|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$850.16 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$944.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,416.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$877.15
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
| Rate for Payer: Priority Health SBD |
$850.16
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
OP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$270.94
|
| Rate for Payer: BCBS Trust/PPO |
$270.94
|
| Rate for Payer: BCN Commercial |
$270.94
|
| Rate for Payer: BCN Commercial |
$270.94
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cofinity Commercial |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Cofinity Commercial |
$484.16
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$435.75
|
| Rate for Payer: Priority Health SBD |
$653.62
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$767.74
|
| Rate for Payer: UHC Exchange |
$511.83
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$653.62 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.58
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$484.16
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health SBD |
$435.75
|
| Rate for Payer: Priority Health SBD |
$653.62
|
|
|
HC CT NECK ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health SBD |
$688.22
|
|
|
HC CT NECK ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$379.07
|
| Rate for Payer: BCN Commercial |
$379.07
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$808.39
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.17 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,822.04
|
| Rate for Payer: BCN Commercial |
$1,822.04
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$512.80
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,263.18
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
HC CTO CATHETER
|
Facility
|
IP
|
$6,462.07
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,071.10 |
| Max. Negotiated Rate |
$5,815.86 |
| Rate for Payer: Aetna Commercial |
$5,492.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: Cash Price |
$5,169.66
|
| Rate for Payer: Cofinity Commercial |
$4,523.45
|
| Rate for Payer: Cofinity Commercial |
$5,557.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,523.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,169.66
|
| Rate for Payer: Healthscope Commercial |
$5,815.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.76
|
| Rate for Payer: PHP Commercial |
$5,492.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,200.35
|
| Rate for Payer: Priority Health SBD |
$4,071.10
|
|
|
HC CTO CATHETER
|
Facility
|
OP
|
$6,462.07
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,584.83 |
| Max. Negotiated Rate |
$5,815.86 |
| Rate for Payer: Aetna Commercial |
$5,492.76
|
| Rate for Payer: Aetna Medicare |
$3,231.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: BCBS Complete |
$2,584.83
|
| Rate for Payer: Cash Price |
$5,169.66
|
| Rate for Payer: Cofinity Commercial |
$4,523.45
|
| Rate for Payer: Cofinity Commercial |
$5,557.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,523.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,169.66
|
| Rate for Payer: Healthscope Commercial |
$5,815.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.76
|
| Rate for Payer: PHP Commercial |
$5,492.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,200.35
|
| Rate for Payer: Priority Health SBD |
$4,071.10
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
IP
|
$1,579.64
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$995.17 |
| Max. Negotiated Rate |
$1,421.68 |
| Rate for Payer: Aetna Commercial |
$1,342.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.77
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cofinity Commercial |
$1,105.75
|
| Rate for Payer: Cofinity Commercial |
$1,358.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.71
|
| Rate for Payer: Healthscope Commercial |
$1,421.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,342.69
|
| Rate for Payer: PHP Commercial |
$1,342.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.77
|
| Rate for Payer: Priority Health SBD |
$995.17
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
OP
|
$1,579.64
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,421.68 |
| Rate for Payer: Aetna Commercial |
$1,342.69
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$249.56
|
| Rate for Payer: BCN Commercial |
$249.56
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cofinity Commercial |
$1,358.49
|
| Rate for Payer: Cofinity Commercial |
$1,105.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,421.68
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,342.69
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,342.69
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$995.17
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,168.93
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT ORBIT WO CON
|
Facility
|
OP
|
$1,435.44
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,291.90 |
| Rate for Payer: Aetna Commercial |
$1,220.12
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$193.62
|
| Rate for Payer: BCN Commercial |
$193.62
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cofinity Commercial |
$1,234.48
|
| Rate for Payer: Cofinity Commercial |
$1,004.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,004.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,291.90
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.12
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$1,220.12
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$904.33
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$1,062.23
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT ORBIT WO CON
|
Facility
|
IP
|
$1,435.44
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$904.33 |
| Max. Negotiated Rate |
$1,291.90 |
| Rate for Payer: Aetna Commercial |
$1,220.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.04
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cofinity Commercial |
$1,004.81
|
| Rate for Payer: Cofinity Commercial |
$1,234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,004.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.35
|
| Rate for Payer: Healthscope Commercial |
$1,291.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.12
|
| Rate for Payer: PHP Commercial |
$1,220.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.04
|
| Rate for Payer: Priority Health SBD |
$904.33
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
OP
|
$1,498.69
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,348.82 |
| Rate for Payer: Aetna Commercial |
$1,273.89
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$296.08
|
| Rate for Payer: BCN Commercial |
$296.08
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.87
|
| Rate for Payer: Cofinity Commercial |
$1,049.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,049.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,348.82
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.89
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,273.89
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$944.17
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,109.03
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
IP
|
$1,498.69
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$944.17 |
| Max. Negotiated Rate |
$1,348.82 |
| Rate for Payer: Aetna Commercial |
$1,273.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.15
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,049.08
|
| Rate for Payer: Cofinity Commercial |
$1,288.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,049.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Healthscope Commercial |
$1,348.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.89
|
| Rate for Payer: PHP Commercial |
$1,273.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.15
