|
HC CT PLEURAL FIBRINOLYSIS SUB DAY
|
Facility
|
OP
|
$1,003.66
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
36100322
|
|
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 RF/MICROWAVE ABLATION
|
Facility
|
OP
|
$1,118.51
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$439.57 |
| Max. Negotiated Rate |
$1,006.66 |
| Rate for Payer: Aetna Commercial |
$950.73
|
| Rate for Payer: Aetna Medicare |
$559.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.03
|
| Rate for Payer: BCBS Complete |
$447.40
|
| Rate for Payer: BCBS Trust/PPO |
$689.01
|
| Rate for Payer: BCN Commercial |
$689.01
|
| Rate for Payer: Cash Price |
$894.81
|
| Rate for Payer: Cash Price |
$894.81
|
| Rate for Payer: Cofinity Advantage |
$782.96
|
| Rate for Payer: Cofinity Commercial |
$961.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.81
|
| Rate for Payer: Healthscope Commercial |
$1,006.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$894.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.88
|
| Rate for Payer: PHP Commercial |
$950.73
|
| Rate for Payer: Priority Health SBD |
$704.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.03
|
| Rate for Payer: UHC Core |
$582.74
|
| Rate for Payer: UHC Exchange |
$439.57
|
|
|
HC CT RF/MICROWAVE ABLATION
|
Facility
|
IP
|
$1,118.51
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$704.66 |
| Max. Negotiated Rate |
$1,006.66 |
| Rate for Payer: Aetna Commercial |
$950.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.03
|
| Rate for Payer: Cash Price |
$894.81
|
| Rate for Payer: Cofinity Advantage |
$782.96
|
| Rate for Payer: Cofinity Commercial |
$961.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.81
|
| Rate for Payer: Healthscope Commercial |
$1,006.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.88
|
| Rate for Payer: PHP Commercial |
$950.73
|
| Rate for Payer: Priority Health SBD |
$704.66
|
|
|
HC CTRL NASAL HEMRRG ANT COMPLEX
|
Facility
|
IP
|
$449.45
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
76100414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.15 |
| Max. Negotiated Rate |
$404.50 |
| Rate for Payer: Aetna Commercial |
$382.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.14
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cofinity Advantage |
$314.62
|
| Rate for Payer: Cofinity Commercial |
$386.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.56
|
| Rate for Payer: Healthscope Commercial |
$404.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.09
|
| Rate for Payer: PHP Commercial |
$382.03
|
| Rate for Payer: Priority Health SBD |
$283.15
|
|
|
HC CTRL NASAL HEMRRG ANT COMPLEX
|
Facility
|
OP
|
$449.45
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
76100414
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$382.03
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$171.80
|
| Rate for Payer: BCN Commercial |
$171.80
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cash Price |
$359.56
|
| Rate for Payer: Cofinity Advantage |
$314.62
|
| Rate for Payer: Cofinity Commercial |
$386.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$404.50
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.03
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.09
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$382.03
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$283.15
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.14
|
| Rate for Payer: UHC Core |
$234.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$176.63
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC CTRL NASAL HEMRRG POSTERIOR PACKS/CAUTERY SUBSQ
|
Facility
|
IP
|
$608.63
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.44 |
| Max. Negotiated Rate |
$547.77 |
| Rate for Payer: Aetna Commercial |
$517.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.61
|
| Rate for Payer: Cash Price |
$486.90
|
| Rate for Payer: Cofinity Advantage |
$426.04
|
| Rate for Payer: Cofinity Commercial |
$523.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.90
|
| Rate for Payer: Healthscope Commercial |
$547.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.47
|
| Rate for Payer: PHP Commercial |
$517.34
|
| Rate for Payer: Priority Health SBD |
$383.44
|
|
|
HC CTRL NASAL HEMRRG POSTERIOR PACKS/CAUTERY SUBSQ
|
Facility
|
OP
|
$608.63
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.57 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Commercial |
$517.34
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$109.57
|
| Rate for Payer: BCN Commercial |
$109.57
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$486.90
|
| Rate for Payer: Cash Price |
$486.90
|
| Rate for Payer: Cash Price |
$486.90
|
| Rate for Payer: Cofinity Advantage |
$426.04
|
| Rate for Payer: Cofinity Commercial |
$523.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$547.77
|
| Rate for Payer: Mclaren Medicaid |
$123.43
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.34
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.47
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$517.34
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$383.44
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.61
|
| Rate for Payer: UHC Core |
$317.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Exchange |
$239.19
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC CT SI JTS W CON
|
Facility
|
IP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$453.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: Priority Health SBD |
$453.35
|
|
|
HC CT SI JTS W CON
|
Facility
|
OP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$199.89
|
| Rate for Payer: BCN Commercial |
$199.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$453.35
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.74
|
| Rate for Payer: UHC Core |
$374.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$282.80
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC CT SI JTS WO CON
|
Facility
|
OP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$199.89
|
| Rate for Payer: BCN Commercial |
$199.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$453.35
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.74
|
| Rate for Payer: UHC Core |
$374.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$282.80
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC CT SI JTS WO CON
|
Facility
|
IP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$453.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: Priority Health SBD |
$453.35
|
|
|
HC CT SI JTS WO W CON
|
Facility
|
IP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$453.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: Priority Health SBD |
$453.35
|
|
|
HC CT SI JTS WO W CON
|
Facility
|
OP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$199.89
|
| Rate for Payer: BCN Commercial |
$199.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$453.35
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.74
|
| Rate for Payer: UHC Core |
$374.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$282.80
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC CT SOFT TISS NECK W CON
|
Facility
|
IP
|
$1,666.95
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,050.18 |
| Max. Negotiated Rate |
$1,500.26 |
| Rate for Payer: Aetna Commercial |
$1,416.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.52
|
| Rate for Payer: Cash Price |
$1,333.56
|
| Rate for Payer: Cofinity Advantage |
$1,166.87
|
| Rate for Payer: Cofinity Commercial |
$1,433.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.56
|
| Rate for Payer: Healthscope Commercial |
$1,500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,250.21
|
| Rate for Payer: PHP Commercial |
$1,416.91
|
| Rate for Payer: Priority Health SBD |
$1,050.18
|
|
|
HC CT SOFT TISS NECK W CON
|
Facility
|
OP
|
$1,666.95
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,500.26 |
| Rate for Payer: Aetna Commercial |
$1,416.91
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.52
|
| 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 |
$277.11
|
| Rate for Payer: BCN Commercial |
