|
HC CRYSTALS BODY FLUID
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Aetna Commercial |
$42.52
|
| Rate for Payer: Aetna Medicare |
$7.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.16
|
| Rate for Payer: ASR ASR |
$45.82
|
| Rate for Payer: ASR Commercial |
$45.82
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$38.68
|
| Rate for Payer: BCN Commercial |
$36.63
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$47.24
|
| Rate for Payer: Healthscope Whirlpool |
$45.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.33
|
| Rate for Payer: Mclaren Commercial |
$42.52
|
| Rate for Payer: Mclaren Medicaid |
$3.93
|
| Rate for Payer: Mclaren Medicare |
$7.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: Meridian Medicaid |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$38.74
|
| Rate for Payer: PACE Medicare |
$6.96
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$8.06
|
| Rate for Payer: PHP Medicaid |
$3.93
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.39
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: Priority Health Narrow Network |
$33.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Exchange |
$11.36
|
| Rate for Payer: UHC Medicare Advantage |
$7.33
|
| Rate for Payer: UHCCP DNSP |
$7.33
|
| Rate for Payer: UHCCP Medicaid |
$3.93
|
| Rate for Payer: VA VA |
$7.33
|
|
|
HC CRYSTALS BODY FLUID
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
30000002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.71 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Aetna Commercial |
$42.52
|
| Rate for Payer: ASR ASR |
$45.82
|
| Rate for Payer: ASR Commercial |
$45.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$36.63
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Healthscope Commercial |
$47.24
|
| Rate for Payer: Healthscope Whirlpool |
$45.82
|
| Rate for Payer: Mclaren Commercial |
$42.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$38.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.57
|
|
|
HC C-SECTION (OB SURGERY)
|
Facility
|
IP
|
$2,996.16
|
|
| Hospital Charge Code |
36000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,947.50 |
| Max. Negotiated Rate |
$2,996.16 |
| Rate for Payer: Aetna Commercial |
$2,696.54
|
| Rate for Payer: ASR ASR |
$2,906.28
|
| Rate for Payer: ASR Commercial |
$2,906.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,441.57
|
| Rate for Payer: BCN Commercial |
$2,322.92
|
| Rate for Payer: Cash Price |
$2,396.93
|
| Rate for Payer: Cofinity Commercial |
$2,816.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.93
|
| Rate for Payer: Healthscope Commercial |
$2,996.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,906.28
|
| Rate for Payer: Mclaren Commercial |
$2,696.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,546.74
|
| Rate for Payer: Nomi Health Commercial |
$2,456.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,636.62
|
|
|
HC C-SECTION (OB SURGERY)
|
Facility
|
OP
|
$2,996.16
|
|
| Hospital Charge Code |
36000024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,198.46 |
| Max. Negotiated Rate |
$2,996.16 |
| Rate for Payer: Aetna Commercial |
$2,696.54
|
| Rate for Payer: Aetna Medicare |
$1,498.08
|
| Rate for Payer: ASR ASR |
$2,906.28
|
| Rate for Payer: ASR Commercial |
$2,906.28
|
| Rate for Payer: BCBS Complete |
$1,198.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,453.56
|
| Rate for Payer: BCN Commercial |
$2,322.92
|
| Rate for Payer: Cash Price |
$2,396.93
|
| Rate for Payer: Cofinity Commercial |
$2,816.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,396.93
|
| Rate for Payer: Healthscope Commercial |
$2,996.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,906.28
|
| Rate for Payer: Mclaren Commercial |
$2,696.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,546.74
|
| Rate for Payer: Nomi Health Commercial |
$2,456.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,625.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,100.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,636.62
|
|
|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
IP
|
$3,679.58
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,391.73 |
| Max. Negotiated Rate |
$3,679.58 |
| Rate for Payer: Aetna Commercial |
$3,311.62
|
| Rate for Payer: ASR ASR |
$3,569.19
|
| Rate for Payer: ASR Commercial |
$3,569.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,998.49
|
| Rate for Payer: BCN Commercial |
$2,852.78
|
| Rate for Payer: Cash Price |
$2,943.66
|
| Rate for Payer: Cofinity Commercial |
$3,458.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.66
|
| Rate for Payer: Healthscope Commercial |
$3,679.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,569.19
|
| Rate for Payer: Mclaren Commercial |
$3,311.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,127.64
|
| Rate for Payer: Nomi Health Commercial |
$3,017.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,391.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,238.03
|
|
|
HC C-SECTION W/STERIL (OB SURGERY
|
Facility
|
OP
|
$3,679.58
|
|
| Hospital Charge Code |
36000025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,471.83 |
| Max. Negotiated Rate |
$3,679.58 |
| Rate for Payer: Aetna Commercial |
$3,311.62
|
| Rate for Payer: Aetna Medicare |
$1,839.79
|
| Rate for Payer: ASR ASR |
$3,569.19
|
| Rate for Payer: ASR Commercial |
$3,569.19
|
| Rate for Payer: BCBS Complete |
$1,471.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,013.21
|
| Rate for Payer: BCN Commercial |
$2,852.78
|
| Rate for Payer: Cash Price |
$2,943.66
|
| Rate for Payer: Cofinity Commercial |
$3,458.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,943.66
|
| Rate for Payer: Healthscope Commercial |
