|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
990
|
| 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 Advantage |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,242.37 |
| Rate for Payer: Aetna Commercial |
$1,173.35
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$434.60
|
| Rate for Payer: BCN Commercial |
$434.60
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Advantage |
$966.29
|
| Rate for Payer: Cofinity Commercial |
$1,187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,242.37
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.31
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,173.35
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$869.66
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.27
|
| Rate for Payer: UHC Core |
$719.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$542.50
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$869.66 |
| Max. Negotiated Rate |
$1,242.37 |
| Rate for Payer: Aetna Commercial |
$1,173.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.27
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Advantage |
$966.29
|
| Rate for Payer: Cofinity Commercial |
$1,187.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Healthscope Commercial |
$1,242.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.31
|
| Rate for Payer: PHP Commercial |
$1,173.35
|
| Rate for Payer: Priority Health SBD |
$869.66
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,408.02
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,267.22 |
| Rate for Payer: Aetna Commercial |
$1,196.82
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$340.71
|
| Rate for Payer: BCN Commercial |
$340.71
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Advantage |
$985.61
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,267.22
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,196.82
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$887.05
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$915.21
|
| Rate for Payer: UHC Core |
$733.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$553.35
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,408.02
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$887.05 |
| Max. Negotiated Rate |
$1,267.22 |
| Rate for Payer: Aetna Commercial |
$1,196.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.21
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Advantage |
$985.61
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Healthscope Commercial |
$1,267.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PHP Commercial |
$1,196.82
|
| Rate for Payer: Priority Health SBD |
$887.05
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$199.89
|
| Rate for Payer: BCN Commercial |
$199.89
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$453.35
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.74
|
| Rate for Payer: UHC Core |
$374.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$282.80
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$453.35 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Aetna Commercial |
$611.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.74
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Advantage |
$503.72
|
| Rate for Payer: Cofinity Commercial |
$618.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$647.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PHP Commercial |
$611.66
|
| Rate for Payer: Priority Health SBD |
$453.35
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,942.22
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$1,650.89
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$542.87
|
| Rate for Payer: BCN Commercial |
$542.87
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cofinity Advantage |
$1,359.55
|
| Rate for Payer: Cofinity Commercial |
$1,670.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,748.00
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.89
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,456.66
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,650.89
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,223.60
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,262.44
|
| Rate for Payer: UHC Core |
$1,011.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$763.29
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,942.22
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,223.60 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$1,650.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,262.44
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cofinity Advantage |
$1,359.55
|
| Rate for Payer: Cofinity Commercial |
$1,670.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.78
|
| Rate for Payer: Healthscope Commercial |
$1,748.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,456.66
|
| Rate for Payer: PHP Commercial |
$1,650.89
|
| Rate for Payer: Priority Health SBD |
$1,223.60
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,643.61
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,479.25 |
| Rate for Payer: Aetna Commercial |
$1,397.07
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,068.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$260.45
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cofinity Advantage |
$1,150.53
|
| Rate for Payer: Cofinity Commercial |
$1,413.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,314.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,479.25
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.07
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,232.71
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,397.07
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,035.47
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,068.35
|
| Rate for Payer: UHC Core |
$856.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$645.94
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,643.61
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.47 |
| Max. Negotiated Rate |
$1,479.25 |
| Rate for Payer: Aetna Commercial |
$1,397.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,068.35
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cofinity Advantage |
$1,150.53
|
| Rate for Payer: Cofinity Commercial |
$1,413.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,314.89
|
| Rate for Payer: Healthscope Commercial |
$1,479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,232.71
|
| Rate for Payer: PHP Commercial |
$1,397.07
|
| Rate for Payer: Priority Health SBD |
$1,035.47
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,403.98
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$884.51 |
| Max. Negotiated Rate |
$1,263.58 |
| Rate for Payer: Aetna Commercial |
$1,193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.59
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cofinity Advantage |
$982.79
|
| Rate for Payer: Cofinity Commercial |
$1,207.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.18
|
| Rate for Payer: Healthscope Commercial |
$1,263.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.98
|
| Rate for Payer: PHP Commercial |
$1,193.38
|
| Rate for Payer: Priority Health SBD |
$884.51
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,403.98
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,263.58 |
| Rate for Payer: Aetna Commercial |
$1,193.38
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$193.07
|
| Rate for Payer: BCN Commercial |
$193.07
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cofinity Advantage |
$982.79
|
| Rate for Payer: Cofinity Commercial |
$1,207.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,263.58
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.38
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.98
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,193.38
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$884.51
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.59
|
| Rate for Payer: UHC Core |
$731.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$551.76
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,121.80 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.42
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Advantage |
$1,246.45
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: Priority Health SBD |
$1,121.80
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$321.03
|
