|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,058.24
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$666.69 |
| Max. Negotiated Rate |
$952.42 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.57
|
| Rate for Payer: Cash Price |
$846.59
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Advantage |
$740.77
|
| Rate for Payer: Cofinity Advantage |
$493.84
|
| Rate for Payer: Cofinity Commercial |
$910.09
|
| Rate for Payer: Cofinity Commercial |
$606.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.59
|
| Rate for Payer: Healthscope Commercial |
$634.94
|
| Rate for Payer: Healthscope Commercial |
$952.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.12
|
| Rate for Payer: PHP Commercial |
$899.50
|
| Rate for Payer: PHP Commercial |
$599.67
|
| Rate for Payer: Priority Health SBD |
$666.69
|
| Rate for Payer: Priority Health SBD |
$444.46
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
OP
|
$1,058.24
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$952.42 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$321.03
|
| Rate for Payer: BCBS Trust/PPO |
$321.03
|
| Rate for Payer: BCN Commercial |
$321.03
|
| Rate for Payer: BCN Commercial |
$321.03
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$846.59
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$846.59
|
| Rate for Payer: Cofinity Advantage |
$493.84
|
| Rate for Payer: Cofinity Advantage |
$740.77
|
| Rate for Payer: Cofinity Commercial |
$606.72
|
| Rate for Payer: Cofinity Commercial |
$910.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$952.42
|
| Rate for Payer: Healthscope Commercial |
$634.94
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.68
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$599.67
|
| Rate for Payer: PHP Commercial |
$899.50
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$444.46
|
| Rate for Payer: Priority Health SBD |
$666.69
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.57
|
| Rate for Payer: UHC Core |
$367.56
|
| Rate for Payer: UHC Core |
$551.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$277.26
|
| Rate for Payer: UHC Exchange |
$415.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT NECK ANGIO
|
Facility
|
IP
|
$1,114.27
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$701.99 |
| Max. Negotiated Rate |
$1,002.84 |
| Rate for Payer: Aetna Commercial |
$947.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.28
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cofinity Advantage |
$779.99
|
| Rate for Payer: Cofinity Commercial |
$958.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.42
|
| Rate for Payer: Healthscope Commercial |
$1,002.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$835.70
|
| Rate for Payer: PHP Commercial |
$947.13
|
| Rate for Payer: Priority Health SBD |
$701.99
|
|
|
HC CT NECK ANGIO
|
Facility
|
OP
|
$1,114.27
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,002.84 |
| Rate for Payer: Aetna Commercial |
$947.13
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.28
|
| 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 |
$450.51
|
| Rate for Payer: BCN Commercial |
$450.51
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cofinity Advantage |
$779.99
|
| Rate for Payer: Cofinity Commercial |
$958.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,002.84
|
| 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 |
$947.13
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$835.70
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$947.13
|
| 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 |
$701.99
|
| 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) |
$724.28
|
| Rate for Payer: UHC Core |
$580.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$437.91
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,333.81 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,333.81
|
| Rate for Payer: BCN Commercial |
$2,333.81
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,473.68 |
| Max. Negotiated Rate |
$3,533.82 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
|
|
HC CTO CATHETER
|
Facility
|
OP
|
$6,591.31
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,590.38 |
| Max. Negotiated Rate |
$5,932.18 |
| Rate for Payer: Aetna Commercial |
$5,602.61
|
| Rate for Payer: Aetna Medicare |
$3,295.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,284.35
|
| Rate for Payer: BCBS Complete |
$2,636.52
|
| Rate for Payer: Cash Price |
$5,273.05
|
| Rate for Payer: Cofinity Advantage |
$4,613.92
|
| Rate for Payer: Cofinity Commercial |
$5,668.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,273.05
|
| Rate for Payer: Healthscope Commercial |
$5,932.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,273.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,602.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,943.48
|
| Rate for Payer: PHP Commercial |
$5,602.61
|
| Rate for Payer: Priority Health SBD |
$4,152.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,284.35
|
| Rate for Payer: UHC Core |
$3,434.07
|
