|
HC CT SOFT TISS NECK W CON
|
Facility
|
OP
|
$1,666.95
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
35000002
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,666.95 |
| Rate for Payer: Aetna Commercial |
$1,500.26
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,616.94
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,374.40
|
| Rate for Payer: BCN Commercial |
$1,374.40
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,333.56
|
| Rate for Payer: Cash Price |
$1,333.56
|
| Rate for Payer: Cofinity Commercial |
$1,566.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,616.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,666.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,500.26
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.91
|
| Rate for Payer: Nomi Health Commercial |
$1,366.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,250.21
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,086.47
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$869.17
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,466.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
OP
|
$1,410.88
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,410.88 |
| Rate for Payer: Aetna Commercial |
$1,269.79
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,368.55
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.27
|
| Rate for Payer: BCN Commercial |
$1,163.27
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cofinity Commercial |
$1,326.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,368.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,410.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,269.79
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.25
|
| Rate for Payer: Nomi Health Commercial |
$1,156.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.16
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$992.66
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$794.13
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,241.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT SOFT TISS NECK WO CON
|
Facility
|
IP
|
$1,410.88
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,058.16 |
| Max. Negotiated Rate |
$1,410.88 |
| Rate for Payer: Aetna Commercial |
$1,269.79
|
| Rate for Payer: ASR ASR |
$1,368.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.61
|
| Rate for Payer: BCN Commercial |
$1,158.61
|
| Rate for Payer: Cash Price |
$1,128.70
|
| Rate for Payer: Cofinity Commercial |
$1,326.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.70
|
| Rate for Payer: Healthscope Commercial |
$1,368.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,410.88
|
| Rate for Payer: Mclaren Commercial |
$1,269.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.25
|
| Rate for Payer: Nomi Health Commercial |
$1,156.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,241.57
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
IP
|
$1,919.09
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,439.32 |
| Max. Negotiated Rate |
$1,919.09 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: ASR ASR |
$1,861.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.96
|
| Rate for Payer: BCN Commercial |
$1,575.96
|
| Rate for Payer: Cash Price |
$1,535.27
|
| Rate for Payer: Cofinity Commercial |
$1,803.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.27
|
| Rate for Payer: Healthscope Commercial |
$1,861.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,919.09
|
| Rate for Payer: Mclaren Commercial |
$1,727.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,631.23
|
| Rate for Payer: Nomi Health Commercial |
$1,573.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,439.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,688.80
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
OP
|
$1,919.09
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,919.09 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,861.52
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.29
|
| Rate for Payer: BCN Commercial |
$1,582.29
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,535.27
|
| Rate for Payer: Cofinity Commercial |
$1,803.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,861.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,919.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,727.18
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,631.23
|
| Rate for Payer: Nomi Health Commercial |
$1,573.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,439.32
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,150.03
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$920.03
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,688.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,977.38 |
| Rate for Payer: Aetna Commercial |
$1,779.64
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$1,918.06
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.35
|
| Rate for Payer: BCN Commercial |
$1,630.35
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,858.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,918.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,977.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,779.64
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.04
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,147.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$918.09
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,483.04 |
| Max. Negotiated Rate |
$1,977.38 |
| Rate for Payer: Aetna Commercial |
$1,779.64
|
| Rate for Payer: ASR ASR |
$1,918.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.82
|
| Rate for Payer: BCN Commercial |
$1,623.82
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,858.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Healthscope Commercial |
$1,918.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,977.38
|
| Rate for Payer: Mclaren Commercial |
$1,779.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
OP
|
$1,650.28
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,650.28 |
| Rate for Payer: Aetna Commercial |
$1,485.25
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,600.77
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.66
|
| Rate for Payer: BCN Commercial |
$1,360.66
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Commercial |
$1,551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,600.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,485.25
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$1,353.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$990.24
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$792.20
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,452.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,650.28
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,237.71 |
| Max. Negotiated Rate |
$1,650.28 |
| Rate for Payer: Aetna Commercial |