$3,679.58
|
| Rate for Payer: Healthscope Whirlpool |
$3,569.19
|
| Rate for Payer: Mclaren Commercial |
$3,311.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,127.64
|
| Rate for Payer: Nomi Health Commercial |
$3,017.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,391.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,224.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,579.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,238.03
|
|
|
HC CSF LACTATE
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: ASR ASR |
$21.19
|
| Rate for Payer: ASR Commercial |
$21.19
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.89
|
| Rate for Payer: BCN Commercial |
$16.94
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.57
|
| Rate for Payer: Mclaren Commercial |
$19.66
|
| Rate for Payer: Mclaren Medicaid |
$6.20
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$6.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicaid |
$6.20
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.14
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow Network |
$15.32
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$11.57
|
| Rate for Payer: UHCCP DNSP |
$11.57
|
| Rate for Payer: UHCCP Medicaid |
$6.20
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC CSF LACTATE
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: ASR ASR |
$21.19
|
| Rate for Payer: ASR Commercial |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.81
|
| Rate for Payer: BCN Commercial |
$16.94
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.23
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC CSU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200016
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$145.08 |
| Rate for Payer: Aetna Commercial |
$130.57
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: ASR ASR |
$140.73
|
| Rate for Payer: ASR Commercial |
$140.73
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$118.81
|
| Rate for Payer: BCN Commercial |
$112.48
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$136.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$145.08
|
| Rate for Payer: Healthscope Whirlpool |
$140.73
|
| Rate for Payer: Mclaren Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.12
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.67
|
|
|
HC CSU R&B
|
Facility
|
IP
|
$7,308.69
|
|
| Hospital Charge Code |
21000002
|
|
Hospital Revenue Code
|
210
|
| Min. Negotiated Rate |
$4,750.65 |
| Max. Negotiated Rate |
$7,308.69 |
| Rate for Payer: Aetna Commercial |
$6,577.82
|
| Rate for Payer: ASR ASR |
$7,089.43
|
| Rate for Payer: ASR Commercial |
$7,089.43
|
| Rate for Payer: BCBS Trust/PPO |
$5,955.85
|
| Rate for Payer: BCN Commercial |
$5,666.43
|
| Rate for Payer: Cash Price |
$5,846.95
|
| Rate for Payer: Cofinity Commercial |
$6,870.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,846.95
|
| Rate for Payer: Healthscope Commercial |
$7,308.69
|
| Rate for Payer: Healthscope Whirlpool |
$7,089.43
|
| Rate for Payer: Mclaren Commercial |
$6,577.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,212.39
|
| Rate for Payer: Nomi Health Commercial |
$5,993.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,750.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,431.65
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
IP
|
$3,709.64
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,411.27 |
| Max. Negotiated Rate |
$3,709.64 |
| Rate for Payer: Aetna Commercial |
$3,338.68
|
| Rate for Payer: ASR ASR |
$3,598.35
|
| Rate for Payer: ASR Commercial |
$3,598.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,022.99
|
| Rate for Payer: BCN Commercial |
$2,876.08
|
| Rate for Payer: Cash Price |
$2,967.71
|
| Rate for Payer: Cofinity Commercial |
$3,487.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,967.71
|
| Rate for Payer: Healthscope Commercial |
$3,709.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,598.35
|
| Rate for Payer: Mclaren Commercial |
$3,338.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,153.19
|
| Rate for Payer: Nomi Health Commercial |
$3,041.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,411.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,264.48
|
|
|
HC CT ABDOMEN AND PELVIS W CON
|
Facility
|
OP
|
$3,709.64
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
35200027
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$3,709.64 |
| Rate for Payer: Aetna Commercial |
$3,338.68
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$3,598.35
|
| Rate for Payer: ASR Commercial |
$3,598.35
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,037.82
|
| Rate for Payer: BCN Commercial |
$2,876.08
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$2,967.71
|
| Rate for Payer: Cash Price |
$2,967.71
|
| Rate for Payer: Cofinity Commercial |
$3,487.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,967.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$3,709.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,598.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$3,338.68
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,153.19
|
| Rate for Payer: Nomi Health Commercial |
$3,041.90
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,411.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,250.39
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,600.46
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,264.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
OP
|
$2,502.26
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$2,502.26 |
| Rate for Payer: Aetna Commercial |
$2,252.03
|
| Rate for Payer: Aetna Medicare |
$235.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.68
