|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$674.37 |
| Max. Negotiated Rate |
$1,037.49 |
| Rate for Payer: Aetna Commercial |
$933.74
|
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: ASR ASR |
$1,006.37
|
| Rate for Payer: ASR Commercial |
$670.91
|
| Rate for Payer: ASR Commercial |
$1,006.37
|
| Rate for Payer: BCBS Trust/PPO |
$563.63
|
| Rate for Payer: BCBS Trust/PPO |
$845.45
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: BCN Commercial |
$804.37
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$1,037.49
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.37
|
| Rate for Payer: Mclaren Commercial |
$933.74
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: Nomi Health Commercial |
$567.16
|
| Rate for Payer: Nomi Health Commercial |
$850.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
|
|
HC CT NECK ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.07 |
| Max. Negotiated Rate |
$1,092.42 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: ASR ASR |
$1,059.65
|
| Rate for Payer: ASR Commercial |
$1,059.65
|
| Rate for Payer: BCBS Trust/PPO |
$890.21
|
| Rate for Payer: BCN Commercial |
$846.95
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$1,026.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$1,092.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,059.65
|
| Rate for Payer: Mclaren Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.33
|
|
|
HC CT NECK ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,092.42 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| 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 |
$1,059.65
|
| Rate for Payer: ASR Commercial |
$1,059.65
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$894.58
|
| Rate for Payer: BCN Commercial |
$846.95
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$1,026.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,092.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,059.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$983.18
|
| 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 |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| 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 |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.18
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$765.79
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.33
|
| 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 NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$8,942.60 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: Aetna Medicare |
$5,769.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,152.34
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,769.42
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$6,346.36
|
| Rate for Payer: PHP Medicaid |
$3,092.41
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,372.91
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,698.49
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$8,942.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP DNSP |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,849.48 |
| Rate for Payer: Aetna Commercial |
$3,464.53
|
| Rate for Payer: ASR ASR |
$3,734.00
|
| Rate for Payer: ASR Commercial |
$3,734.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,136.94
|
| Rate for Payer: BCN Commercial |
$2,984.50
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,618.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,849.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,734.00
|
| Rate for Payer: Mclaren Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,387.54
|
|
|
HC CTO CATHETER
|
Facility
|
OP
|
$6,462.07
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,584.83 |
| Max. Negotiated Rate |
$6,462.07 |
| Rate for Payer: Aetna Commercial |
$5,815.86
|
| Rate for Payer: Aetna Medicare |
$3,231.03
|
| Rate for Payer: ASR ASR |
$6,268.21
|
| Rate for Payer: ASR Commercial |
$6,268.21
|
| Rate for Payer: BCBS Complete |
$2,584.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,291.79
|
| Rate for Payer: BCN Commercial |
$5,010.04
|
| Rate for Payer: Cash Price |
$5,169.66
|
| Rate for Payer: Cofinity Commercial |
$6,074.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,169.66
|
| Rate for Payer: Healthscope Commercial |
$6,462.07
|
| Rate for Payer: Healthscope Whirlpool |
$6,268.21
|
| Rate for Payer: Mclaren Commercial |
$5,815.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.76
|
| Rate for Payer: Nomi Health Commercial |
$5,298.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,200.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,662.07
|
| Rate for Payer: Priority Health Narrow Network |
$4,529.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,686.62
|
|
|
HC CTO CATHETER
|
Facility
|
IP
|
$6,462.07
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,200.35 |
| Max. Negotiated Rate |
$6,462.07 |
| Rate for Payer: Aetna Commercial |
$5,815.86
|
| Rate for Payer: ASR ASR |
$6,268.21
|
| Rate for Payer: ASR Commercial |
$6,268.21
|
| Rate for Payer: BCBS Trust/PPO |
$5,265.94
|
| Rate for Payer: BCN Commercial |
$5,010.04
|
| Rate for Payer: Cash Price |
$5,169.66
|
| Rate for Payer: Cofinity Commercial |
$6,074.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,169.66
|
| Rate for Payer: Healthscope Commercial |
$6,462.07
|
| Rate for Payer: Healthscope Whirlpool |
$6,268.21
|
| Rate for Payer: Mclaren Commercial |
$5,815.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.76
|
| Rate for Payer: Nomi Health Commercial |
$5,298.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,200.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,686.62
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
OP
|
$1,579.64
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,579.64 |
| Rate for Payer: Aetna Commercial |
$1,421.68
|
| 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 |
$1,532.25
|
| Rate for Payer: ASR Commercial |
