|
HC CT SI JTS W CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$553.33
|
| 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: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.11
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$473.69
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC CT SI JTS WO CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000023
|
|
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
|
|
|
HC CT SI JTS WO CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$553.33
|
| 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: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.11
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$473.69
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC CT SI JTS WO W CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$553.33
|
| 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: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.11
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$473.69
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC CT SI JTS WO W CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000026
|
|
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
|
|
|
HC CT SOFT TISS NECK W CON
|
Facility
|
OP
|
$1,602.22
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,602.22 |
| Rate for Payer: Aetna Commercial |
$1,442.00
|
| 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 |
$1,554.15
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.20
|
| Rate for Payer: BCN Commercial |
$1,242.20
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,281.78
|
| Rate for Payer: Cash Price |
$1,281.78
|
| Rate for Payer: Cofinity Commercial |
$1,506.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,602.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,554.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,442.00
|
| 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 |
$1,361.89
|
| 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 |
$1,121.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$920.99
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$736.79
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,409.95
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT SOFT TISS NECK W CON
|
Facility
|
IP
|
$1,602.22
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,121.55 |
| Max. Negotiated Rate |
$1,602.22 |
| Rate for Payer: Aetna Commercial |
$1,442.00
|
| Rate for Payer: ASR ASR |
$1,554.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.20
|
| Rate for Payer: BCN Commercial |
$1,242.20
|
| Rate for Payer: Cash Price |
$1,281.78
|
| Rate for Payer: Cofinity Commercial |
$1,506.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.78
|
| Rate for Payer: Healthscope Commercial |
$1,602.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,554.15
|
| Rate for Payer: Mclaren Commercial |
$1,442.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,361.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,409.95
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
OP
|
$1,356.10
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,356.10 |
| Rate for Payer: Aetna Commercial |
$1,220.49
|
| 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 |
$1,315.42
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,051.38
|
| Rate for Payer: BCN Commercial |
$1,051.38
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,274.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,356.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,315.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,220.49
|
| 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 |
$1,152.68
|
| 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 |
$949.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$841.47
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$673.18
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,193.37
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
IP
|
$1,356.10
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$949.27 |
| Max. Negotiated Rate |
$1,356.10 |
| Rate for Payer: Aetna Commercial |
$1,220.49
|
| Rate for Payer: ASR ASR |
$1,315.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,051.38
|
| Rate for Payer: BCN Commercial |
$1,051.38
|
| Rate for Payer: Cash Price |
$1,084.88
|
| Rate for Payer: Cofinity Commercial |
$1,274.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,084.88
|
| Rate for Payer: Healthscope Commercial |
$1,356.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,315.42
|
| Rate for Payer: Mclaren Commercial |
$1,220.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,152.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,193.37
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
OP
|
$1,844.57
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,844.57 |
| Rate for Payer: Aetna Commercial |
$1,660.11
|
| 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 |
$1,789.23
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,430.10
|
| Rate for Payer: BCN Commercial |
$1,430.10
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,475.66
|
| Rate for Payer: Cash Price |
$1,475.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,475.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,844.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,789.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,660.11
|
| 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 |
$1,567.88
|
| 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 |
$1,291.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$974.87
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$779.90
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,623.22
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
IP
|
$1,844.57
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,291.20 |
| Max. Negotiated Rate |
$1,844.57 |
| Rate for Payer: Aetna Commercial |
$1,660.11
|
| Rate for Payer: ASR ASR |
$1,789.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,430.10
|
| Rate for Payer: BCN Commercial |
$1,430.10
|
| Rate for Payer: Cash Price |
$1,475.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,475.66
|
| Rate for Payer: Healthscope Commercial |
$1,844.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,789.23
|
| Rate for Payer: Mclaren Commercial |
$1,660.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,567.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,291.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,623.22
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
OP
|
$1,900.60
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$1,900.60 |
| Rate for Payer: Aetna Commercial |
$1,710.54
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$1,843.58
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,473.54
|
| Rate for Payer: BCN Commercial |
$1,473.54
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,520.48
|
| Rate for Payer: Cash Price |
$1,520.48
|
| Rate for Payer: Cofinity Commercial |
$1,786.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$1,900.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,843.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,710.54
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,615.51
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$972.82
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$778.26
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,672.53
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
IP
|
$1,900.60
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,330.42 |
| Max. Negotiated Rate |
$1,900.60 |
| Rate for Payer: Aetna Commercial |
$1,710.54
|
| Rate for Payer: ASR ASR |
$1,843.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,473.54
|
| Rate for Payer: BCN Commercial |
$1,473.54
|
| Rate for Payer: Cash Price |
$1,520.48
|
| Rate for Payer: Cofinity Commercial |
$1,786.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,520.48
|
| Rate for Payer: Healthscope Commercial |
$1,900.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,843.58
|
| Rate for Payer: Mclaren Commercial |
$1,710.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,615.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,672.53
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,586.20 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| 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 |
$1,538.61
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.78
|
| Rate for Payer: BCN Commercial |
$1,229.78
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,491.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,586.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,538.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,427.58
|
| 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 |
$1,348.27
|
| 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 |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.42
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$671.54
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,395.86
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,110.34 |
