31
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$2,297.08 |
| Rate for Payer: Aetna Commercial |
$2,169.46
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$237.75
|
| Rate for Payer: BCN Commercial |
$237.75
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$2,041.85
|
| Rate for Payer: Cash Price |
$2,041.85
|
| Rate for Payer: Cofinity Advantage |
$1,786.62
|
| Rate for Payer: Cofinity Commercial |
$2,194.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$2,297.08
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,169.46
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,914.23
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$2,169.46
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,607.96
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,659.00
|
| Rate for Payer: UHC Core |
$1,329.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$1,003.06
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
IP
|
$2,552.31
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,607.96 |
| Max. Negotiated Rate |
$2,297.08 |
| Rate for Payer: Aetna Commercial |
$2,169.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.00
|
| Rate for Payer: Cash Price |
$2,041.85
|
| Rate for Payer: Cofinity Advantage |
$1,786.62
|
| Rate for Payer: Cofinity Commercial |
$2,194.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,041.85
|
| Rate for Payer: Healthscope Commercial |
$2,297.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,169.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,914.23
|
| Rate for Payer: PHP Commercial |
$2,169.46
|
| Rate for Payer: Priority Health SBD |
$1,607.96
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
IP
|
$4,522.30
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,849.05 |
| Max. Negotiated Rate |
$4,070.07 |
| Rate for Payer: Aetna Commercial |
$3,843.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,939.49
|
| Rate for Payer: Cash Price |
$3,617.84
|
| Rate for Payer: Cofinity Advantage |
$3,165.61
|
| Rate for Payer: Cofinity Commercial |
$3,889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,617.84
|
| Rate for Payer: Healthscope Commercial |
$4,070.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,843.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,391.72
|
| Rate for Payer: PHP Commercial |
$3,843.95
|
| Rate for Payer: Priority Health SBD |
$2,849.05
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
OP
|
$4,522.30
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$4,070.07 |
| Rate for Payer: Aetna Commercial |
$3,843.95
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,939.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$564.83
|
| Rate for Payer: BCN Commercial |
$564.83
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$3,617.84
|
| Rate for Payer: Cash Price |
$3,617.84
|
| Rate for Payer: Cofinity Advantage |
$3,165.61
|
| Rate for Payer: Cofinity Commercial |
$3,889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,617.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$4,070.07
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$3,843.95
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,391.72
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$3,843.95
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,849.05
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,939.49
|
| Rate for Payer: UHC Core |
$2,356.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,777.26
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
OP
|
$1,119.37
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,007.43 |
| Rate for Payer: Aetna Commercial |
$951.46
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$511.08
|
| Rate for Payer: BCN Commercial |
$511.08
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cofinity Advantage |
$783.56
|
| Rate for Payer: Cofinity Commercial |
$962.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,007.43
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| 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 |
$183.51
|
| 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 |
$951.46
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$839.53
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$951.46
|
| 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/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$705.20
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.59
|
| Rate for Payer: UHC Core |
$583.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$439.91
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
IP
|
$1,119.37
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$705.20 |
| Max. Negotiated Rate |
$1,007.43 |
| Rate for Payer: Aetna Commercial |
$951.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.59
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cofinity Advantage |
$783.56
|
| Rate for Payer: Cofinity Commercial |
$962.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$895.50
|
| Rate for Payer: Healthscope Commercial |
$1,007.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$951.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$839.53
|
| Rate for Payer: PHP Commercial |
$951.46
|
| Rate for Payer: Priority Health SBD |
$705.20
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
OP
|
$1,998.95
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,799.06 |
| Rate for Payer: Aetna Commercial |
$1,699.11
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$395.99
|
| Rate for Payer: BCN Commercial |
$395.99
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,599.16
|
| Rate for Payer: Cash Price |
$1,599.16
|
| Rate for Payer: Cofinity Advantage |
$1,399.27
|
| Rate for Payer: Cofinity Commercial |
$1,719.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,799.06
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| 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 |
$183.51
|
| 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 |
$1,699.11
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.21
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,699.11
|
| 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/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,259.34
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.32
|
| Rate for Payer: UHC Core |
$1,041.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$785.59
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
IP
|
$1,998.95
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,259.34 |
| Max. Negotiated Rate |
$1,799.06 |
| Rate for Payer: Aetna Commercial |
$1,699.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.32
|
| Rate for Payer: Cash Price |
$1,599.16
|
| Rate for Payer: Cofinity Advantage |
$1,399.27
|
| Rate for Payer: Cofinity Commercial |
$1,719.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.16
|
| Rate for Payer: Healthscope Commercial |
$1,799.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,699.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.21
|
| Rate for Payer: PHP Commercial |
$1,699.11
|
| Rate for Payer: Priority Health SBD |
$1,259.34
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
IP
|
$1,639.04
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,032.60 |
| Max. Negotiated Rate |
$1,475.14 |
| Rate for Payer: Aetna Commercial |
$1,393.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.38
|
| Rate for Payer: Cash Price |
$1,311.23
|
| Rate for Payer: Cofinity Advantage |
$1,147.33
|
| Rate for Payer: Cofinity Commercial |
$1,409.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.23
|
| Rate for Payer: Healthscope Commercial |
