|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$2,016.93
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,270.67 |
| Max. Negotiated Rate |
$1,815.24 |
| Rate for Payer: Aetna Commercial |
$1,714.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.00
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Advantage |
$1,411.85
|
| Rate for Payer: Cofinity Commercial |
$1,734.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Healthscope Commercial |
$1,815.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: PHP Commercial |
$1,714.39
|
| Rate for Payer: Priority Health SBD |
$1,270.67
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$2,016.93
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,815.24 |
| Rate for Payer: Aetna Commercial |
$1,714.39
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.00
|
| 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 |
$260.45
|
| Rate for Payer: BCN Commercial |
$260.45
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Advantage |
$1,411.85
|
| Rate for Payer: Cofinity Commercial |
$1,734.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,815.24
|
| 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 |
$1,714.39
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,714.39
|
| 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 |
$1,270.67
|
| 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) |
$1,311.00
|
| Rate for Payer: UHC Core |
$1,050.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$792.65
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,650.28
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
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 |
$192.31
|
| Rate for Payer: BCN Commercial |
$192.31
|
| 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 LUMBAR WO CON
|
Facility
|
IP
|
$1,650.28
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
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 LUMBAR WO W CON
|
Facility
|
OP
|
$2,247.16
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| 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 |
$318.75
|
| Rate for Payer: BCN Commercial |
$318.75
|
| 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 LUMBAR WO W CON
|
Facility
|
IP
|
$2,247.16
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| 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
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$2,016.93
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,815.24 |
| Rate for Payer: Aetna Commercial |
$1,714.39
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.00
|
| 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 |
$261.97
|
| Rate for Payer: BCN Commercial |
$261.97
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Advantage |
$1,411.85
|
| Rate for Payer: Cofinity Commercial |
$1,734.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,815.24
|
| 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 |
$1,714.39
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,714.39
|
| 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 |
$1,270.67
|
| 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) |
$1,311.00
|
| Rate for Payer: UHC Core |
$1,050.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$792.65
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$2,016.93
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,270.67 |
| Max. Negotiated Rate |
$1,815.24 |
| Rate for Payer: Aetna Commercial |
$1,714.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.00
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Advantage |
$1,411.85
|
| Rate for Payer: Cofinity Commercial |
$1,734.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Healthscope Commercial |
$1,815.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: PHP Commercial |
$1,714.39
|
| Rate for Payer: Priority Health SBD |
$1,270.67
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,650.28
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
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 |
$193.07
|
| Rate for Payer: BCN Commercial |
$193.07
|
| 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 THORACIC WO CON
|
Facility
|
IP
|
$1,650.28
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
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 THORACIC WO W CON
|
Facility
|
IP
|
$2,247.16
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
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
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,247.16
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
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 |
$322.55
|
| Rate for Payer: BCN Commercial |
$322.55
|
| 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 UPPER EXTREM ANGIO
|
Facility
|
IP
|
$1,871.98
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,179.35 |
| Max. Negotiated Rate |
$1,684.78 |
| Rate for Payer: Aetna Commercial |
$1,591.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,216.79
|
| Rate for Payer: Cash Price |
$1,497.58
|
| Rate for Payer: Cofinity Advantage |
$1,310.39
|
| Rate for Payer: Cofinity Commercial |
$1,609.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,497.58
|
| Rate for Payer: Healthscope Commercial |
$1,684.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,591.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,403.98
|
| Rate for Payer: PHP Commercial |
$1,591.18
|
| Rate for Payer: Priority Health SBD |
$1,179.35
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,871.98
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,684.78 |
| Rate for Payer: Aetna Commercial |
$1,591.18
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,216.79
|
| 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 |
$493.66
|
| Rate for Payer: BCN Commercial |
$493.66
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,497.58
|
| Rate for Payer: Cash Price |
$1,497.58
|
| Rate for Payer: Cofinity Advantage |
$1,310.39
|
| Rate for Payer: Cofinity Commercial |
$1,609.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,497.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,684.78
|
| 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 |
$1,591.18
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,403.98
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,591.18
|
| 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 |
$1,179.35
|
| 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) |
$1,216.79
|
| Rate for Payer: UHC Core |
$975.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$735.69
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
IP
|
$1,479.33
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$931.98 |
| Max. Negotiated Rate |
$1,331.40 |
| Rate for Payer: Aetna Commercial |
$1,257.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.56
|
| Rate for Payer: Cash Price |
$1,183.46
|
| Rate for Payer: Cofinity Advantage |
$1,035.53
|
| Rate for Payer: Cofinity Commercial |
$1,272.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.46
|
| Rate for Payer: Healthscope Commercial |
$1,331.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,109.50
|
| Rate for Payer: PHP Commercial |
$1,257.43
|
| Rate for Payer: Priority Health SBD |
$931.98
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
OP
|
$1,479.33
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,331.40 |
| Rate for Payer: Aetna Commercial |
$1,257.43
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.56
|
| 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 |
$336.93
|
| Rate for Payer: BCN Commercial |
$336.93
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,183.46
|
| Rate for Payer: Cash Price |
$1,183.46
|
| Rate for Payer: Cofinity Advantage |
$1,035.53
|
| Rate for Payer: Cofinity Commercial |
$1,272.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,331.40
|
| 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 |
$1,257.43
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,109.50
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,257.43
|
| 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 |
$931.98
|
| 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) |
$961.56
|
| Rate for Payer: UHC Core |
$770.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$581.38