| Rate for Payer: UHC Exchange |
$2,590.38
|
|
|
HC CTO CATHETER
|
Facility
|
IP
|
$6,591.31
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,152.53 |
| Max. Negotiated Rate |
$5,932.18 |
| Rate for Payer: Aetna Commercial |
$5,602.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,284.35
|
| Rate for Payer: Cash Price |
$5,273.05
|
| Rate for Payer: Cofinity Advantage |
$4,613.92
|
| Rate for Payer: Cofinity Commercial |
$5,668.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,273.05
|
| Rate for Payer: Healthscope Commercial |
$5,932.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,602.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,943.48
|
| Rate for Payer: PHP Commercial |
$5,602.61
|
| Rate for Payer: Priority Health SBD |
$4,152.53
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
OP
|
$1,611.23
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,450.11 |
| Rate for Payer: Aetna Commercial |
$1,369.55
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.30
|
| 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 |
$295.28
|
| Rate for Payer: BCN Commercial |
$295.28
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cofinity Advantage |
$1,127.86
|
| Rate for Payer: Cofinity Commercial |
$1,385.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,288.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,450.11
|
| 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 |
$1,369.55
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.42
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,369.55
|
| 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 |
$1,015.07
|
| 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) |
$1,047.30
|
| Rate for Payer: UHC Core |
$839.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$633.21
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
IP
|
$1,611.23
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,015.07 |
| Max. Negotiated Rate |
$1,450.11 |
| Rate for Payer: Healthscope Commercial |
$1,450.11
|
| Rate for Payer: Aetna Commercial |
$1,369.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.30
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cofinity Advantage |
$1,127.86
|
| Rate for Payer: Cofinity Commercial |
$1,385.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,288.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.42
|
| Rate for Payer: PHP Commercial |
$1,369.55
|
| Rate for Payer: Priority Health SBD |
$1,015.07
|
|
|
HC CT ORBIT WO CON
|
Facility
|
OP
|
$1,464.15
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,317.73 |
| Rate for Payer: Aetna Commercial |
$1,244.53
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.70
|
| 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 |
$229.42
|
| Rate for Payer: BCN Commercial |
$229.42
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,171.32
|
| Rate for Payer: Cash Price |
$1,171.32
|
| Rate for Payer: Cofinity Advantage |
$1,024.90
|
| Rate for Payer: Cofinity Commercial |
$1,259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,171.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,317.73
|
| 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 |
$1,244.53
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,098.11
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,244.53
|
| 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 |
$922.41
|
| 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) |
$951.70
|
| Rate for Payer: UHC Core |
$762.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$575.41
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT ORBIT WO CON
|
Facility
|
IP
|
$1,464.15
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$922.41 |
| Max. Negotiated Rate |
$1,317.73 |
| Rate for Payer: Aetna Commercial |
$1,244.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.70
|
| Rate for Payer: Cash Price |
$1,171.32
|
| Rate for Payer: Cofinity Advantage |
$1,024.90
|
| Rate for Payer: Cofinity Commercial |
$1,259.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,171.32
|
| Rate for Payer: Healthscope Commercial |
$1,317.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,244.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,098.11
|
| Rate for Payer: PHP Commercial |
$1,244.53
|
| Rate for Payer: Priority Health SBD |
$922.41
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
OP
|
$1,528.66
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,375.79 |
| Rate for Payer: Aetna Commercial |
$1,299.36
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.63
|
| 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 |
$349.05
|
| Rate for Payer: BCN Commercial |
$349.05
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cofinity Advantage |
$1,070.06
|
| Rate for Payer: Cofinity Commercial |
$1,314.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,375.79
|
| 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 |
$1,299.36
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.49
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,299.36
|
| 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 |
