|
HC CTO CATHETER
|
Facility
|
IP
|
$6,335.36
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,434.75 |
| Max. Negotiated Rate |
$6,335.36 |
| Rate for Payer: Aetna Commercial |
$5,701.82
|
| Rate for Payer: ASR ASR |
$6,145.30
|
| Rate for Payer: BCBS Trust/PPO |
$4,911.80
|
| Rate for Payer: BCN Commercial |
$4,911.80
|
| Rate for Payer: Cash Price |
$5,068.29
|
| Rate for Payer: Cofinity Commercial |
$5,955.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,068.29
|
| Rate for Payer: Healthscope Commercial |
$6,335.36
|
| Rate for Payer: Healthscope Whirlpool |
$6,145.30
|
| Rate for Payer: Mclaren Commercial |
$5,701.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,385.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,434.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,575.12
|
|
|
HC CTO CATHETER
|
Facility
|
OP
|
$6,335.36
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,534.14 |
| Max. Negotiated Rate |
$6,335.36 |
| Rate for Payer: Aetna Commercial |
$5,701.82
|
| Rate for Payer: ASR ASR |
$6,145.30
|
| Rate for Payer: BCBS Complete |
$2,534.14
|
| Rate for Payer: BCBS Trust/PPO |
$4,911.80
|
| Rate for Payer: BCN Commercial |
$4,911.80
|
| Rate for Payer: Cash Price |
$5,068.29
|
| Rate for Payer: Cofinity Commercial |
$5,955.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,068.29
|
| Rate for Payer: Healthscope Commercial |
$6,335.36
|
| Rate for Payer: Healthscope Whirlpool |
$6,145.30
|
| Rate for Payer: Mclaren Commercial |
$5,701.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,385.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,434.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,765.18
|
| Rate for Payer: Priority Health Narrow Network |
$4,498.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,575.12
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
IP
|
$1,548.67
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,084.07 |
| Max. Negotiated Rate |
$1,548.67 |
| Rate for Payer: Aetna Commercial |
$1,393.80
|
| Rate for Payer: ASR ASR |
$1,502.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.68
|
| Rate for Payer: BCN Commercial |
$1,200.68
|
| Rate for Payer: Cash Price |
$1,238.94
|
| Rate for Payer: Cofinity Commercial |
$1,455.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.94
|
| Rate for Payer: Healthscope Commercial |
$1,548.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,502.21
|
| Rate for Payer: Mclaren Commercial |
$1,393.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,316.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.83
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
OP
|
$1,548.67
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,548.67 |
| Rate for Payer: Aetna Commercial |
$1,393.80
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,502.21
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.68
|
| Rate for Payer: BCN Commercial |
$1,200.68
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,238.94
|
| Rate for Payer: Cash Price |
$1,238.94
|
| Rate for Payer: Cofinity Commercial |
$1,455.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,548.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,502.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,393.80
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,316.37
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$719.86
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$575.89
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,362.83
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT ORBIT WO CON
|
Facility
|
OP
|
$1,407.29
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,407.29 |
| Rate for Payer: Aetna Commercial |
$1,266.56
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,365.07
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.07
|
| Rate for Payer: BCN Commercial |
$1,091.07
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,125.83
|
| Rate for Payer: Cash Price |
$1,125.83
|
| Rate for Payer: Cofinity Commercial |
$1,322.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,407.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,365.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,266.56
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,196.20
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$642.90
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$514.32
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,238.42
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT ORBIT WO CON
|
Facility
|
IP
|
$1,407.29
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$985.10 |
| Max. Negotiated Rate |
$1,407.29 |
| Rate for Payer: Aetna Commercial |
$1,266.56
|
| Rate for Payer: ASR ASR |
$1,365.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.07
|
| Rate for Payer: BCN Commercial |
$1,091.07
|
| Rate for Payer: Cash Price |
$1,125.83
|
| Rate for Payer: Cofinity Commercial |
$1,322.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.83
|
| Rate for Payer: Healthscope Commercial |
$1,407.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,365.07
|
| Rate for Payer: Mclaren Commercial |
$1,266.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,196.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,238.42
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
OP
|
$1,469.30
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,469.30 |
| Rate for Payer: Aetna Commercial |
$1,322.37
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,425.22
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.15
|
| Rate for Payer: BCN Commercial |
$1,139.15
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,381.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,469.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,322.37
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.59
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$661.27
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
IP
|
$1,469.30
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,028.51 |
| Max. Negotiated Rate |
$1,469.30 |
| Rate for Payer: Aetna Commercial |
$1,322.37
|
| Rate for Payer: ASR ASR |
$1,425.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,139.15
|
| Rate for Payer: BCN Commercial |
$1,139.15
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,381.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.44
|
| Rate for Payer: Healthscope Commercial |
$1,469.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.22
|
| Rate for Payer: Mclaren Commercial |
$1,322.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,292.98
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$1,719.90
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,853.67
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.60
|
| Rate for Payer: BCN Commercial |
$1,481.60
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,796.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,911.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,719.90
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,624.35
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$833.25