$1,485.25
|
| Rate for Payer: ASR ASR |
$1,600.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.21
|
| Rate for Payer: BCN Commercial |
$1,355.21
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Commercial |
$1,551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Healthscope Commercial |
$1,600.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.28
|
| Rate for Payer: Mclaren Commercial |
$1,485.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$1,353.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,452.25
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,247.16
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,247.16 |
| Rate for Payer: Aetna Commercial |
$2,022.44
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$2,179.75
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,852.78
|
| Rate for Payer: BCN Commercial |
$1,852.78
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Commercial |
$2,112.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,179.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$2,022.44
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$1,842.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,305.58
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,044.46
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,247.16
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,685.37 |
| Max. Negotiated Rate |
$2,247.16 |
| Rate for Payer: Aetna Commercial |
$2,022.44
|
| Rate for Payer: ASR ASR |
$2,179.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.37
|
| Rate for Payer: BCN Commercial |
$1,845.37
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Commercial |
$2,112.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Healthscope Commercial |
$2,179.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.16
|
| Rate for Payer: Mclaren Commercial |
$2,022.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$1,842.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.50
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$2,016.93
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,016.93 |
| Rate for Payer: Aetna Commercial |
$1,815.24
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$1,956.42
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,662.96
|
| Rate for Payer: BCN Commercial |
$1,662.96
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Commercial |
$1,895.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,956.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,016.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,815.24
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.39
|
| Rate for Payer: Nomi Health Commercial |
$1,653.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,491.41
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,193.13
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,774.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$2,016.93
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,512.70 |
| Max. Negotiated Rate |
$2,016.93 |
| Rate for Payer: Aetna Commercial |
$1,815.24
|
| Rate for Payer: ASR ASR |
$1,956.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.30
|
| Rate for Payer: BCN Commercial |
$1,656.30
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Commercial |
$1,895.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Healthscope Commercial |
$1,956.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,016.93
|
| Rate for Payer: Mclaren Commercial |
$1,815.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.39
|
| Rate for Payer: Nomi Health Commercial |
$1,653.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,774.90
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,650.28
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,237.71 |
| Max. Negotiated Rate |
$1,650.28 |
| Rate for Payer: Aetna Commercial |
$1,485.25
|
| Rate for Payer: ASR ASR |
$1,600.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.21
|
| Rate for Payer: BCN Commercial |
$1,355.21
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Commercial |
$1,551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Healthscope Commercial |
$1,600.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.28
|
| Rate for Payer: Mclaren Commercial |
$1,485.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$1,353.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,452.25
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,650.28
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,650.28 |
| Rate for Payer: Aetna Commercial |
$1,485.25
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,600.77
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.66
|
| Rate for Payer: BCN Commercial |
$1,360.66
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Commercial |
$1,551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,600.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,485.25
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$1,353.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,449.04
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.23
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,452.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,247.16
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,685.37 |
| Max. Negotiated Rate |
$2,247.16 |
| Rate for Payer: Aetna Commercial |
$2,022.44
|
| Rate for Payer: ASR ASR |
$2,179.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.37
|
| Rate for Payer: BCN Commercial |
$1,845.37
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Commercial |
$2,112.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Healthscope Commercial |
$2,179.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.16
|
| Rate for Payer: Mclaren Commercial |
$2,022.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$1,842.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.50
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,247.16
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,247.16 |
| Rate for Payer: Aetna Commercial |
$2,022.44
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$2,179.75
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,852.78
|
| Rate for Payer: BCN Commercial |
$1,852.78
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Commercial |
$2,112.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,179.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$2,022.44
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$1,842.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,577.36
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$2,016.93
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,016.93 |
| Rate for Payer: Aetna Commercial |
$1,815.24
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,956.42
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,662.96
|
| Rate for Payer: BCN Commercial |
$1,662.96
