|
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 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 CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
35200007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| 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 |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.91
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| 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 |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| 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 |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,417.62
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.16
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
| 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 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 |
$93.06 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| 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 |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.12
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| 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 |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| 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 |
$1,872.63
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| 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 |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,930.36
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.37
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
| 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 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 |
$1,872.63
|
| 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 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 W CON
|
Facility
|
OP
|
$1,977.38
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
35200006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,977.38 |
| Rate for Payer: Aetna Commercial |
$1,779.64
|
| 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 |
$1,918.06
|
| Rate for Payer: ASR Commercial |
$1,918.06
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,619.28
|
| Rate for Payer: BCN Commercial |
$1,533.06
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cash Price |
$1,581.90
|
| Rate for Payer: Cofinity Commercial |
$1,858.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,581.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,977.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,918.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,779.64
|
| 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 |
$1,680.77
|
| Rate for Payer: Nomi Health Commercial |
$1,621.45
|
| 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 |
$1,285.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,732.58
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,386.14
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,740.09
|
| 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 SPINE THORACIC WO CON
|
Facility
|
OP
|
$1,617.92
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
35200005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,617.92 |
| Rate for Payer: Aetna Commercial |
$1,456.13
|
| 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 |
$1,569.38
|
| Rate for Payer: ASR Commercial |
$1,569.38
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.91
|
| Rate for Payer: BCN Commercial |
$1,254.37
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,617.92
|
| Rate for Payer: Healthscope Whirlpool |
$1,569.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,456.13
|
| 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 |
$1,375.23
|
| Rate for Payer: Nomi Health Commercial |
$1,326.69
|
| 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 |
$1,051.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,417.62
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.16
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,423.77
|
| 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 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 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 |
$1,872.63
|
| 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 THORACIC WO W CON
|
Facility
|
OP
|
$2,203.10
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
35000008
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$2,203.10 |
| Rate for Payer: Aetna Commercial |
$1,982.79
|
| 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 |
$2,137.01
|
| Rate for Payer: ASR Commercial |
$2,137.01
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.12
|
| Rate for Payer: BCN Commercial |
$1,708.06
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| 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 |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,203.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,137.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,982.79
|
| 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 |
$1,872.63
|
| Rate for Payer: Nomi Health Commercial |
$1,806.54
|
| 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 |
$1,432.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,930.36
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,544.37
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,938.73
|
| 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 UPPER EXTREM ANGIO
|
Facility
|
OP
|
$1,835.27
|
|
|
Service Code
|
CPT 73206
|
| Hospital Charge Code |
35000010
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,835.27 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| 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 |
$1,780.21
|
| Rate for Payer: ASR Commercial |
$1,780.21
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.90
|
| Rate for Payer: BCN Commercial |
$1,422.88
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| 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 |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,835.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,651.74
|
| 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 |
$1,559.98
|
| Rate for Payer: Nomi Health Commercial |
$1,504.92
|
| 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 |
$1,192.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,608.06
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,286.52
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,615.04
|
| 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 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 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
|
|
|
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 |
$186.69 |
| Max. Negotiated Rate |
$1,450.32 |
| Rate for Payer: Aetna Commercial |
$1,305.29
|
| 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 |
$1,406.81
|
| Rate for Payer: ASR Commercial |
$1,406.81
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,187.67
|
| Rate for Payer: BCN Commercial |
$1,124.43
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| 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 |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,450.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,406.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$1,305.29
|
| 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 |
$1,232.77
|
| Rate for Payer: Nomi Health Commercial |
$1,189.26
|
| 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 |
$942.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,270.77
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,016.67
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,276.28
|
| 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 UPPER EXTREMITY WO CON
|
Facility
|
IP
|
$1,215.19
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$789.87 |
| Max. Negotiated Rate |
$1,215.19 |
| Rate for Payer: Aetna Commercial |
$1,093.67
|
| Rate for Payer: ASR ASR |
$1,178.73
|
| Rate for Payer: ASR Commercial |
$1,178.73
|
| Rate for Payer: BCBS Trust/PPO |
$990.26
|
| Rate for Payer: BCN Commercial |
$942.14
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cofinity Commercial |
$1,142.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.15
|
| Rate for Payer: Healthscope Commercial |
$1,215.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.73
|
| Rate for Payer: Mclaren Commercial |
$1,093.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,032.91
|
| Rate for Payer: Nomi Health Commercial |
$996.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.37
|
|
|
HC CT UPPER EXTREMITY WO CON
|
Facility
|
OP
|
$1,215.19
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
35200013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,215.19 |
| Rate for Payer: Aetna Commercial |
$1,093.67
|
| 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 |
$1,178.73
|
| Rate for Payer: ASR Commercial |
$1,178.73
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$995.12
|
| Rate for Payer: BCN Commercial |
$942.14
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cash Price |
$972.15
|
| Rate for Payer: Cofinity Commercial |