$963.06
|
| 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) |
$993.63
|
| Rate for Payer: UHC Core |
$796.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$600.76
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
IP
|
$1,528.66
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$963.06 |
| Max. Negotiated Rate |
$1,375.79 |
| Rate for Payer: Aetna Commercial |
$1,299.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.63
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cofinity Advantage |
$1,070.06
|
| Rate for Payer: Cofinity Commercial |
$1,314.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.93
|
| Rate for Payer: Healthscope Commercial |
$1,375.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.49
|
| Rate for Payer: PHP Commercial |
$1,299.36
|
| Rate for Payer: Priority Health SBD |
$963.06
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
IP
|
$1,988.20
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,252.57 |
| Max. Negotiated Rate |
$1,789.38 |
| Rate for Payer: Aetna Commercial |
$1,689.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.33
|
| Rate for Payer: Cash Price |
$1,590.56
|
| Rate for Payer: Cofinity Advantage |
$1,391.74
|
| Rate for Payer: Cofinity Commercial |
$1,709.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.56
|
| Rate for Payer: Healthscope Commercial |
$1,789.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.15
|
| Rate for Payer: PHP Commercial |
$1,689.97
|
| Rate for Payer: Priority Health SBD |
$1,252.57
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
OP
|
$1,988.20
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,789.38 |
| Rate for Payer: Aetna Commercial |
$1,689.97
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.33
|
| 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 |
$510.31
|
| Rate for Payer: BCN Commercial |
$510.31
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,590.56
|
| Rate for Payer: Cash Price |
$1,590.56
|
| Rate for Payer: Cofinity Advantage |
$1,391.74
|
| Rate for Payer: Cofinity Commercial |
$1,709.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,789.38
|
| 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 |
$1,689.97
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.15
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,689.97
|
| 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 |
$1,252.57
|
| 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) |
$1,292.33
|
| Rate for Payer: UHC Core |
$1,035.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$781.36
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT PELVIS W CON
|
Facility
|
OP
|
$1,975.52
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,777.97 |
| Rate for Payer: Aetna Commercial |
$1,679.19
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,284.09
|
| 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 |
$399.01
|
| Rate for Payer: BCN Commercial |
$399.01
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,580.42
|
| Rate for Payer: Cash Price |
$1,580.42
|
| Rate for Payer: Cofinity Advantage |
$1,382.86
|
| Rate for Payer: Cofinity Commercial |
$1,698.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,777.97
|
| 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 |
$1,679.19
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,481.64
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,679.19
|
| 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 |
$1,244.58
|
| 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) |
$1,284.09
|
| Rate for Payer: UHC Core |
$1,029.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$776.38
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT PELVIS W CON
|
Facility
|
IP
|
$1,975.52
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,244.58 |
| Max. Negotiated Rate |
$1,777.97 |
| Rate for Payer: Aetna Commercial |
$1,679.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,284.09
|
| Rate for Payer: Cash Price |
$1,580.42
|
| Rate for Payer: Cofinity Advantage |
$1,382.86
|
| Rate for Payer: Cofinity Commercial |
$1,698.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.42
|
| Rate for Payer: Healthscope Commercial |
$1,777.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,481.64
|
| Rate for Payer: PHP Commercial |
$1,679.19
|
| Rate for Payer: Priority Health SBD |
$1,244.58
|
|
|
HC CT PELVIS WO CON
|
Facility
|
OP
|
$1,448.55
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,303.69 |
| Rate for Payer: Aetna Commercial |
$1,231.27
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.56
|
| 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 |
$190.81
|
| Rate for Payer: BCN Commercial |
$190.81
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,158.84
|
| Rate for Payer: Cash Price |
$1,158.84
|
| Rate for Payer: Cofinity Advantage |
$1,013.99
|
| Rate for Payer: Cofinity Commercial |
$1,245.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,303.69
|
| 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 |
$1,231.27
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.41
