|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,387.95 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.02
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,542.17
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,542.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health SBD |
$1,387.95
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
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 Commercial |
$1,384.17
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,384.17
|
| 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: PHP Commercial |
$1,680.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health SBD |
$1,245.75
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$219.39
|
| Rate for Payer: BCN Commercial |
$219.39
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Cofinity Commercial |
$1,384.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,384.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,680.77
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$1,245.75
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,463.26
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.65
|
| 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 |
$161.56
|
| Rate for Payer: BCN Commercial |
$161.56
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Cofinity Commercial |
$1,132.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| 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 |
$1,375.23
|
| 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 |
$1,375.23
|
| 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 |
$1,051.65
|
| 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 |
$1,019.29
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$1,197.26
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,019.29 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.65
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,132.54
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health SBD |
$1,019.29
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,387.95 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.02
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,542.17
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,542.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health SBD |
$1,387.95
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$270.94
|
| Rate for Payer: BCN Commercial |
$270.94
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Cofinity Commercial |
$1,542.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,542.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| 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 |
$1,872.64
|
| 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 |
$1,872.64
|
| 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 |
$1,432.02
|
| 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 |
$1,387.95
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,630.29
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,779.64 |
| Rate for Payer: Aetna Commercial |
$1,680.77
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.30
|
| 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 |
$220.65
|
| Rate for Payer: BCN Commercial |
$220.65
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Cofinity Commercial |
$1,384.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,384.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,779.64
|
| 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 |
$1,680.77
|
| 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 |
$1,680.77
|
| 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 |
$1,285.30
|
| 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 |
$1,245.75
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,463.26
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
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 Commercial |
$1,384.17
|
| Rate for Payer: Cofinity Commercial |
$1,700.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,384.17
|
| 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: PHP Commercial |
$1,680.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health SBD |
$1,245.75
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,019.29 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.65
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,132.54
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: PHP Commercial |
$1,375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health SBD |
$1,019.29
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,456.13 |
| Rate for Payer: Aetna Commercial |
$1,375.23
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.65
|
| 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 |
$162.81
|
| Rate for Payer: BCN Commercial |
$162.81
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,391.41
|
| Rate for Payer: Cofinity Commercial |
$1,132.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,456.13
|
| 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 |
$1,375.23
|
| 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 |
$1,375.23
|
| 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 |
$1,051.65
|
| 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 |
$1,019.29
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$1,197.26
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,387.95 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.02
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,542.17
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,542.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: PHP Commercial |
$1,872.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health SBD |
$1,387.95
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,982.79 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$272.20
|
| Rate for Payer: BCN Commercial |
$272.20
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$1,894.67
|
| Rate for Payer: Cofinity Commercial |
$1,542.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,542.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,982.79
|
| 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 |
$1,872.64
|
| 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 |
$1,872.64
|
| 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 |
$1,432.02
|
| 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 |
$1,387.95
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,630.29
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
IP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,156.22 |
| Max. Negotiated Rate |
$1,651.74 |
| Rate for Payer: Aetna Commercial |
$1,559.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.93
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cofinity Commercial |
$1,284.69
|
| Rate for Payer: Cofinity Commercial |
$1,578.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,284.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.22
|
| Rate for Payer: Healthscope Commercial |
$1,651.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.98
|
| Rate for Payer: PHP Commercial |
$1,559.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.93
|
| Rate for Payer: Priority Health SBD |
$1,156.22
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,651.74 |
| Rate for Payer: Aetna Commercial |
$1,559.98
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.93
|
| 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 |
$416.78
|
| Rate for Payer: BCN Commercial |
$416.78
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cofinity Commercial |
$1,578.33
|
| Rate for Payer: Cofinity Commercial |
$1,284.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,284.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,651.74
|
| 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 |
$1,559.98
|
| 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 |
$1,559.98
|
| 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 |
$1,192.93
|
| 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 |
$1,156.22
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,358.10
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
OP
|
$1,450.32
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,305.29 |
| Rate for Payer: Aetna Commercial |
$1,232.77
|
| Rate for Payer: Aetna Medicare |
$363.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$286.02
