|
HC CT SOFT TISS NECK WO CON
|
Facility
|
OP
|
$1,383.22
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
35000001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,383.22 |
| Rate for Payer: Aetna Commercial |
$1,244.90
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,341.72
|
| Rate for Payer: ASR Commercial |
$1,341.72
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.72
|
| Rate for Payer: BCN Commercial |
$1,072.41
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$1,300.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,106.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,383.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,341.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,244.90
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,175.74
|
| Rate for Payer: Nomi Health Commercial |
$1,134.24
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.37
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$720.30
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,217.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
OP
|
$1,881.46
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,881.46 |
| Rate for Payer: Aetna Commercial |
$1,693.31
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,825.02
|
| Rate for Payer: ASR Commercial |
$1,825.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.73
|
| Rate for Payer: BCN Commercial |
$1,458.70
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,505.17
|
| Rate for Payer: Cash Price |
$1,505.17
|
| Rate for Payer: Cofinity Commercial |
$1,768.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,505.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,881.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,825.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,693.31
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,599.24
|
| Rate for Payer: Nomi Health Commercial |
$1,542.80
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,043.11
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$834.49
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,655.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SOFT TISS NECK WO W CON
|
Facility
|
IP
|
$1,881.46
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,222.95 |
| Max. Negotiated Rate |
$1,881.46 |
| Rate for Payer: Aetna Commercial |
$1,693.31
|
| Rate for Payer: ASR ASR |
$1,825.02
|
| Rate for Payer: ASR Commercial |
$1,825.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,533.20
|
| Rate for Payer: BCN Commercial |
$1,458.70
|
| Rate for Payer: Cash Price |
$1,505.17
|
| Rate for Payer: Cofinity Commercial |
$1,768.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,505.17
|
| Rate for Payer: Healthscope Commercial |
$1,881.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,825.02
|
| Rate for Payer: Mclaren Commercial |
$1,693.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,599.24
|
| Rate for Payer: Nomi Health Commercial |
$1,542.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,655.68
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
IP
|
$1,938.61
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,260.10 |
| Max. Negotiated Rate |
$1,938.61 |
| Rate for Payer: Aetna Commercial |
$1,744.75
|
| Rate for Payer: ASR ASR |
$1,880.45
|
| Rate for Payer: ASR Commercial |
$1,880.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.77
|
| Rate for Payer: BCN Commercial |
$1,503.00
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,822.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Healthscope Commercial |
$1,938.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.45
|
| Rate for Payer: Mclaren Commercial |
$1,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.82
|
| Rate for Payer: Nomi Health Commercial |
$1,589.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.98
|
|
|
HC CT SPINE CERVICAL W CON
|
Facility
|
OP
|
$1,938.61
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
35200004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,938.61 |
| Rate for Payer: Aetna Commercial |
$1,744.75
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,880.45
|
| Rate for Payer: ASR Commercial |
$1,880.45
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.53
|
| Rate for Payer: BCN Commercial |
$1,503.00
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cash Price |
$1,550.89
|
| Rate for Payer: Cofinity Commercial |
$1,822.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,550.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,938.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,880.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,744.75
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,647.82
|
| Rate for Payer: Nomi Health Commercial |
$1,589.66
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,040.92
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$832.74
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,705.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| Rate for Payer: ASR ASR |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.44
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
|
|
HC CT SPINE CERVICAL WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
35200003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.91
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$898.18
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$718.54
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.12
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,184.20
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$947.36
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SPINE CERVICAL WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,432.02 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| Rate for Payer: ASR ASR |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,795.31
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,285.30 |
| 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: ASR Commercial |
$1,918.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.37
|
| Rate for Payer: BCN Commercial |
$1,533.06
|
| 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 |
$1,977.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.06
|
| 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: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
|
|
HC CT SPINE LUMBAR W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
35200008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,977.38 |
| Rate for Payer: Aetna Commercial |
$1,779.64
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,918.06
|
| Rate for Payer: ASR Commercial |
$1,918.06
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.28
|
| Rate for Payer: BCN Commercial |
$1,533.06
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| 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 |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,977.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,779.64
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,352.75