$1,532.25
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,293.57
|
| Rate for Payer: BCN Commercial |
$1,224.69
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cofinity Commercial |
$1,484.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,579.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,421.68
|
| 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 |
$1,342.69
|
| Rate for Payer: Nomi Health Commercial |
$1,295.30
|
| 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 |
$1,026.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,384.08
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.33
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.08
|
| 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 ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
IP
|
$1,579.64
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,026.77 |
| Max. Negotiated Rate |
$1,579.64 |
| Rate for Payer: Aetna Commercial |
$1,421.68
|
| Rate for Payer: ASR ASR |
$1,532.25
|
| Rate for Payer: ASR Commercial |
$1,532.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.25
|
| Rate for Payer: BCN Commercial |
$1,224.69
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cofinity Commercial |
$1,484.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.71
|
| Rate for Payer: Healthscope Commercial |
$1,579.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.25
|
| Rate for Payer: Mclaren Commercial |
$1,421.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,342.69
|
| Rate for Payer: Nomi Health Commercial |
$1,295.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.08
|
|
|
HC CT ORBIT WO CON
|
Facility
|
OP
|
$1,435.44
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,435.44 |
| Rate for Payer: Aetna Commercial |
$1,291.90
|
| 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 |
$1,392.38
|
| Rate for Payer: ASR Commercial |
$1,392.38
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.48
|
| Rate for Payer: BCN Commercial |
$1,112.90
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cofinity Commercial |
$1,349.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,435.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,392.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,291.90
|
| 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 |
$1,220.12
|
| Rate for Payer: Nomi Health Commercial |
$1,177.06
|
| 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 |
$933.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,257.73
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,006.24
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,263.19
|
| 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 ORBIT WO CON
|
Facility
|
IP
|
$1,435.44
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$933.04 |
| Max. Negotiated Rate |
$1,435.44 |
| Rate for Payer: Aetna Commercial |
$1,291.90
|
| Rate for Payer: ASR ASR |
$1,392.38
|
| Rate for Payer: ASR Commercial |
$1,392.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.74
|
| Rate for Payer: BCN Commercial |
$1,112.90
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cofinity Commercial |
$1,349.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.35
|
| Rate for Payer: Healthscope Commercial |
$1,435.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,392.38
|
| Rate for Payer: Mclaren Commercial |
$1,291.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.12
|
| Rate for Payer: Nomi Health Commercial |
$1,177.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,263.19
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
OP
|
$1,498.69
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,498.69 |
| Rate for Payer: Aetna Commercial |
$1,348.82
|
| 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 |
$1,453.73
|
| Rate for Payer: ASR Commercial |
$1,453.73
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.28
|
| Rate for Payer: BCN Commercial |
$1,161.93
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,408.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,498.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,453.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,348.82
|
| 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 |
$1,273.89
|
| Rate for Payer: Nomi Health Commercial |
$1,228.93
|
| 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 |
$974.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,313.15
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,050.58
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,318.85
|
| 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 ORBIT WO W CON
|
Facility
|
IP
|
$1,498.69
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$974.15 |
| Max. Negotiated Rate |
$1,498.69 |
| Rate for Payer: Aetna Commercial |
$1,348.82
|
| Rate for Payer: ASR ASR |
$1,453.73
|
| Rate for Payer: ASR Commercial |
$1,453.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.28
|
| Rate for Payer: BCN Commercial |
$1,161.93
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,408.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Healthscope Commercial |
$1,498.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,453.73
|
| Rate for Payer: Mclaren Commercial |
$1,348.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.89
|
| Rate for Payer: Nomi Health Commercial |
$1,228.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,318.85
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
OP
|
$1,949.22
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,754.30
|
| 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 |
$1,890.74
|
| Rate for Payer: ASR Commercial |
$1,890.74
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.22
|
| Rate for Payer: BCN Commercial |
$1,511.23
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,832.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,949.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,890.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,754.30