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
IP
|
$1,239.49
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$780.88 |
| Max. Negotiated Rate |
$1,115.54 |
| Rate for Payer: Aetna Commercial |
$1,053.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.67
|
| Rate for Payer: Cash Price |
$991.59
|
| Rate for Payer: Cofinity Advantage |
$867.64
|
| Rate for Payer: Cofinity Commercial |
$1,065.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.59
|
| Rate for Payer: Healthscope Commercial |
$1,115.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.62
|
| Rate for Payer: PHP Commercial |
$1,053.57
|
| Rate for Payer: Priority Health SBD |
$780.88
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
OP
|
$1,239.49
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,115.54 |
| Rate for Payer: Aetna Commercial |
$1,053.57
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.67
|
| 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 |
$264.25
|
| Rate for Payer: BCN Commercial |
$264.25
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$991.59
|
| Rate for Payer: Cash Price |
$991.59
|
| Rate for Payer: Cofinity Advantage |
$867.64
|
| Rate for Payer: Cofinity Commercial |
$1,065.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,115.54
|
| 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 |
$1,053.57
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.62
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,053.57
|
| 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 |
$780.88
|
| 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) |
$805.67
|
| Rate for Payer: UHC Core |
$645.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$487.12
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,724.67
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,086.54 |
| Max. Negotiated Rate |
$1,552.20 |
| Rate for Payer: Aetna Commercial |
$1,465.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,121.04
|
| Rate for Payer: Cash Price |
$1,379.74
|
| Rate for Payer: Cofinity Advantage |
$1,207.27
|
| Rate for Payer: Cofinity Commercial |
$1,483.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,379.74
|
| Rate for Payer: Healthscope Commercial |
$1,552.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,465.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,293.50
|
| Rate for Payer: PHP Commercial |
$1,465.97
|
| Rate for Payer: Priority Health SBD |
$1,086.54
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,724.67
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,552.20 |
| Rate for Payer: Aetna Commercial |
$1,465.97
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,121.04
|
| 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 |
$438.39
|
| Rate for Payer: BCN Commercial |
$438.39
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,379.74
|
| Rate for Payer: Cash Price |
$1,379.74
|
| Rate for Payer: Cofinity Advantage |
$1,207.27
|
| Rate for Payer: Cofinity Commercial |
$1,483.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,379.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,552.20
|
| 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 |
$1,465.97
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,293.50
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,465.97
|
| 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 |
$1,086.54
|
| 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) |
$1,121.04
|
| Rate for Payer: UHC Core |
$898.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$677.80
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
OP
|
$1,034.26
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$930.83 |
| Rate for Payer: Aetna Commercial |
$879.12
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.27
|
| 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: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$827.41
|
| Rate for Payer: Cash Price |
$827.41
|
| Rate for Payer: Cofinity Advantage |
$723.98
|
| Rate for Payer: Cofinity Commercial |
$889.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$930.83
|
| 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 |
$879.12
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.70
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$879.12
|
| 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 |
$651.58
|
| 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) |
$672.27
|
| Rate for Payer: UHC Core |
$538.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$406.46
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
IP
|
$1,034.26
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$651.58 |
| Max. Negotiated Rate |
$930.83 |
| Rate for Payer: Aetna Commercial |
$879.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.27
|
| Rate for Payer: Cash Price |
$827.41
|
| Rate for Payer: Cofinity Advantage |
$723.98
|
| Rate for Payer: Cofinity Commercial |
$889.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.41
|
| Rate for Payer: Healthscope Commercial |
$930.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$879.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.70
|
| Rate for Payer: PHP Commercial |
$879.12
|
| Rate for Payer: Priority Health SBD |
$651.58
|
|
|
HC CT VIRTUAL COLON W CON DIAG
|
Facility
|
IP
|
$1,312.26
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$826.72 |
| Max. Negotiated Rate |
$1,181.03 |
| Rate for Payer: Aetna Commercial |
$1,115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.97
|
| Rate for Payer: Cash Price |
$1,049.81
|
| Rate for Payer: Cofinity Advantage |
$918.58
|
| Rate for Payer: Cofinity Commercial |
$1,128.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,049.81
|
| Rate for Payer: Healthscope Commercial |
$1,181.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,115.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.20
|
| Rate for Payer: PHP Commercial |
$1,115.42
|
| Rate for Payer: Priority Health SBD |
$826.72
|
|
|
HC CT VIRTUAL COLON W CON DIAG
|
Facility
|
OP
|
$1,312.26
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,181.03 |
| Rate for Payer: Aetna Commercial |
$1,115.42
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.97
|
| 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 |
$795.75
|
| Rate for Payer: BCN Commercial |
$795.75
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,049.81
|
| Rate for Payer: Cash Price |
$1,049.81
|
| Rate for Payer: Cofinity Advantage |
$918.58
|
| Rate for Payer: Cofinity Commercial |
$1,128.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,049.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,181.03
|
| 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 |
$1,115.42
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.20
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,115.42
|
| 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 |
$826.72
|
| 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) |
$852.97
|
| Rate for Payer: UHC Core |
$683.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$515.72
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT VIRTUAL COLON WO CON DIAG
|
Facility
|
OP
|
$1,312.26
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
35000012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,181.03 |
| Rate for Payer: Aetna Commercial |
$1,115.42
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.97
|
| 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 |
$689.01
|
| Rate for Payer: BCN Commercial |
$689.01
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,049.81
|
| Rate for Payer: Cash Price |
$1,049.81
|
| Rate for Payer: Cofinity Advantage |
$918.58
|
| Rate for Payer: Cofinity Commercial |
$1,128.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,049.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,181.03
|
| 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 |
$1,115.42
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$984.20
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,115.42
|
| 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 |
$826.72
|
| 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) |
$852.97
|
| Rate for Payer: UHC Core |
$683.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$515.72
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
