|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,448.55
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$912.59 |
| Max. Negotiated Rate |
$1,303.69 |
| Rate for Payer: Aetna Commercial |
$1,231.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.56
|
| Rate for Payer: Cash Price |
$1,158.84
|
| Rate for Payer: Cofinity Commercial |
$1,013.99
|
| Rate for Payer: Cofinity Commercial |
$1,245.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,013.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.84
|
| Rate for Payer: Healthscope Commercial |
$1,303.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.27
|
| Rate for Payer: PHP Commercial |
$1,231.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.56
|
| Rate for Payer: Priority Health SBD |
$912.59
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,310.90
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$825.87 |
| Max. Negotiated Rate |
$1,179.81 |
| Rate for Payer: Aetna Commercial |
$1,114.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.09
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cofinity Commercial |
$1,127.37
|
| Rate for Payer: Cofinity Commercial |
$917.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$917.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.72
|
| Rate for Payer: Healthscope Commercial |
$1,179.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.27
|
| Rate for Payer: PHP Commercial |
$1,114.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.09
|
| Rate for Payer: Priority Health SBD |
$825.87
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,310.90
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$524.36 |
| Max. Negotiated Rate |
$1,179.81 |
| Rate for Payer: Aetna Commercial |
$1,114.27
|
| Rate for Payer: Aetna Medicare |
$655.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.09
|
| Rate for Payer: BCBS Complete |
$524.36
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cofinity Commercial |
$1,127.37
|
| Rate for Payer: Cofinity Commercial |
$917.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$917.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.72
|
| Rate for Payer: Healthscope Commercial |
$1,179.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.27
|
| Rate for Payer: PHP Commercial |
$1,114.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.09
|
| Rate for Payer: Priority Health SBD |
$825.87
|
| Rate for Payer: UHC Core |
$970.07
|
| Rate for Payer: UHC Exchange |
$970.07
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$447.67 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.88
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$497.41
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$497.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health SBD |
$447.67
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna Medicare |
$355.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.88
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$497.41
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$497.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health SBD |
$447.67
|
| Rate for Payer: UHC Core |
$525.84
|
| Rate for Payer: UHC Exchange |
$525.84
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,197.50
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$479.00 |
| Max. Negotiated Rate |
$1,077.75 |
| Rate for Payer: Aetna Commercial |
$1,017.88
|
| Rate for Payer: Aetna Medicare |
$598.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.38
|
| Rate for Payer: BCBS Complete |
$479.00
|
| Rate for Payer: Cash Price |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.85
|
| Rate for Payer: Cofinity Commercial |
$838.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$838.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.00
|
| Rate for Payer: Healthscope Commercial |
$1,077.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.88
|
| Rate for Payer: PHP Commercial |
$1,017.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.38
|
| Rate for Payer: Priority Health SBD |
$754.42
|
| Rate for Payer: UHC Core |
$886.15
|
| Rate for Payer: UHC Exchange |
$886.15
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$1,197.50
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$754.42 |
| Max. Negotiated Rate |
$1,077.75 |
| Rate for Payer: Aetna Commercial |
$1,017.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.38
|
| Rate for Payer: Cash Price |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.85
|
| Rate for Payer: Cofinity Commercial |
$838.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$838.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.00
|
| Rate for Payer: Healthscope Commercial |
$1,077.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.88
|
| Rate for Payer: PHP Commercial |
$1,017.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.38
|
| Rate for Payer: Priority Health SBD |
$754.42
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health SBD |
$688.22
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$808.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$808.39
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$148.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$148.00
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
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: Cofinity Medicare Advantage |
$140.00
|
| 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: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| 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: Cofinity Medicare Advantage |
$947.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| 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 |
$1,150.34
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| 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 |
$879.67
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$852.60
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,001.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,001.47
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
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: Cofinity Medicare Advantage |
$947.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.67
|
| Rate for Payer: Priority Health SBD |
$852.60
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
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 Commercial |
$1,187.15
|
| Rate for Payer: Cofinity Commercial |
$966.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.29
|
| 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: PHP Commercial |
$1,173.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.27
|
| Rate for Payer: Priority Health SBD |
$869.66
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,242.37 |
| Rate for Payer: Aetna Commercial |
$1,173.35
|
| Rate for Payer: Aetna Medicare |
$362.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Commercial |
$966.29
|
| Rate for Payer: Cofinity Commercial |
$1,187.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,242.37
|
| 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 |
$1,173.35