|
| 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 |
$1,656.84
|
| Rate for Payer: Nomi Health Commercial |
$1,598.36
|
| 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 |
$1,266.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,707.91
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,366.40
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,715.31
|
| 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 PELVIS ANGIO
|
Facility
|
IP
|
$1,949.22
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,266.99 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,754.30
|
| Rate for Payer: ASR ASR |
$1,890.74
|
| Rate for Payer: ASR Commercial |
$1,890.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.42
|
| Rate for Payer: BCN Commercial |
$1,511.23
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,832.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Healthscope Commercial |
$1,949.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,890.74
|
| Rate for Payer: Mclaren Commercial |
$1,754.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,656.84
|
| Rate for Payer: Nomi Health Commercial |
$1,598.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,715.31
|
|
|
HC CT PELVIS W CON
|
Facility
|
OP
|
$1,936.78
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,936.78 |
| Rate for Payer: Aetna Commercial |
$1,743.10
|
| 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 |
$1,878.68
|
| Rate for Payer: ASR Commercial |
$1,878.68
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.03
|
| Rate for Payer: BCN Commercial |
$1,501.59
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,549.42
|
| Rate for Payer: Cash Price |
$1,549.42
|
| Rate for Payer: Cofinity Commercial |
$1,820.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,936.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,878.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,743.10
|
| 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 |
$1,646.26
|
| Rate for Payer: Nomi Health Commercial |
$1,588.16
|
| 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 |
$1,258.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,697.01
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,357.68
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,704.37
|
| 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 PELVIS W CON
|
Facility
|
IP
|
$1,936.78
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
35200011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,258.91 |
| Max. Negotiated Rate |
$1,936.78 |
| Rate for Payer: Aetna Commercial |
$1,743.10
|
| Rate for Payer: ASR ASR |
$1,878.68
|
| Rate for Payer: ASR Commercial |
$1,878.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,578.28
|
| Rate for Payer: BCN Commercial |
$1,501.59
|
| Rate for Payer: Cash Price |
$1,549.42
|
| Rate for Payer: Cofinity Commercial |
$1,820.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.42
|
| Rate for Payer: Healthscope Commercial |
$1,936.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,878.68
|
| Rate for Payer: Mclaren Commercial |
$1,743.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,646.26
|
| Rate for Payer: Nomi Health Commercial |
$1,588.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,258.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,704.37
|
|
|
HC CT PELVIS WO CON
|
Facility
|
OP
|
$1,420.15
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,420.15 |
| Rate for Payer: Aetna Commercial |
$1,278.13
|
| 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 |
$1,377.55
|
| Rate for Payer: ASR Commercial |
$1,377.55
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.96
|
| Rate for Payer: BCN Commercial |
$1,101.04
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,334.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,420.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,278.13
|
| 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 |
$1,207.13
|
| Rate for Payer: Nomi Health Commercial |
$1,164.52
|
| 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 |
$923.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,244.34
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$995.53
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.73
|
| 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 PELVIS WO CON
|
Facility
|
IP
|
$1,420.15
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
35200010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$923.10 |
| Max. Negotiated Rate |
$1,420.15 |
| Rate for Payer: Aetna Commercial |
$1,278.13
|
| Rate for Payer: ASR ASR |
$1,377.55
|
| Rate for Payer: ASR Commercial |
$1,377.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.28
|
| Rate for Payer: BCN Commercial |
$1,101.04
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,334.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.12
|
| Rate for Payer: Healthscope Commercial |
$1,420.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,377.55
|
| Rate for Payer: Mclaren Commercial |
$1,278.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.13
|
| Rate for Payer: Nomi Health Commercial |
$1,164.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,249.73
|
|
|
HC CT PELVIS WO W CON
|
Facility
|
OP
|
$2,205.70
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$2,205.70 |
| Rate for Payer: Aetna Commercial |
$1,985.13
|
| 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 |
$2,139.53
|
| Rate for Payer: ASR Commercial |
$2,139.53
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,806.25
|
| Rate for Payer: BCN Commercial |
$1,710.08
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,764.56
|
| Rate for Payer: Cash Price |
$1,764.56
|
| Rate for Payer: Cofinity Commercial |
$2,073.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,205.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,139.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,985.13