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Commercial |
$1,895.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,956.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,016.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,815.24
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.39
|
| Rate for Payer: Nomi Health Commercial |
$1,653.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,480.50
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,184.40
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,774.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$2,016.93
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,512.70 |
| Max. Negotiated Rate |
$2,016.93 |
| Rate for Payer: Aetna Commercial |
$1,815.24
|
| Rate for Payer: ASR ASR |
$1,956.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,656.30
|
| Rate for Payer: BCN Commercial |
$1,656.30
|
| Rate for Payer: Cash Price |
$1,613.54
|
| Rate for Payer: Cofinity Commercial |
$1,895.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.54
|
| Rate for Payer: Healthscope Commercial |
$1,956.42
|
| Rate for Payer: Healthscope Whirlpool |
$2,016.93
|
| Rate for Payer: Mclaren Commercial |
$1,815.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.39
|
| Rate for Payer: Nomi Health Commercial |
$1,653.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,512.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,774.90
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
IP
|
$1,650.28
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,237.71 |
| Max. Negotiated Rate |
$1,650.28 |
| Rate for Payer: Aetna Commercial |
$1,485.25
|
| Rate for Payer: ASR ASR |
$1,600.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.21
|
| Rate for Payer: BCN Commercial |
$1,355.21
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Commercial |
$1,551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Healthscope Commercial |
$1,600.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.28
|
| Rate for Payer: Mclaren Commercial |
$1,485.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$1,353.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,452.25
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,650.28
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,650.28 |
| Rate for Payer: Aetna Commercial |
$1,485.25
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,600.77
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.66
|
| Rate for Payer: BCN Commercial |
$1,360.66
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cash Price |
$1,320.22
|
| Rate for Payer: Cofinity Commercial |
$1,551.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,600.77
|
| Rate for Payer: Healthscope Whirlpool |
$1,650.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,485.25
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,402.74
|
| Rate for Payer: Nomi Health Commercial |
$1,353.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,237.71
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,433.91
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,147.13
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,452.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,247.16
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,685.37 |
| Max. Negotiated Rate |
$2,247.16 |
| Rate for Payer: Aetna Commercial |
$2,022.44
|
| Rate for Payer: ASR ASR |
$2,179.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.37
|
| Rate for Payer: BCN Commercial |
$1,845.37
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Commercial |
$2,112.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Healthscope Commercial |
$2,179.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.16
|
| Rate for Payer: Mclaren Commercial |
$2,022.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$1,842.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.50
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,247.16
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,247.16 |
| Rate for Payer: Aetna Commercial |
$2,022.44
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$2,179.75
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,852.78
|
| Rate for Payer: BCN Commercial |
$1,852.78
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cash Price |
$1,797.73
|
| Rate for Payer: Cofinity Commercial |
$2,112.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,797.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,179.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$2,022.44
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,910.09
|
| Rate for Payer: Nomi Health Commercial |
$1,842.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,685.37
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,597.32
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,277.86
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,977.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
IP
|
$1,871.98
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,403.98 |
| Max. Negotiated Rate |
$1,871.98 |
| Rate for Payer: Aetna Commercial |
$1,684.78
|
| Rate for Payer: ASR ASR |
$1,815.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.27
|
| Rate for Payer: BCN Commercial |
$1,537.27
|
| Rate for Payer: Cash Price |
$1,497.58
|
| Rate for Payer: Cofinity Commercial |
$1,759.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,497.58
|
| Rate for Payer: Healthscope Commercial |
$1,815.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,871.98
|
| Rate for Payer: Mclaren Commercial |
$1,684.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,591.18
|
| Rate for Payer: Nomi Health Commercial |
$1,535.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,403.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,647.34
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,871.98
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,871.98 |
| Rate for Payer: Aetna Commercial |
$1,684.78
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,815.82
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.45
|
| Rate for Payer: BCN Commercial |
$1,543.45
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,497.58
|
| Rate for Payer: Cash Price |
$1,497.58
|
| Rate for Payer: Cofinity Commercial |
$1,759.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,497.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,815.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,871.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,684.78
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,591.18
|
| Rate for Payer: Nomi Health Commercial |
$1,535.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,403.98
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$906.70
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$725.36
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,647.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