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$666.60
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.68
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,337.70 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$1,719.90
|
| Rate for Payer: ASR ASR |
$1,853.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.60
|
| Rate for Payer: BCN Commercial |
$1,481.60
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,796.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.80
|
| Rate for Payer: Healthscope Commercial |
$1,911.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.67
|
| Rate for Payer: Mclaren Commercial |
$1,719.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,624.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.68
|
|
|
HC CT PELVIS W CON
|
Facility
|
IP
|
$1,898.80
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,329.16 |
| Max. Negotiated Rate |
$1,898.80 |
| Rate for Payer: Aetna Commercial |
$1,708.92
|
| Rate for Payer: ASR ASR |
$1,841.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,472.14
|
| Rate for Payer: BCN Commercial |
$1,472.14
|
| Rate for Payer: Cash Price |
$1,519.04
|
| Rate for Payer: Cofinity Commercial |
$1,784.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,519.04
|
| Rate for Payer: Healthscope Commercial |
$1,898.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,841.84
|
| Rate for Payer: Mclaren Commercial |
$1,708.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,613.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,329.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,670.94
|
|
|
HC CT PELVIS W CON
|
Facility
|
OP
|
$1,898.80
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,898.80 |
| Rate for Payer: Aetna Commercial |
$1,708.92
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,841.84
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,472.14
|
| Rate for Payer: BCN Commercial |
$1,472.14
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,519.04
|
| Rate for Payer: Cash Price |
$1,519.04
|
| Rate for Payer: Cofinity Commercial |
$1,784.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,519.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,898.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,841.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,708.92
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,613.98
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,329.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.63
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$615.70
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,670.94
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT PELVIS WO CON
|
Facility
|
OP
|
$1,392.30
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Commercial |
$1,253.07
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,350.53
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,079.45
|
| Rate for Payer: BCN Commercial |
$1,079.45
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,113.84
|
| Rate for Payer: Cash Price |
$1,113.84
|
| Rate for Payer: Cofinity Commercial |
$1,308.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,113.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,392.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,350.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,253.07
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,183.46
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.67
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$585.34
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,225.22
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT PELVIS WO CON
|
Facility
|
IP
|
$1,392.30
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$974.61 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Commercial |
$1,253.07
|
| Rate for Payer: ASR ASR |
$1,350.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,079.45
|
| Rate for Payer: BCN Commercial |
$1,079.45
|
| Rate for Payer: Cash Price |
$1,113.84
|
| Rate for Payer: Cofinity Commercial |
$1,308.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,113.84
|
| Rate for Payer: Healthscope Commercial |
$1,392.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,350.53
|
| Rate for Payer: Mclaren Commercial |
$1,253.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,183.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,225.22
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
OP
|
$2,162.45
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,162.45 |
| Rate for Payer: Aetna Commercial |
$1,946.20
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$2,097.58
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.55
|
| Rate for Payer: BCN Commercial |
$1,676.55
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cofinity Commercial |
$2,032.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,162.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,097.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,946.20
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,838.08
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.33
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$700.26
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,902.96
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
IP
|
$2,162.45
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,513.72 |
| Max. Negotiated Rate |
$2,162.45 |
| Rate for Payer: Aetna Commercial |
$1,946.20
|
| Rate for Payer: ASR ASR |
$2,097.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.55
|
| Rate for Payer: BCN Commercial |
$1,676.55
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cofinity Commercial |
$2,032.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.96
|
| Rate for Payer: Healthscope Commercial |
$2,162.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,097.58
|
| Rate for Payer: Mclaren Commercial |
$1,946.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,838.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,513.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,902.96
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
IP
|
$964.69
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.28 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$868.22
|
| Rate for Payer: ASR ASR |
$935.75
|
| Rate for Payer: BCBS Trust/PPO |
$747.92
|
| Rate for Payer: BCN Commercial |
$747.92
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cofinity Commercial |
$906.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.75
|
| Rate for Payer: Healthscope Commercial |
$964.69
|
| Rate for Payer: Healthscope Whirlpool |
$935.75
|
| Rate for Payer: Mclaren Commercial |
$868.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$819.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.93
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
OP
|
$964.69
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$868.22
|
| Rate for Payer: Aetna Medicare |
$558.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.00
|
| Rate for Payer: ASR ASR |
$935.75
|
| Rate for Payer: BCBS Complete |
$320.74
|
| Rate for Payer: BCBS MAPPO |
$558.40
|