|
| 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 |
$1,874.85
|
| Rate for Payer: Nomi Health Commercial |
$1,808.67
|
| 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 |
$1,433.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.63
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,546.20
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,941.02
|
| 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 PELVIS WO W CON
|
Facility
|
IP
|
$2,205.70
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
35200012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,433.70 |
| Max. Negotiated Rate |
$2,205.70 |
| Rate for Payer: Aetna Commercial |
$1,985.13
|
| Rate for Payer: ASR ASR |
$2,139.53
|
| Rate for Payer: ASR Commercial |
$2,139.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,797.42
|
| Rate for Payer: BCN Commercial |
$1,710.08
|
| Rate for Payer: Cash Price |
$1,764.56
|
| Rate for Payer: Cofinity Commercial |
$2,073.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.56
|
| Rate for Payer: Healthscope Commercial |
$2,205.70
|
| Rate for Payer: Healthscope Whirlpool |
$2,139.53
|
| Rate for Payer: Mclaren Commercial |
$1,985.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,874.85
|
| Rate for Payer: Nomi Health Commercial |
$1,808.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,941.02
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
IP
|
$983.98
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.59 |
| Max. Negotiated Rate |
$983.98 |
| Rate for Payer: Aetna Commercial |
$885.58
|
| Rate for Payer: ASR ASR |
$954.46
|
| Rate for Payer: ASR Commercial |
$954.46
|
| Rate for Payer: BCBS Trust/PPO |
$801.85
|
| Rate for Payer: BCN Commercial |
$762.88
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cofinity Commercial |
$924.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.18
|
| Rate for Payer: Healthscope Commercial |
$983.98
|
| Rate for Payer: Healthscope Whirlpool |
$954.46
|
| Rate for Payer: Mclaren Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.38
|
| Rate for Payer: Nomi Health Commercial |
$806.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$865.90
|
|
|
HC CT PLEURAL FIBRINOLYSIS INITIAL
|
Facility
|
OP
|
$983.98
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
36100323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$983.98 |
| Rate for Payer: Aetna Commercial |
$885.58
|
| Rate for Payer: Aetna Medicare |
$602.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: ASR ASR |
$954.46
|
| Rate for Payer: ASR Commercial |
$954.46
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCBS Trust/PPO |
$805.78
|
| Rate for Payer: BCN Commercial |
$762.88
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cofinity Commercial |
$924.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$983.98
|
| Rate for Payer: Healthscope Whirlpool |
$954.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$602.98
|
| Rate for Payer: Mclaren Commercial |
$885.58
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.38
|
| Rate for Payer: Nomi Health Commercial |
$806.86
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$663.28
|
| Rate for Payer: PHP Medicaid |
$323.20
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.16
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health Narrow Network |
$689.77
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$865.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$934.62
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP DNSP |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
HC CT PLEURAL FIBRINOLYSIS SUB DAY
|
Facility
|
OP
|
$983.98
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
36100322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$983.98 |
| Rate for Payer: Aetna Commercial |
$885.58
|
| Rate for Payer: Aetna Medicare |
$602.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: ASR ASR |
$954.46
|
| Rate for Payer: ASR Commercial |
$954.46
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCBS Trust/PPO |
$805.78
|
| Rate for Payer: BCN Commercial |
$762.88
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cofinity Commercial |
$924.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$983.98
|
| Rate for Payer: Healthscope Whirlpool |
$954.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$602.98
|
| Rate for Payer: Mclaren Commercial |
$885.58
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.38
|
| Rate for Payer: Nomi Health Commercial |
$806.86
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$663.28
|
| Rate for Payer: PHP Medicaid |
$323.20
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.16
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health Narrow Network |
$689.77
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$865.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$934.62
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP DNSP |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
HC CT PLEURAL FIBRINOLYSIS SUB DAY
|
Facility
|
IP
|
$983.98
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
36100322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.59 |
| Max. Negotiated Rate |
$983.98 |
| Rate for Payer: Aetna Commercial |
$885.58
|
| Rate for Payer: ASR ASR |
$954.46
|
| Rate for Payer: ASR Commercial |
$954.46
|
| Rate for Payer: BCBS Trust/PPO |
$801.85
|
| Rate for Payer: BCN Commercial |
$762.88
|
| Rate for Payer: Cash Price |
$787.18
|
| Rate for Payer: Cofinity Commercial |
$924.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.18
|
| Rate for Payer: Healthscope Commercial |
$983.98
|
| Rate for Payer: Healthscope Whirlpool |
$954.46
|
| Rate for Payer: Mclaren Commercial |
$885.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.38
|
| Rate for Payer: Nomi Health Commercial |
$806.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$865.90
|
|