| Max. Negotiated Rate |
$1,586.20 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: ASR ASR |
$1,538.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.78
|
| Rate for Payer: BCN Commercial |
$1,229.78
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,491.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Healthscope Commercial |
$1,586.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,538.61
|
| Rate for Payer: Mclaren Commercial |
$1,427.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,395.86
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,511.93 |
| Max. Negotiated Rate |
$2,159.90 |
| Rate for Payer: Aetna Commercial |
$1,943.91
|
| Rate for Payer: ASR ASR |
$2,095.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.57
|
| Rate for Payer: BCN Commercial |
$1,674.57
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$2,030.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Healthscope Commercial |
$2,159.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,095.10
|
| Rate for Payer: Mclaren Commercial |
$1,943.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,900.71
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,159.90 |
| Rate for Payer: Aetna Commercial |
$1,943.91
|
| 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 |
$2,095.10
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.57
|
| Rate for Payer: BCN Commercial |
$1,674.57
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$2,030.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,159.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,095.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,943.91
|
| 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 |
$1,835.92
|
| 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 |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,106.73
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$885.38
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,900.71
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,357.03 |
| Max. Negotiated Rate |
$1,938.61 |
| Rate for Payer: Aetna Commercial |
$1,744.75
|
| Rate for Payer: ASR ASR |
$1,880.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.00
|
| Rate for Payer: BCN Commercial |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,822.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Healthscope Commercial |
$1,938.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.45
|
| Rate for Payer: Mclaren Commercial |
$1,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.98
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$1,938.61
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$186.99 |
| Max. Negotiated Rate |
$1,938.61 |
| Rate for Payer: Aetna Commercial |
$1,744.75
|
| Rate for Payer: Aetna Medicare |
$341.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.30
|
| Rate for Payer: ASR ASR |
$1,880.45
|
| Rate for Payer: BCBS Complete |
$196.35
|
| Rate for Payer: BCBS MAPPO |
$341.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.00
|
| Rate for Payer: BCN Commercial |
$1,503.00
|
| Rate for Payer: BCN Medicare Advantage |
$341.84
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,822.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.84
|
| Rate for Payer: Healthscope Commercial |
$1,938.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$341.84
|
| Rate for Payer: Mclaren Commercial |
$1,744.75
|
| Rate for Payer: Mclaren Medicaid |
$186.99
|
| Rate for Payer: Mclaren Medicare |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$196.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: PACE Medicare |
$324.75
|
| Rate for Payer: PACE SWMI |
$341.84
|
| Rate for Payer: PHP Commercial |
$376.02
|
| Rate for Payer: PHP Medicaid |
$186.99
|
| Rate for Payer: PHP Medicare Advantage |
$341.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,264.25
|
| Rate for Payer: Priority Health Medicare |
$341.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,011.40
|
| Rate for Payer: Railroad Medicare Medicare |
$341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.98
|
| Rate for Payer: UHC Medicare Advantage |
$352.10
|
| Rate for Payer: VA VA |
$341.84
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,586.20
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,110.34 |
| Max. Negotiated Rate |
$1,586.20 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| Rate for Payer: ASR ASR |
$1,538.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.78
|
| Rate for Payer: BCN Commercial |
$1,229.78
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,491.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Healthscope Commercial |
$1,586.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,538.61
|
| Rate for Payer: Mclaren Commercial |
$1,427.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,348.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,395.86
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,586.20
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,586.20 |
| Rate for Payer: Aetna Commercial |
$1,427.58
|
| 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 |
$1,538.61
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,229.78
|
| Rate for Payer: BCN Commercial |
$1,229.78
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cash Price |
$1,268.96
|
| Rate for Payer: Cofinity Commercial |
$1,491.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,268.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,586.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,538.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,427.58
|
| 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 |
$1,348.27
|
| 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 |
$1,110.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.34
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$982.67
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,395.86
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,159.90
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,511.93 |
| Max. Negotiated Rate |
$2,159.90 |
| Rate for Payer: Aetna Commercial |
$1,943.91
|
| Rate for Payer: ASR ASR |
$2,095.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.57
|
| Rate for Payer: BCN Commercial |
$1,674.57
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$2,030.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Healthscope Commercial |
$2,159.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,095.10
|
| Rate for Payer: Mclaren Commercial |
$1,943.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,835.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,900.71
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,159.90
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,159.90 |
| Rate for Payer: Aetna Commercial |
$1,943.91
|
| 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 |
$2,095.10
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.57
|
| Rate for Payer: BCN Commercial |
$1,674.57
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cash Price |
$1,727.92
|
| Rate for Payer: Cofinity Commercial |
$2,030.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,727.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,159.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,095.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,943.91
|
| 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 |
$1,835.92
|
| 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 |
$1,511.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,337.11
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,900.71
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,357.03 |
| Max. Negotiated Rate |
$1,938.61 |
| Rate for Payer: Aetna Commercial |
$1,744.75
|
| Rate for Payer: ASR ASR |
$1,880.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.00
|
| Rate for Payer: BCN Commercial |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,822.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Healthscope Commercial |
$1,938.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.45
|
| Rate for Payer: Mclaren Commercial |
$1,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,647.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.98
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$1,938.61
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,938.61 |
| Rate for Payer: Aetna Commercial |
$1,744.75
|
| 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 |
$1,880.45
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,503.00
|
| Rate for Payer: BCN Commercial |
$1,503.00
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,822.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,938.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,744.75
|
| 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 |
$1,647.82
|
| 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 |
$1,357.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,255.01
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,004.01
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