|
| Rate for Payer: BCN Commercial |
$286.02
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cofinity Commercial |
$1,247.28
|
| Rate for Payer: Cofinity Commercial |
$1,015.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,015.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,305.29
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.77
|
| Rate for Payer: Nomi Health Commercial |
$1,049.73
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$1,232.77
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.76
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$879.81
|
| Rate for Payer: Priority Health SBD |
$913.70
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$1,073.24
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$197.00
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
IP
|
$1,450.32
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$913.70 |
| Max. Negotiated Rate |
$1,305.29 |
| Rate for Payer: Aetna Commercial |
$1,232.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.71
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cofinity Commercial |
$1,015.22
|
| Rate for Payer: Cofinity Commercial |
$1,247.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,015.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.26
|
| Rate for Payer: Healthscope Commercial |
$1,305.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.77
|
| Rate for Payer: PHP Commercial |
$1,232.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.71
|
| Rate for Payer: Priority Health SBD |
$913.70
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
IP
|
$1,215.19
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$765.57 |
| Max. Negotiated Rate |
$1,093.67 |
| Rate for Payer: Aetna Commercial |
$1,032.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.87
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cofinity Commercial |
$1,045.06
|
| Rate for Payer: Cofinity Commercial |
$850.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$850.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.15
|
| Rate for Payer: Healthscope Commercial |
$1,093.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,032.91
|
| Rate for Payer: PHP Commercial |
$1,032.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.87
|
| Rate for Payer: Priority Health SBD |
$765.57
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
OP
|
$1,215.19
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,093.67 |
| Rate for Payer: Aetna Commercial |
$1,032.91
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.87
|
| 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 |
$223.80
|
| Rate for Payer: BCN Commercial |
$223.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cofinity Commercial |
$850.63
|
| Rate for Payer: Cofinity Commercial |
$1,045.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$850.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,093.67
|
| 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 |
$1,032.91
|
| 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 |
$1,032.91
|
| 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 |
$789.87
|
| 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 |
$765.57
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$899.24
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,690.85
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,065.24 |
| Max. Negotiated Rate |
$1,521.76 |
| Rate for Payer: Aetna Commercial |
$1,437.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.05
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cofinity Commercial |
$1,183.60
|
| Rate for Payer: Cofinity Commercial |
$1,454.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,183.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.68
|
| Rate for Payer: Healthscope Commercial |
$1,521.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.22
|
| Rate for Payer: PHP Commercial |
$1,437.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.05
|
| Rate for Payer: Priority Health SBD |
$1,065.24
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,690.85
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,521.76 |
| Rate for Payer: Aetna Commercial |
$1,437.22
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.05
|
| 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 |
$374.66
|
| Rate for Payer: BCN Commercial |
$374.66
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cofinity Commercial |
$1,454.13
|
| Rate for Payer: Cofinity Commercial |
$1,183.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,183.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,521.76
|
| 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 |
$1,437.22
|
| 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 |
$1,437.22
|
| 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 |
$1,099.05
|
| 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 |
$1,065.24
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$1,251.23
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
OP
|
$1,013.98
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$912.58 |
| Rate for Payer: Aetna Commercial |
$861.88
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cofinity Commercial |
$872.02
|
| Rate for Payer: Cofinity Commercial |
$709.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$709.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$912.58
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.88
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$861.88
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$638.81
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$750.35
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC CT VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
IP
|
$1,013.98
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$638.81 |
| Max. Negotiated Rate |
$912.58 |
| Rate for Payer: Aetna Commercial |
$861.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.09
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cofinity Commercial |
$709.79
|
| Rate for Payer: Cofinity Commercial |
$872.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$709.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.18
|
| Rate for Payer: Healthscope Commercial |
$912.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.88
|
| Rate for Payer: PHP Commercial |
$861.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.09
|
| Rate for Payer: Priority Health SBD |
$638.81
|
|
|
HC CT VIRTUAL COLON W CON DIAG
|
Facility
|
OP
|
$1,286.53
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,157.88 |
| Rate for Payer: Aetna Commercial |
$1,093.55
|
| Rate for Payer: Aetna Medicare |
$181.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.24
|
| 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 |
$682.06
|
| Rate for Payer: BCN Commercial |
$682.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cofinity Commercial |
$900.57
|
| Rate for Payer: Cofinity Commercial |
$1,106.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$900.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,157.88
|
| 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 |
$1,093.55
|
| 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 |
$1,093.55
|
| 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 |
$836.24
|
| 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 |
$810.51
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$952.03
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$98.20
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT VIRTUAL COLON W CON DIAG
|
Facility
|
IP
|
$1,286.53
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$810.51 |
| Max. Negotiated Rate |
$1,157.88 |
| Rate for Payer: Aetna Commercial |
$1,093.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.24
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cofinity Commercial |
$1,106.42
|
| Rate for Payer: Cofinity Commercial |
$900.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$900.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.22
|
| Rate for Payer: Healthscope Commercial |
$1,157.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,093.55
|
| Rate for Payer: PHP Commercial |
$1,093.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.24
|
| Rate for Payer: Priority Health SBD |
$810.51
|
|