$1,475.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.28
|
| Rate for Payer: PHP Commercial |
$1,393.18
|
| Rate for Payer: Priority Health SBD |
$1,032.60
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
OP
|
$1,639.04
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,475.14 |
| Rate for Payer: Aetna Commercial |
$1,393.18
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$187.76
|
| Rate for Payer: BCN Commercial |
$187.76
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,311.23
|
| Rate for Payer: Cash Price |
$1,311.23
|
| Rate for Payer: Cofinity Advantage |
$1,147.33
|
| Rate for Payer: Cofinity Commercial |
$1,409.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,475.14
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| 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 |
$109.38
|
| 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 |
$1,393.18
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.28
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,393.18
|
| 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/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$1,032.60
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.38
|
| Rate for Payer: UHC Core |
$853.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$644.14
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
IP
|
$2,502.70
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,576.70 |
| Max. Negotiated Rate |
$2,252.43 |
| Rate for Payer: Aetna Commercial |
$2,127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,626.76
|
| Rate for Payer: Cash Price |
$2,002.16
|
| Rate for Payer: Cofinity Advantage |
$1,751.89
|
| Rate for Payer: Cofinity Commercial |
$2,152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,002.16
|
| Rate for Payer: Healthscope Commercial |
$2,252.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,127.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,877.03
|
| Rate for Payer: PHP Commercial |
$2,127.30
|
| Rate for Payer: Priority Health SBD |
$1,576.70
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
OP
|
$2,502.70
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,252.43 |
| Rate for Payer: Aetna Commercial |
$2,127.30
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,626.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$448.98
|
| Rate for Payer: BCN Commercial |
$448.98
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$2,002.16
|
| Rate for Payer: Cash Price |
$2,002.16
|
| Rate for Payer: Cofinity Advantage |
$1,751.89
|
| Rate for Payer: Cofinity Commercial |
$2,152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,002.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,252.43
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| 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 |
$183.51
|
| 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 |
$2,127.30
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,877.03
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$2,127.30
|
| 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/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,576.70
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,626.76
|
| Rate for Payer: UHC Core |
$1,303.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$983.56
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
OP
|
$1,156.81
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.63 |
| Max. Negotiated Rate |
$1,041.13 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Aetna Medicare |
$578.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.93
|
| Rate for Payer: BCBS Complete |
$462.72
|
| Rate for Payer: BCBS Trust/PPO |
$689.01
|
| Rate for Payer: BCN Commercial |
$689.01
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cofinity Advantage |
$809.77
|
| Rate for Payer: Cofinity Commercial |
$994.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.45
|
| Rate for Payer: Healthscope Commercial |
$1,041.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$925.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$867.61
|
| Rate for Payer: PHP Commercial |
$983.29
|
| Rate for Payer: Priority Health SBD |
$728.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.93
|
| Rate for Payer: UHC Core |
$602.70
|
| Rate for Payer: UHC Exchange |
$454.63
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
IP
|
$1,156.81
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$728.79 |
| Max. Negotiated Rate |
$1,041.13 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.93
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cofinity Advantage |
$809.77
|
| Rate for Payer: Cofinity Commercial |
$994.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.45
|
| Rate for Payer: Healthscope Commercial |
$1,041.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$867.61
|
| Rate for Payer: PHP Commercial |
$983.29
|
| Rate for Payer: Priority Health SBD |
$728.79
|
|
|
HC CTA HEAD/NECK W CONTRAST
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
35100012
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Aetna Commercial |
$1,858.95
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,421.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,749.60
|
| Rate for Payer: Cofinity Advantage |
$1,530.90
|
| Rate for Payer: Cofinity Commercial |
$1,880.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,749.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,968.30
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| 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 |
$365.00
|
| 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 |
$1,858.95
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,640.25
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,858.95
|
| 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/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,377.81
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,421.55
|
| Rate for Payer: UHC Core |
$1,139.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$859.49
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CTA HEAD/NECK W CONTRAST
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
35100012
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,377.81 |
| Max. Negotiated Rate |
$1,968.30 |
| Rate for Payer: Aetna Commercial |
$1,858.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,421.55
|
| Rate for Payer: Cash Price |
$1,749.60
|
| Rate for Payer: Cofinity Advantage |
$1,530.90
|
| Rate for Payer: Cofinity Commercial |
$1,880.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,749.60
|
| Rate for Payer: Healthscope Commercial |
$1,968.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,858.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,640.25
|
| Rate for Payer: PHP Commercial |
$1,858.95
|
| Rate for Payer: Priority Health SBD |
$1,377.81
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
IP
|
$3,147.33
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,982.82 |
| Max. Negotiated Rate |
$2,832.60 |
| Rate for Payer: Aetna Commercial |
$2,675.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.76
|
| Rate for Payer: Cash Price |
$2,517.86
|
| Rate for Payer: Cofinity Advantage |
$2,203.13
|
| Rate for Payer: Cofinity Commercial |
$2,706.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,517.86
|
| Rate for Payer: Healthscope Commercial |
$2,832.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,675.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,360.50
|
| Rate for Payer: PHP Commercial |
$2,675.23
|
| Rate for Payer: Priority Health SBD |
$1,982.82
|
|