|
| Rate for Payer: ASR ASR |
$2,427.19
|
| Rate for Payer: ASR Commercial |
$2,427.19
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.10
|
| Rate for Payer: BCN Commercial |
$1,940.00
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$2,001.81
|
| Rate for Payer: Cash Price |
$2,001.81
|
| Rate for Payer: Cofinity Commercial |
$2,352.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,001.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$2,502.26
|
| Rate for Payer: Healthscope Whirlpool |
$2,427.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$2,252.03
|
| Rate for Payer: Mclaren Medicaid |
$126.36
|
| Rate for Payer: Mclaren Medicare |
$235.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.53
|
| Rate for Payer: Meridian Medicaid |
$132.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,126.92
|
| Rate for Payer: Nomi Health Commercial |
$2,051.85
|
| Rate for Payer: PACE Medicare |
$223.95
|
| Rate for Payer: PACE SWMI |
$235.74
|
| Rate for Payer: PHP Commercial |
$259.31
|
| Rate for Payer: PHP Medicaid |
$126.36
|
| Rate for Payer: PHP Medicare Advantage |
$235.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,192.48
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,754.08
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,201.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.74
|
| Rate for Payer: UHC Exchange |
$365.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.74
|
| Rate for Payer: UHCCP DNSP |
$235.74
|
| Rate for Payer: UHCCP Medicaid |
$126.36
|
| Rate for Payer: VA VA |
$235.74
|
|
|
HC CT ABDOMEN AND PELVIS WO CON
|
Facility
|
IP
|
$2,502.26
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
35200026
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,626.47 |
| Max. Negotiated Rate |
$2,502.26 |
| Rate for Payer: Aetna Commercial |
$2,252.03
|
| Rate for Payer: ASR ASR |
$2,427.19
|
| Rate for Payer: ASR Commercial |
$2,427.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.09
|
| Rate for Payer: BCN Commercial |
$1,940.00
|
| Rate for Payer: Cash Price |
$2,001.81
|
| Rate for Payer: Cofinity Commercial |
$2,352.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,001.81
|
| Rate for Payer: Healthscope Commercial |
$2,502.26
|
| Rate for Payer: Healthscope Whirlpool |
$2,427.19
|
| Rate for Payer: Mclaren Commercial |
$2,252.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,126.92
|
| Rate for Payer: Nomi Health Commercial |
$2,051.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,201.99
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
IP
|
$4,433.63
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,881.86 |
| Max. Negotiated Rate |
$4,433.63 |
| Rate for Payer: Aetna Commercial |
$3,990.27
|
| Rate for Payer: ASR ASR |
$4,300.62
|
| Rate for Payer: ASR Commercial |
$4,300.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,612.97
|
| Rate for Payer: BCN Commercial |
$3,437.39
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cofinity Commercial |
$4,167.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,546.90
|
| Rate for Payer: Healthscope Commercial |
$4,433.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,300.62
|
| Rate for Payer: Mclaren Commercial |
$3,990.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,768.59
|
| Rate for Payer: Nomi Health Commercial |
$3,635.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,881.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,901.59
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
OP
|
$4,433.63
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$4,433.63 |
| Rate for Payer: Aetna Commercial |
$3,990.27
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$4,300.62
|
| Rate for Payer: ASR Commercial |
$4,300.62
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,630.70
|
| Rate for Payer: BCN Commercial |
$3,437.39
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cofinity Commercial |
$4,167.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,546.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$4,433.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,300.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$3,990.27
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,768.59
|
| Rate for Payer: Nomi Health Commercial |
$3,635.58
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,881.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,884.75
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,107.97
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,901.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
OP
|
$1,097.42
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,097.42 |
| Rate for Payer: Aetna Commercial |
$987.68
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$1,064.50
|
| Rate for Payer: ASR Commercial |
$1,064.50
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$898.68
|
| Rate for Payer: BCN Commercial |
$850.83
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$1,031.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,097.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$987.68
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: Nomi Health Commercial |
$899.88
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$961.56
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$769.29
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
IP
|
$1,097.42
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$713.32 |
| Max. Negotiated Rate |
$1,097.42 |
| Rate for Payer: Aetna Commercial |
$987.68
|
| Rate for Payer: ASR ASR |
$1,064.50
|
| Rate for Payer: ASR Commercial |
$1,064.50
|
| Rate for Payer: BCBS Trust/PPO |
$894.29
|
| Rate for Payer: BCN Commercial |
$850.83