|
| Rate for Payer: Priority Health SBD |
$944.17
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
OP
|
$1,949.22
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,754.30 |
| Rate for Payer: Aetna Commercial |
$1,656.84
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$431.23
|
| Rate for Payer: BCN Commercial |
$431.23
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,676.33
|
| Rate for Payer: Cofinity Commercial |
$1,364.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,364.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,656.84
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,228.01
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,442.42
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
IP
|
$1,949.22
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,228.01 |
| Max. Negotiated Rate |
$1,754.30 |
| Rate for Payer: Aetna Commercial |
$1,656.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.99
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,364.45
|
| Rate for Payer: Cofinity Commercial |
$1,676.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,364.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: PHP Commercial |
$1,656.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: Priority Health SBD |
$1,228.01
|
|
|
HC CT PELVIS W CON
|
Facility
|
OP
|
$1,936.78
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,743.10 |
| Rate for Payer: Aetna Commercial |
$1,646.26
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$340.72
|
| Rate for Payer: BCN Commercial |
$340.72
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,549.42
|
| Rate for Payer: Cash Price |
$1,549.42
|
| Rate for Payer: Cofinity Commercial |
$1,665.63
|
| Rate for Payer: Cofinity Commercial |
$1,355.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,355.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,743.10
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,646.26
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,646.26
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,258.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,220.17
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,433.22
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT PELVIS W CON
|
Facility
|
IP
|
$1,936.78
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,220.17 |
| Max. Negotiated Rate |
$1,743.10 |
| Rate for Payer: Aetna Commercial |
$1,646.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.91
|
| Rate for Payer: Cash Price |
$1,549.42
|
| Rate for Payer: Cofinity Commercial |
$1,355.75
|
| Rate for Payer: Cofinity Commercial |
$1,665.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,355.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.42
|
| Rate for Payer: Healthscope Commercial |
$1,743.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,646.26
|
| Rate for Payer: PHP Commercial |
$1,646.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,258.91
|
| Rate for Payer: Priority Health SBD |
$1,220.17
|
|
|
HC CT PELVIS WO CON
|
Facility
|
IP
|
$1,420.15
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$894.69 |
| Max. Negotiated Rate |
$1,278.14 |
| Rate for Payer: Aetna Commercial |
$1,207.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.10
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,221.33
|
| Rate for Payer: Cofinity Commercial |
$994.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Healthscope Commercial |
$1,278.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.13
|
| Rate for Payer: PHP Commercial |
$1,207.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.10
|
| Rate for Payer: Priority Health SBD |
$894.69
|
|
|
HC CT PELVIS WO CON
|
Facility
|
OP
|
$1,420.15
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,278.14 |
| Rate for Payer: Aetna Commercial |
$1,207.13
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$160.93
|
| Rate for Payer: BCN Commercial |
$160.93
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$994.10
|
| Rate for Payer: Cofinity Commercial |
$1,221.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,278.14
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.13
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$1,207.13
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$894.69
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$1,050.91
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
OP
|
$2,205.70
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,985.13 |
| Rate for Payer: Aetna Commercial |
$1,874.84
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,433.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$382.20
|
| Rate for Payer: BCN Commercial |
$382.20
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,764.56
|
| Rate for Payer: Cash Price |
$1,764.56
|
| Rate for Payer: Cofinity Commercial |
$1,896.90
|
| Rate for Payer: Cofinity Commercial |
$1,543.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,985.13
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,874.84
|
| Rate for Payer: Nomi Health Commercial |
$523.26
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$1,874.84
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.19
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$438.55
|
| Rate for Payer: Priority Health SBD |
$1,389.59
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,632.22
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
IP
|
$2,205.70
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,389.59 |
| Max. Negotiated Rate |
$1,985.13 |
| Rate for Payer: Aetna Commercial |
$1,874.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,433.70
|
| Rate for Payer: Cash Price |
$1,764.56
|
| Rate for Payer: Cofinity Commercial |
$1,543.99
|
| Rate for Payer: Cofinity Commercial |
$1,896.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.56
|
| Rate for Payer: Healthscope Commercial |
$1,985.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,874.84
|
| Rate for Payer: PHP Commercial |
$1,874.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.70
|
| Rate for Payer: Priority Health SBD |
$1,389.59
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
OP
|
$983.98
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.94 |
| Max. Negotiated Rate |
$1,903.90 |
| Rate for Payer: Aetna Commercial |
$836.38
|
| Rate for Payer: Aetna Medicare |
$629.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$366.70
|
| Rate for Payer: BCN Commercial |
$366.70
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cofinity Commercial |
$688.79
|
| Rate for Payer: Cofinity Commercial |
$846.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$688.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Healthscope Commercial |
$885.58
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.38
|
| Rate for Payer: Nomi Health Commercial |
$1,272.10
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$836.38
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.90
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.12
|
| Rate for Payer: Priority Health SBD |
$619.91
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.94
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$341.04
|
| Rate for Payer: VA VA |
$605.76
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
IP
|
$983.98
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.91 |
| Max. Negotiated Rate |
$885.58 |
| Rate for Payer: Aetna Commercial |
$836.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.59
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cofinity Commercial |
$688.79
|
| Rate for Payer: Cofinity Commercial |
$846.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$688.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.18
|
| Rate for Payer: Healthscope Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.38
|
| Rate for Payer: PHP Commercial |
$836.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.59
|
| Rate for Payer: Priority Health SBD |
$619.91
|
|