$277.11
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,333.56
|
| Rate for Payer: Cash Price |
$1,333.56
|
| Rate for Payer: Cofinity Advantage |
$1,166.87
|
| Rate for Payer: Cofinity Commercial |
$1,433.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,500.26
|
| 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 |
$1,416.91
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,250.21
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,416.91
|
| 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 |
$1,050.18
|
| 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) |
$1,083.52
|
| Rate for Payer: UHC Core |
$868.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$655.11
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
IP
|
$1,410.88
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$888.85 |
| Max. Negotiated Rate |
$1,269.79 |
| Rate for Payer: Aetna Commercial |
$1,199.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.07
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cofinity Advantage |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,213.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.70
|
| Rate for Payer: Healthscope Commercial |
$1,269.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.16
|
| Rate for Payer: PHP Commercial |
$1,199.25
|
| Rate for Payer: Priority Health SBD |
$888.85
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
OP
|
$1,410.88
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,269.79 |
| Rate for Payer: Aetna Commercial |
$1,199.25
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.07
|
| 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 |
$208.98
|
| Rate for Payer: BCN Commercial |
$208.98
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cofinity Advantage |
$987.62
|
| Rate for Payer: Cofinity Commercial |
$1,213.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,269.79
|
| 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 |
$1,199.25
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.16
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,199.25
|
| 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 |
$888.85
|
| 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) |
$917.07
|
| Rate for Payer: UHC Core |
$735.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$554.48
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
IP
|
$1,919.09
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,209.03 |
| Max. Negotiated Rate |
$1,727.18 |
| Rate for Payer: Aetna Commercial |
$1,631.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.41
|
| Rate for Payer: Cash Price |
$1,535.27
|
| Rate for Payer: Cofinity Advantage |
$1,343.36
|
| Rate for Payer: Cofinity Commercial |
$1,650.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.27
|
| Rate for Payer: Healthscope Commercial |
$1,727.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,631.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,439.32
|
| Rate for Payer: PHP Commercial |
$1,631.23
|
| Rate for Payer: Priority Health SBD |
$1,209.03
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
OP
|
$1,919.09
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,727.18 |
| Rate for Payer: Aetna Commercial |
$1,631.23
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.41
|
| 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 |
$336.93
|
| Rate for Payer: BCN Commercial |
$336.93
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,535.27
|
| Rate for Payer: Cofinity Advantage |
$1,343.36
|
| Rate for Payer: Cofinity Commercial |
$1,650.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,727.18
|
| 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 |
$1,631.23
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,439.32
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,631.23
|
| 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 |
$1,209.03
|
| 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) |
$1,247.41
|
| Rate for Payer: UHC Core |
$999.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$754.20
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,245.75 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.30
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Advantage |
$1,384.17
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.04
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| Rate for Payer: Priority Health SBD |
$1,245.75
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.30
|
| 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 |
$258.94
|
| Rate for Payer: BCN Commercial |
$258.94
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Advantage |
$1,384.17
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| 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 |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.04
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| 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 |
$1,245.75
|
| 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) |
$1,285.30
|
| Rate for Payer: UHC Core |
$1,030.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$777.11
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
OP
|
$1,650.28
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,485.25 |
| Rate for Payer: Aetna Commercial |
$1,402.74
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.68
|
| 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 |
$193.84
|
| Rate for Payer: BCN Commercial |
$193.84
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Advantage |
$1,155.20
|
| Rate for Payer: Cofinity Commercial |
$1,419.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,485.25
|
| 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 |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,402.74
|
| 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 |
$1,039.68
|
| 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) |
$1,072.68
|
| Rate for Payer: UHC Core |
$859.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$648.56
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,650.28
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,039.68 |
| Max. Negotiated Rate |
$1,485.25 |
| Rate for Payer: Aetna Commercial |
$1,402.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.68
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Advantage |
$1,155.20
|
| Rate for Payer: Cofinity Commercial |
$1,419.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Healthscope Commercial |
$1,485.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: PHP Commercial |
$1,402.74
|
| Rate for Payer: Priority Health SBD |
$1,039.68
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,247.16
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,022.44 |
| Rate for Payer: Aetna Commercial |
$1,910.09
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,460.65
|
| 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 |
$318.00
|
| Rate for Payer: BCN Commercial |
$318.00
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Advantage |
$1,573.01
|
| Rate for Payer: Cofinity Commercial |
$1,932.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,022.44
|
| 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 |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,910.09
|
| 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 |
$1,415.71
|
| 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) |
$1,460.65
|
| Rate for Payer: UHC Core |
$1,170.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$883.13
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,247.16
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,415.71 |
| Max. Negotiated Rate |
$2,022.44 |
| Rate for Payer: Aetna Commercial |
$1,910.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,460.65
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Advantage |
$1,573.01
|
| Rate for Payer: Cofinity Commercial |
$1,932.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Healthscope Commercial |
$2,022.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: PHP Commercial |
$1,910.09
|
| Rate for Payer: Priority Health SBD |
$1,415.71
|
|