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,231.27
|
| 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 |
$912.59
|
| 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) |
$941.56
|
| Rate for Payer: UHC Core |
$754.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$569.28
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT PELVIS WO CON
|
Facility
|
IP
|
$1,448.55
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$912.59 |
| Max. Negotiated Rate |
$1,303.69 |
| Rate for Payer: Aetna Commercial |
$1,231.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.56
|
| Rate for Payer: Cash Price |
$1,158.84
|
| Rate for Payer: Cofinity Advantage |
$1,013.99
|
| Rate for Payer: Cofinity Commercial |
$1,245.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.84
|
| Rate for Payer: Healthscope Commercial |
$1,303.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.41
|
| Rate for Payer: PHP Commercial |
$1,231.27
|
| Rate for Payer: Priority Health SBD |
$912.59
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
IP
|
$2,249.81
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,417.38 |
| Max. Negotiated Rate |
$2,024.83 |
| Rate for Payer: Aetna Commercial |
$1,912.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.38
|
| Rate for Payer: Cash Price |
$1,799.85
|
| Rate for Payer: Cofinity Advantage |
$1,574.87
|
| Rate for Payer: Cofinity Commercial |
$1,934.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,799.85
|
| Rate for Payer: Healthscope Commercial |
$2,024.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,687.36
|
| Rate for Payer: PHP Commercial |
$1,912.34
|
| Rate for Payer: Priority Health SBD |
$1,417.38
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
OP
|
$2,249.81
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,024.83 |
| Rate for Payer: Aetna Commercial |
$1,912.34
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.38
|
| 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 |
$447.48
|
| Rate for Payer: BCN Commercial |
$447.48
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,799.85
|
| Rate for Payer: Cash Price |
$1,799.85
|
| Rate for Payer: Cofinity Advantage |
$1,574.87
|
| Rate for Payer: Cofinity Commercial |
$1,934.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,799.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,024.83
|
| 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 |
$1,912.34
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,687.36
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,912.34
|
| 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 |
$1,417.38
|
| 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) |
$1,462.38
|
| Rate for Payer: UHC Core |
$1,172.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$884.18
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
IP
|
$1,003.66
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$632.31 |
| Max. Negotiated Rate |
$903.29 |
| Rate for Payer: Aetna Commercial |
$853.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.38
|
| Rate for Payer: Cash Price |
$802.93
|
| Rate for Payer: Cofinity Advantage |
$702.56
|
| Rate for Payer: Cofinity Commercial |
$863.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.93
|
| Rate for Payer: Healthscope Commercial |
$903.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$752.75
|
| Rate for Payer: PHP Commercial |
$853.11
|
| Rate for Payer: Priority Health SBD |
$632.31
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
OP
|
$1,003.66
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Commercial |
$853.11
|
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$469.70
|
| Rate for Payer: BCN Commercial |
$469.70
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$802.93
|
| Rate for Payer: Cash Price |
$802.93
|
| Rate for Payer: Cash Price |
$802.93
|
| Rate for Payer: Cofinity Advantage |
$702.56
|
| Rate for Payer: Cofinity Commercial |
$863.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$903.29
|
| Rate for Payer: Mclaren Medicaid |
$326.90
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.11
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$752.75
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$853.11
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health SBD |
$632.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC CT PLEURAL FIBRINOLYSIS SUB DAY
|
Facility
|
IP
|
$1,003.66
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
36100322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$632.31 |
| Max. Negotiated Rate |
$903.29 |
| Rate for Payer: Aetna Commercial |
$853.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.38
|
| Rate for Payer: Cash Price |
$802.93
|
| Rate for Payer: Cofinity Advantage |
$702.56
|
| Rate for Payer: Cofinity Commercial |
$863.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.93
|
| Rate for Payer: Healthscope Commercial |
$903.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$752.75
|
| Rate for Payer: PHP Commercial |
$853.11
|
| Rate for Payer: Priority Health SBD |
$632.31
|
|