$1,142.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,215.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,178.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,093.67
|
| 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 |
$1,032.91
|
| Rate for Payer: Nomi Health Commercial |
$996.46
|
| 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 |
$789.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,064.75
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$851.85
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,069.37
|
| 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 UPPER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,690.85
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,099.05 |
| Max. Negotiated Rate |
$1,690.85 |
| Rate for Payer: Aetna Commercial |
$1,521.77
|
| Rate for Payer: ASR ASR |
$1,640.12
|
| Rate for Payer: ASR Commercial |
$1,640.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.87
|
| Rate for Payer: BCN Commercial |
$1,310.92
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cofinity Commercial |
$1,589.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.68
|
| Rate for Payer: Healthscope Commercial |
$1,690.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,640.12
|
| Rate for Payer: Mclaren Commercial |
$1,521.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.22
|
| Rate for Payer: Nomi Health Commercial |
$1,386.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.95
|
|
|
HC CT UPPER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,690.85
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
35200015
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,690.85 |
| Rate for Payer: Aetna Commercial |
$1,521.77
|
| 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 |
$1,640.12
|
| Rate for Payer: ASR Commercial |
$1,640.12
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.64
|
| Rate for Payer: BCN Commercial |
$1,310.92
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cash Price |
$1,352.68
|
| Rate for Payer: Cofinity Commercial |
$1,589.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,690.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,640.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,521.77
|
| 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 |
$1,437.22
|
| Rate for Payer: Nomi Health Commercial |
$1,386.50
|
| 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 |
$1,099.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,481.52
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,185.29
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.95
|
| 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 VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
OP
|
$1,013.98
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$1,013.98 |
| Rate for Payer: Aetna Commercial |
$912.58
|
| 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 |
$983.56
|
| Rate for Payer: ASR Commercial |
$983.56
|
| Rate for Payer: BCBS Complete |
$132.67
|
| Rate for Payer: BCBS MAPPO |
$235.74
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$786.14
|
| Rate for Payer: BCN Medicare Advantage |
$235.74
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cofinity Commercial |
$953.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.74
|
| Rate for Payer: Healthscope Commercial |
$1,013.98
|
| Rate for Payer: Healthscope Whirlpool |
$983.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$235.74
|
| Rate for Payer: Mclaren Commercial |
$912.58
|
| 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 |
$861.88
|
| Rate for Payer: Nomi Health Commercial |
$831.46
|
| 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 |
$659.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.45
|
| Rate for Payer: Priority Health Medicare |
$235.74
|
| Rate for Payer: Priority Health Narrow Network |
$710.80
|
| Rate for Payer: Railroad Medicare Medicare |
$235.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$892.30
|
| 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 VIRTUAL COLONOSCOPY SCREENING
|
Facility
|
IP
|
$1,013.98
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
35000014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$659.09 |
| Max. Negotiated Rate |
$1,013.98 |
| Rate for Payer: Aetna Commercial |
$912.58
|
| Rate for Payer: ASR ASR |
$983.56
|
| Rate for Payer: ASR Commercial |
$983.56
|
| Rate for Payer: BCBS Trust/PPO |
$826.29
|
| Rate for Payer: BCN Commercial |
$786.14
|
| Rate for Payer: Cash Price |
$811.18
|
| Rate for Payer: Cofinity Commercial |
$953.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.18
|
| Rate for Payer: Healthscope Commercial |
$1,013.98
|
| Rate for Payer: Healthscope Whirlpool |
$983.56
|
| Rate for Payer: Mclaren Commercial |
$912.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$861.88
|
| Rate for Payer: Nomi Health Commercial |
$831.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$892.30
|
|
|
HC CT VIRTUAL COLON W CON DIAG
|
Facility
|
IP
|
$1,286.53
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$836.24 |
| Max. Negotiated Rate |
$1,286.53 |
| Rate for Payer: Aetna Commercial |
$1,157.88
|
| Rate for Payer: ASR ASR |
$1,247.93
|
| Rate for Payer: ASR Commercial |
$1,247.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.39
|
| Rate for Payer: BCN Commercial |
$997.45
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cofinity Commercial |
$1,209.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.22
|
| Rate for Payer: Healthscope Commercial |
$1,286.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,247.93
|
| Rate for Payer: Mclaren Commercial |
$1,157.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,093.55
|
| Rate for Payer: Nomi Health Commercial |
$1,054.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.15
|
|
|
HC CT VIRTUAL COLON W CON DIAG
|
Facility
|
OP
|
$1,286.53
|
|
|
Service Code
|
CPT 74262
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,286.53 |
| Rate for Payer: Aetna Commercial |
$1,157.88
|
| 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 |
$1,247.93
|
| Rate for Payer: ASR Commercial |
$1,247.93
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.54
|
| Rate for Payer: BCN Commercial |
$997.45
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cofinity Commercial |
$1,209.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,286.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,247.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,157.88
|
| 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 |
$1,093.55
|
| Rate for Payer: Nomi Health Commercial |
$1,054.95
|
| 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 |
$836.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,127.26
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$901.86
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.15
|
| 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 VIRTUAL COLON WO CON DIAG
|
Facility
|
IP
|
$1,286.53
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
35000012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$836.24 |
| Max. Negotiated Rate |
$1,286.53 |
| Rate for Payer: Aetna Commercial |
$1,157.88
|
| Rate for Payer: ASR ASR |
$1,247.93
|
| Rate for Payer: ASR Commercial |
$1,247.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.39
|
| Rate for Payer: BCN Commercial |
$997.45
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cofinity Commercial |
$1,209.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.22
|
| Rate for Payer: Healthscope Commercial |
$1,286.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,247.93
|
| Rate for Payer: Mclaren Commercial |
$1,157.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,093.55
|
| Rate for Payer: Nomi Health Commercial |
$1,054.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.15
|
|
|
HC CT VIRTUAL COLON WO CON DIAG
|
Facility
|
OP
|
$1,286.53
|
|
|
Service Code
|
CPT 74261
|
| Hospital Charge Code |
35000012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,286.53 |
| Rate for Payer: Aetna Commercial |
$1,157.88
|
| 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 |
$1,247.93
|
| Rate for Payer: ASR Commercial |
$1,247.93
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.54
|
| Rate for Payer: BCN Commercial |
$997.45
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cash Price |
$1,029.22
|
| Rate for Payer: Cofinity Commercial |
$1,209.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,029.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,286.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,247.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,157.88
|
| 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 |
$1,093.55
|
| Rate for Payer: Nomi Health Commercial |
$1,054.95
|
| 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 |
$836.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,127.26
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$901.86
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,132.15
|
| 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
|
|