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,082.20
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.91
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,314.32
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,051.46
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT SPINE LUMBAR WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| Rate for Payer: ASR ASR |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.44
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,432.02 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| Rate for Payer: ASR ASR |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,795.31
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
|
|
HC CT SPINE LUMBAR WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
35200009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.12
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,430.71
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.57
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,977.38 |
| Rate for Payer: Aetna Commercial |
$1,779.64
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,918.06
|
| Rate for Payer: ASR Commercial |
$1,918.06
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.28
|
| Rate for Payer: BCN Commercial |
$1,533.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| 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 |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,977.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,779.64
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,342.86
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,074.29
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SPINE THORACIC W CON
|
Facility
|
IP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,285.30 |
| 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: ASR Commercial |
$1,918.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.37
|
| Rate for Payer: BCN Commercial |
$1,533.06
|
| 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 |
$1,977.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.06
|
| 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: Priority Health Cigna Priority Health |
$1,285.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
IP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| Rate for Payer: ASR ASR |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.44
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
|
|
HC CT SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.91
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cash Price |
$1,294.34
|
| Rate for Payer: Cofinity Commercial |
$1,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.60
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,040.48
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.12
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,448.82
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.06
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT SPINE THORACIC WO W CON
|
Facility
|
IP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,432.02 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| Rate for Payer: ASR ASR |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,795.31
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: Cash Price |
$1,762.48
|
| Rate for Payer: Cofinity Commercial |
$2,070.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,762.48
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,872.64
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
IP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,192.93 |
| Max. Negotiated Rate |
$1,835.27 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: ASR ASR |
$1,780.21
|
| Rate for Payer: ASR Commercial |
$1,780.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.56
|
| Rate for Payer: BCN Commercial |
$1,422.88
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cofinity Commercial |
$1,725.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.22
|
| Rate for Payer: Healthscope Commercial |
$1,835.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.21
|
| Rate for Payer: Mclaren Commercial |
$1,651.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.98
|
| Rate for Payer: Nomi Health Commercial |
$1,504.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,615.04
|
|
|
HC CT UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,835.27 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,780.21
|
| Rate for Payer: ASR Commercial |
$1,780.21
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.90
|
| Rate for Payer: BCN Commercial |
$1,422.88
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cash Price |
$1,468.22
|
| Rate for Payer: Cofinity Commercial |
$1,725.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,468.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,835.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,651.74
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.98
|
| Rate for Payer: Nomi Health Commercial |
$1,504.92
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.40
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$657.92
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,615.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
OP
|
$1,450.32
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,450.32 |
| Rate for Payer: Aetna Commercial |
$1,305.29
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,406.81
|
| Rate for Payer: ASR Commercial |
$1,406.81
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,187.67
|
| Rate for Payer: BCN Commercial |
$1,124.43
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cofinity Commercial |
$1,363.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,450.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,305.29
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.77
|
| Rate for Payer: Nomi Health Commercial |
$1,189.26
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,236.36
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$989.09
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,276.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT UPPER EXTREMITY W CON
|
Facility
|
IP
|
$1,450.32
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
35200014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.71 |
| Max. Negotiated Rate |
$1,450.32 |
| Rate for Payer: Aetna Commercial |
$1,305.29
|
| Rate for Payer: ASR ASR |
$1,406.81
|
| Rate for Payer: ASR Commercial |
$1,406.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.87
|
| Rate for Payer: BCN Commercial |
$1,124.43
|
| Rate for Payer: Cash Price |
$1,160.26
|
| Rate for Payer: Cofinity Commercial |
$1,363.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.26
|
| Rate for Payer: Healthscope Commercial |
$1,450.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.81
|
| Rate for Payer: Mclaren Commercial |
$1,305.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,232.77
|
| Rate for Payer: Nomi Health Commercial |
$1,189.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,276.28
|
|