|
| Rate for Payer: PACE Medicare |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$1,173.35
|
| 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 |
$897.27
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health SBD |
$869.66
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$980.43
|
| Rate for Payer: UHC Core |
$1,021.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$1,021.50
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$196.09
|
| Rate for Payer: VA VA |
$348.30
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$705.49
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$444.46 |
| Max. Negotiated Rate |
$634.94 |
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.57
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Commercial |
$493.84
|
| Rate for Payer: Cofinity Commercial |
$606.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Healthscope Commercial |
$634.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: PHP Commercial |
$599.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.57
|
| Rate for Payer: Priority Health SBD |
$444.46
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$705.49
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$634.94 |
| Rate for Payer: Aetna Commercial |
$599.67
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Commercial |
$493.84
|
| Rate for Payer: Cofinity Commercial |
$606.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$634.94
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$599.67
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.57
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$444.46
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$522.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$522.06
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,904.14
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,199.61 |
| Max. Negotiated Rate |
$1,713.73 |
| Rate for Payer: Aetna Commercial |
$1,618.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.69
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cofinity Commercial |
$1,332.90
|
| Rate for Payer: Cofinity Commercial |
$1,637.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,332.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.31
|
| Rate for Payer: Healthscope Commercial |
$1,713.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,618.52
|
| Rate for Payer: PHP Commercial |
$1,618.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.69
|
| Rate for Payer: Priority Health SBD |
$1,199.61
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,904.14
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,713.73 |
| Rate for Payer: Aetna Commercial |
$1,618.52
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cofinity Commercial |
$1,637.56
|
| Rate for Payer: Cofinity Commercial |
$1,332.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,332.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,713.73
|
| 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 |
$1,618.52
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,618.52
|
| 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 |
$1,237.69
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,199.61
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,409.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,409.06
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,611.38
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,015.17 |
| Max. Negotiated Rate |
$1,450.24 |
| Rate for Payer: Aetna Commercial |
$1,369.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.40
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cofinity Commercial |
$1,127.97
|
| Rate for Payer: Cofinity Commercial |
$1,385.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,127.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,289.10
|
| Rate for Payer: Healthscope Commercial |
$1,450.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.67
|
| Rate for Payer: PHP Commercial |
$1,369.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.40
|
| Rate for Payer: Priority Health SBD |
$1,015.17
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,611.38
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,450.24 |
| Rate for Payer: Aetna Commercial |
$1,369.67
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,047.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cofinity Commercial |
$1,385.79
|
| Rate for Payer: Cofinity Commercial |
$1,127.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,127.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,289.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,450.24
|
| 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 |
$1,369.67
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,369.67
|
| 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 |
$1,047.40
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,015.17
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,192.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,192.42
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,238.81 |
| Rate for Payer: Aetna Commercial |
$1,169.98
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$963.51
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| 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 |
$1,169.98
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| 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 |
$894.69
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$867.16
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,018.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$1,018.57
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
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 New Business (MI Preferred) |
$894.69
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$1,183.75
|
| Rate for Payer: Cofinity Commercial |
$963.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Healthscope Commercial |
$1,238.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: PHP Commercial |
$1,169.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.69
|
| Rate for Payer: Priority Health SBD |
$867.16
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,099.81 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.72
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,222.01
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,222.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health SBD |
$1,099.81
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Cofinity Commercial |
$1,222.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,222.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| 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 |
$1,483.87
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| 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 |
$1,134.72
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,099.81
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,291.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,291.84
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