| Rate for Payer: BCBS Trust/PPO |
$747.92
|
| Rate for Payer: BCN Commercial |
$747.92
|
| Rate for Payer: BCN Medicare Advantage |
$558.40
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cofinity Commercial |
$906.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.40
|
| Rate for Payer: Healthscope Commercial |
$964.69
|
| Rate for Payer: Healthscope Whirlpool |
$935.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.40
|
| Rate for Payer: Mclaren Commercial |
$868.22
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Mclaren Medicare |
$558.40
|
| Rate for Payer: Meridian Medicaid |
$320.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$819.99
|
| Rate for Payer: PACE Medicare |
$530.48
|
| Rate for Payer: PACE SWMI |
$558.40
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: PHP Medicaid |
$305.44
|
| Rate for Payer: PHP Medicare Advantage |
$558.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.87
|
| Rate for Payer: Priority Health Medicare |
$558.40
|
| Rate for Payer: Priority Health Narrow Network |
$684.93
|
| Rate for Payer: Railroad Medicare Medicare |
$558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.93
|
| Rate for Payer: UHC Medicare Advantage |
$575.15
|
| Rate for Payer: VA VA |
$558.40
|
|
|
HC CT PLEURAL FIBRINOLYSIS SUB DAY
|
Facility
|
IP
|
$964.69
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
36100322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.28 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$868.22
|
| Rate for Payer: ASR ASR |
$935.75
|
| Rate for Payer: BCBS Trust/PPO |
$747.92
|
| Rate for Payer: BCN Commercial |
$747.92
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cofinity Commercial |
$906.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.75
|
| Rate for Payer: Healthscope Commercial |
$964.69
|
| Rate for Payer: Healthscope Whirlpool |
$935.75
|
| Rate for Payer: Mclaren Commercial |
$868.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$819.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.93
|
|
|
HC CT PLEURAL FIBRINOLYSIS SUB DAY
|
Facility
|
OP
|
$964.69
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
36100322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$964.69 |
| Rate for Payer: Aetna Commercial |
$868.22
|
| Rate for Payer: Aetna Medicare |
$558.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.00
|
| Rate for Payer: ASR ASR |
$935.75
|
| Rate for Payer: BCBS Complete |
$320.74
|
| Rate for Payer: BCBS MAPPO |
$558.40
|
| Rate for Payer: BCBS Trust/PPO |
$747.92
|
| Rate for Payer: BCN Commercial |
$747.92
|
| Rate for Payer: BCN Medicare Advantage |
$558.40
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cofinity Commercial |
$906.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.40
|
| Rate for Payer: Healthscope Commercial |
$964.69
|
| Rate for Payer: Healthscope Whirlpool |
$935.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.40
|
| Rate for Payer: Mclaren Commercial |
$868.22
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Mclaren Medicare |
$558.40
|
| Rate for Payer: Meridian Medicaid |
$320.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$819.99
|
| Rate for Payer: PACE Medicare |
$530.48
|
| Rate for Payer: PACE SWMI |
$558.40
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: PHP Medicaid |
$305.44
|
| Rate for Payer: PHP Medicare Advantage |
$558.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$877.87
|
| Rate for Payer: Priority Health Medicare |
$558.40
|
| Rate for Payer: Priority Health Narrow Network |
$684.93
|
| Rate for Payer: Railroad Medicare Medicare |
$558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.93
|
| Rate for Payer: UHC Medicare Advantage |
$575.15
|
| Rate for Payer: VA VA |
$558.40
|
|
|
HC CT RF/MICROWAVE ABLATION
|
Facility
|
OP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$430.03 |
| Max. Negotiated Rate |
$1,075.08 |
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: ASR ASR |
$1,042.83
|
| Rate for Payer: BCBS Complete |
$430.03
|
| Rate for Payer: BCBS Trust/PPO |
$833.51
|
| Rate for Payer: BCN Commercial |
$833.51
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$1,010.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$860.06
|
| Rate for Payer: Healthscope Commercial |
$1,075.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.83
|
| Rate for Payer: Mclaren Commercial |
$967.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$978.32
|
| Rate for Payer: Priority Health Narrow Network |
$763.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$946.07
|
|
|
HC CT RF/MICROWAVE ABLATION
|
Facility
|
IP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000042
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$752.56 |
| Max. Negotiated Rate |
$1,075.08 |
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: ASR ASR |
$1,042.83
|
| Rate for Payer: BCBS Trust/PPO |
$833.51
|
| Rate for Payer: BCN Commercial |
$833.51
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$1,010.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$860.06
|
| Rate for Payer: Healthscope Commercial |
$1,075.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,042.83
|
| Rate for Payer: Mclaren Commercial |
$967.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$946.07
|
|
|
HC CTRL NASAL HEMRRG POSTERIOR PACKS/CAUTERY SUBSQ
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$526.50
|
| Rate for Payer: ASR ASR |
$567.45
|
| Rate for Payer: BCBS Trust/PPO |
$453.55
|
| Rate for Payer: BCN Commercial |
$453.55
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cofinity Commercial |
$549.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.00
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Healthscope Whirlpool |
$567.45
|
| Rate for Payer: Mclaren Commercial |
$526.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$497.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.80
|
|
|
HC CTRL NASAL HEMRRG POSTERIOR PACKS/CAUTERY SUBSQ
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
76100394
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$526.50
|
| Rate for Payer: Aetna Medicare |
$217.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: ASR ASR |
$567.45
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$453.55
|
| Rate for Payer: BCN Commercial |
$453.55
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cofinity Commercial |
$549.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Healthscope Whirlpool |
$567.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$217.12
|
| Rate for Payer: Mclaren Commercial |
$526.50
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$497.25
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Commercial |
$238.83
|
| Rate for Payer: PHP Medicaid |
$118.76
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$532.35
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$415.35
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$514.80
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
HC CT SI JTS W CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$484.16 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
|