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$1,031.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Healthscope Commercial |
$1,097.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.50
|
| Rate for Payer: Mclaren Commercial |
$987.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: Nomi Health Commercial |
$899.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.73
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
OP
|
$1,959.75
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,959.75 |
| Rate for Payer: Aetna Commercial |
$1,763.78
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$1,900.96
|
| Rate for Payer: ASR Commercial |
$1,900.96
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.84
|
| Rate for Payer: BCN Commercial |
$1,519.39
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cofinity Commercial |
$1,842.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,959.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,763.78
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.79
|
| Rate for Payer: Nomi Health Commercial |
$1,606.99
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,717.13
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,373.78
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
IP
|
$1,959.75
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,273.84 |
| Max. Negotiated Rate |
$1,959.75 |
| Rate for Payer: Aetna Commercial |
$1,763.78
|
| Rate for Payer: ASR ASR |
$1,900.96
|
| Rate for Payer: ASR Commercial |
$1,900.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,597.00
|
| Rate for Payer: BCN Commercial |
$1,519.39
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cofinity Commercial |
$1,842.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.80
|
| Rate for Payer: Healthscope Commercial |
$1,959.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.96
|
| Rate for Payer: Mclaren Commercial |
$1,763.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.79
|
| Rate for Payer: Nomi Health Commercial |
$1,606.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.58
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
IP
|
$1,606.90
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,044.48 |
| Max. Negotiated Rate |
$1,606.90 |
| Rate for Payer: Aetna Commercial |
$1,446.21
|
| Rate for Payer: ASR ASR |
$1,558.69
|
| Rate for Payer: ASR Commercial |
$1,558.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.46
|
| Rate for Payer: BCN Commercial |
$1,245.83
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cofinity Commercial |
$1,510.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.52
|
| Rate for Payer: Healthscope Commercial |
$1,606.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.69
|
| Rate for Payer: Mclaren Commercial |
$1,446.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.87
|
| Rate for Payer: Nomi Health Commercial |
$1,317.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,414.07
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
OP
|
$1,606.90
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,606.90 |
| Rate for Payer: Aetna Commercial |
$1,446.21
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$1,558.69
|
| Rate for Payer: ASR Commercial |
$1,558.69
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.89
|
| Rate for Payer: BCN Commercial |
$1,245.83
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cofinity Commercial |
$1,510.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,606.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,446.21
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.87
|
| Rate for Payer: Nomi Health Commercial |
$1,317.66
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,407.97
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.44
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,414.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
OP
|
$2,453.63
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$2,453.63 |
| Rate for Payer: Aetna Commercial |
$2,208.27
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$2,380.02
|
| Rate for Payer: ASR Commercial |
$2,380.02
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.28
|
| Rate for Payer: BCN Commercial |
$1,902.30
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cofinity Commercial |
$2,306.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,962.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,453.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,380.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$2,208.27
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.59
|
| Rate for Payer: Nomi Health Commercial |
$2,011.98
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,149.87
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,719.99
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,159.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
IP
|
$2,453.63
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,594.86 |
| Max. Negotiated Rate |
$2,453.63 |
| Rate for Payer: Aetna Commercial |
$2,208.27
|
| Rate for Payer: ASR ASR |
$2,380.02
|
| Rate for Payer: ASR Commercial |
$2,380.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,999.46
|
| Rate for Payer: BCN Commercial |
$1,902.30
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cofinity Commercial |
$2,306.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,962.90
|
| Rate for Payer: Healthscope Commercial |
$2,453.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,380.02
|
| Rate for Payer: Mclaren Commercial |
$2,208.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.59
|
| Rate for Payer: Nomi Health Commercial |
$2,011.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,159.19
|
|