| Rate for Payer: BCN Commercial |
$321.03
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Advantage |
$1,246.45
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,121.80
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.42
|
| Rate for Payer: UHC Core |
$927.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$699.79
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,102.56
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,892.30 |
| Rate for Payer: Aetna Commercial |
$1,787.18
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,366.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$260.45
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cofinity Advantage |
$1,471.79
|
| Rate for Payer: Cofinity Commercial |
$1,808.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,892.30
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.18
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.92
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,787.18
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,324.61
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,366.66
|
| Rate for Payer: UHC Core |
$1,095.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$826.31
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,102.56
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,324.61 |
| Max. Negotiated Rate |
$1,892.30 |
| Rate for Payer: Aetna Commercial |
$1,787.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,366.66
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cofinity Advantage |
$1,471.79
|
| Rate for Payer: Cofinity Commercial |
$1,808.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.05
|
| Rate for Payer: Healthscope Commercial |
$1,892.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.92
|
| Rate for Payer: PHP Commercial |
$1,787.18
|
| Rate for Payer: Priority Health SBD |
$1,324.61
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$193.07
|
| Rate for Payer: BCN Commercial |
$193.07
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Advantage |
$1,246.45
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$1,121.80
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.42
|
| Rate for Payer: UHC Core |
$927.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$699.79
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,121.80 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.42
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Advantage |
$1,246.45
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: Priority Health SBD |
$1,121.80
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Commercial |
$2,270.32
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,736.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$321.03
|
| Rate for Payer: BCBS Trust/PPO |
$321.03
|
| Rate for Payer: BCN Commercial |
$321.03
|
| Rate for Payer: BCN Commercial |
$321.03
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Advantage |
$1,869.67
|
| Rate for Payer: Cofinity Advantage |
$1,246.45
|
| Rate for Payer: Cofinity Commercial |
$2,297.03
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Healthscope Commercial |
$2,403.86
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.32
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$2,270.32
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,682.70
|
| Rate for Payer: Priority Health SBD |
$1,121.80
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,736.12
|
| Rate for Payer: UHC Core |
$1,391.57
|
| Rate for Payer: UHC Core |
$927.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$1,049.69
|
| Rate for Payer: UHC Exchange |
$699.79
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,121.80 |
| Max. Negotiated Rate |
$1,602.58 |
| Rate for Payer: Aetna Commercial |
$1,513.54
|
| Rate for Payer: Aetna Commercial |
$2,270.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,736.12
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cofinity Advantage |
$1,246.45
|
| Rate for Payer: Cofinity Advantage |
$1,869.67
|
| Rate for Payer: Cofinity Commercial |
$1,531.35
|
| Rate for Payer: Cofinity Commercial |
$2,297.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Healthscope Commercial |
$2,403.86
|
| Rate for Payer: Healthscope Commercial |
$1,602.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.22
|
| Rate for Payer: PHP Commercial |
$1,513.54
|
| Rate for Payer: PHP Commercial |
$2,270.32
|
| Rate for Payer: Priority Health SBD |
$1,121.80
|
| Rate for Payer: Priority Health SBD |
$1,682.70
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,576.53
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,418.88 |
| Rate for Payer: Aetna Commercial |
$1,340.05
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$260.45
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cofinity Advantage |
$1,103.57
|
| Rate for Payer: Cofinity Commercial |
$1,355.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,418.88
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.05
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.40
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,340.05
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$993.21
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.74
|
| Rate for Payer: UHC Core |
$821.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$619.58
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
IP
|
$1,576.53
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$993.21 |
| Max. Negotiated Rate |
$1,418.88 |
| Rate for Payer: Aetna Commercial |
$1,340.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.74
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cofinity Advantage |
$1,103.57
|
| Rate for Payer: Cofinity Commercial |
$1,355.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.22
|
| Rate for Payer: Healthscope Commercial |
$1,418.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.40
|
| Rate for Payer: PHP Commercial |
$1,340.05
|
| Rate for Payer: Priority Health SBD |
$993.21
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$867.16 |
| Max. Negotiated Rate |
$1,238.81 |
| Rate for Payer: Aetna Commercial |
$1,169.98
|
| Rate for Payer: Aetna Commercial |
$1,754.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,342.04
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cofinity Advantage |
$963.51
|
| Rate for Payer: Cofinity Advantage |
$1,445.27
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Cofinity Commercial |
$1,775.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,651.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Healthscope Commercial |
$1,858.20
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,754.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,548.50
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| Rate for Payer: PHP Commercial |
$1,754.97
|
| Rate for Payer: Priority Health SBD |
$867.16
|
| Rate for Payer: Priority Health SBD |
$1,300.74
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
OP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,238.81 |
| Rate for Payer: Aetna Commercial |
$1,169.98
|
| Rate for Payer: Aetna Commercial |
$1,754.97
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,342.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$193.07
|
| Rate for Payer: BCBS Trust/PPO |
$193.07
|
| Rate for Payer: BCN Commercial |
$193.07
|
| Rate for Payer: BCN Commercial |
$193.07
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Advantage |
$1,445.27
|
| Rate for Payer: Cofinity Advantage |
$963.51
|
| Rate for Payer: Cofinity Commercial |
$1,775.62
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,651.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| Rate for Payer: Healthscope Commercial |
$1,858.20
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,754.97
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,548.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.34
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,754.97
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$1,300.74
|
| Rate for Payer: Priority Health SBD |
$867.16
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,342.04
|
| Rate for Payer: UHC Core |
$1,075.69
|
| Rate for Payer: UHC Core |
$717.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$811.42
|
| Rate for Payer: UHC Exchange |
$540.94
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
| Rate for Payer: VA VA |
$104.17
|
|
