|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.55 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna Commercial |
$870.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.60
|
| Rate for Payer: BCBS Complete |
$409.60
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$125.76
|
| Rate for Payer: BCBS Trust/PPO |
$125.76
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Cofinity Commercial |
$880.64
|
| Rate for Payer: Cofinity Commercial |
$716.80
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$921.60
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$870.40
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$645.12
|
| Rate for Payer: Priority Health SBD |
$438.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.30
|
| Rate for Payer: UHC Exchange |
$117.55
|
| Rate for Payer: UHC Exchange |
$117.55
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,174.02
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$217.42 |
| Max. Negotiated Rate |
$1,056.62 |
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Aetna Commercial |
$2,003.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.05
|
| Rate for Payer: BCBS Complete |
$942.80
|
| Rate for Payer: BCBS Complete |
$469.61
|
| Rate for Payer: BCBS Trust/PPO |
$269.73
|
| Rate for Payer: BCBS Trust/PPO |
$269.73
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cofinity Commercial |
$1,009.66
|
| Rate for Payer: Cofinity Commercial |
$821.81
|
| Rate for Payer: Cofinity Commercial |
$1,649.90
|
| Rate for Payer: Cofinity Commercial |
$2,027.02
|
| Rate for Payer: Healthscope Commercial |
$1,056.62
|
| Rate for Payer: Healthscope Commercial |
$2,121.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.92
|
| Rate for Payer: PHP Commercial |
$997.92
|
| Rate for Payer: PHP Commercial |
$2,003.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.90
|
| Rate for Payer: Priority Health SBD |
$1,484.91
|
| Rate for Payer: Priority Health SBD |
$739.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.16
|
| Rate for Payer: UHC Exchange |
$217.42
|
| Rate for Payer: UHC Exchange |
$217.42
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$2,357.00
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,484.91 |
| Max. Negotiated Rate |
$2,121.30 |
| Rate for Payer: Aetna Commercial |
$2,003.45
|
| Rate for Payer: Aetna Commercial |
$997.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.11
|
| Rate for Payer: Cash Price |
$1,885.60
|
| Rate for Payer: Cash Price |
$939.22
|
| Rate for Payer: Cofinity Commercial |
$2,027.02
|
| Rate for Payer: Cofinity Commercial |
$1,009.66
|
| Rate for Payer: Cofinity Commercial |
$821.81
|
| Rate for Payer: Cofinity Commercial |
$1,649.90
|
| Rate for Payer: Healthscope Commercial |
$1,056.62
|
| Rate for Payer: Healthscope Commercial |
$2,121.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$997.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,003.45
|
| Rate for Payer: PHP Commercial |
$2,003.45
|
| Rate for Payer: PHP Commercial |
$997.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,649.90
|
| Rate for Payer: Priority Health SBD |
$739.63
|
| Rate for Payer: Priority Health SBD |
$1,484.91
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$337.03
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$278.00
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$124.67
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$100.52
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$835.88 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.42
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Cofinity Commercial |
$928.76
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.78
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.76
|
| Rate for Payer: Priority Health SBD |
$835.88
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$318.83
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$928.76
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.78
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.76
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$835.88
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$252.63
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$947.34
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$852.60
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$229.21
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$852.60 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Cofinity Commercial |
$947.34
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: Priority Health SBD |
$852.60
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$150.59
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Cofinity Commercial |
$484.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$435.75
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$131.63
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.58
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$484.16
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health SBD |
$435.75
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,866.80
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,680.12 |
| Rate for Payer: Aetna Commercial |
$1,586.78
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,213.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$409.29
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cofinity Commercial |
$1,605.45
|
| Rate for Payer: Cofinity Commercial |
$1,306.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,680.12
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,586.78
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,586.78
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.75
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$432.60
|
| Rate for Payer: Priority Health SBD |
$1,176.08
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$325.48
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,866.80
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,176.08 |
| Max. Negotiated Rate |
$1,680.12 |
| Rate for Payer: Aetna Commercial |
$1,586.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,213.42
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cofinity Commercial |
$1,306.76
|
| Rate for Payer: Cofinity Commercial |
$1,605.45
|
| Rate for Payer: Healthscope Commercial |
$1,680.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,586.78
|
| Rate for Payer: PHP Commercial |
$1,586.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.76
|
| Rate for Payer: Priority Health SBD |
$1,176.08
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,579.78
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,342.81
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$195.27
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cofinity Commercial |
$1,105.85
|
| Rate for Payer: Cofinity Commercial |
$1,358.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,421.80
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.81
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,342.81
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.75
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$432.60
|
| Rate for Payer: Priority Health SBD |
$995.26
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$167.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,579.78
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$995.26 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,342.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.86
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cofinity Commercial |
$1,105.85
|
| Rate for Payer: Cofinity Commercial |
$1,358.61
|
| Rate for Payer: Healthscope Commercial |
$1,421.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.81
|
| Rate for Payer: PHP Commercial |
$1,342.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.85
|
| Rate for Payer: Priority Health SBD |
$995.26
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$143.97
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$850.16
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$130.32
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$850.16 |
| Max. Negotiated Rate |
$1,214.51 |
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.15
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Cofinity Commercial |
$944.62
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health SBD |
$850.16
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,711.50
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$240.50
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Cofinity Commercial |
$1,198.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.75
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$432.60
|
| Rate for Payer: Priority Health SBD |
$1,078.24
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$196.79
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,711.50
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.24 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.48
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,198.05
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health SBD |
$1,078.24
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,020.91
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,273.17 |
| Max. Negotiated Rate |
$1,818.82 |
| Rate for Payer: Aetna Commercial |
$1,717.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.59
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cofinity Commercial |
$1,414.64
|
| Rate for Payer: Cofinity Commercial |
$1,737.98
|
| Rate for Payer: Healthscope Commercial |
$1,818.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.77
|
| Rate for Payer: PHP Commercial |
$1,717.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.64
|
| Rate for Payer: Priority Health SBD |
$1,273.17
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,020.91
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,818.82 |
| Rate for Payer: Aetna Commercial |
$1,717.77
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$195.27
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cofinity Commercial |
$1,737.98
|
| Rate for Payer: Cofinity Commercial |
$1,414.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,818.82
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.77
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,717.77
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$540.75
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$432.60
|
| Rate for Payer: Priority Health SBD |
$1,273.17
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$167.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,711.50
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$143.97
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,198.05
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$256.38
|
| Rate for Payer: Priority Health SBD |
$1,078.24
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$130.32
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
IP
|
$1,711.50
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.24 |
| Max. Negotiated Rate |
$1,540.35 |
| Rate for Payer: Aetna Commercial |
$1,454.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.48
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,198.05
|
| Rate for Payer: Cofinity Commercial |
$1,471.89
|
| Rate for Payer: Healthscope Commercial |
$1,540.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PHP Commercial |
$1,454.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health SBD |
$1,078.24
|
|
