|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,061.33
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,855.20 |
| Rate for Payer: Aetna Commercial |
$1,752.13
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,339.86
|
| 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 |
$1,649.06
|
| Rate for Payer: Cash Price |
$1,649.06
|
| Rate for Payer: Cofinity Commercial |
$1,772.74
|
| Rate for Payer: Cofinity Commercial |
$1,442.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,442.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,649.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,855.20
|
| 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 |
$1,752.13
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,752.13
|
| 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 |
$1,339.86
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,298.64
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,525.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,525.38
|
| 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 BIL W CON
|
Facility
|
IP
|
$2,061.33
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,298.64 |
| Max. Negotiated Rate |
$1,855.20 |
| Rate for Payer: Aetna Commercial |
$1,752.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,339.86
|
| Rate for Payer: Cash Price |
$1,649.06
|
| Rate for Payer: Cofinity Commercial |
$1,442.93
|
| Rate for Payer: Cofinity Commercial |
$1,772.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,442.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,649.06
|
| Rate for Payer: Healthscope Commercial |
$1,855.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,752.13
|
| Rate for Payer: PHP Commercial |
$1,752.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.86
|
| Rate for Payer: Priority Health SBD |
$1,298.64
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,571.16 |
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.72
|
| 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 |
$1,396.58
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| 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 |
$1,483.87
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$1,099.81
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,291.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$1,291.84
|
| 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 BIL WO CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
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 EXTREMITY WO W CON
|
Facility
|
OP
|
$2,618.59
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$2,356.73 |
| Rate for Payer: Aetna Commercial |
$2,225.80
|
| Rate for Payer: Aetna Commercial |
$1,483.87
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.08
|
| 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: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$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: Cash Price |
$2,094.87
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$2,251.99
|
| Rate for Payer: Cofinity Commercial |
$1,222.01
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Cofinity Commercial |
$1,833.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,833.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,222.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,356.73
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,225.80
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Commercial |
$2,225.80
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,649.71
|
| Rate for Payer: Priority Health SBD |
$1,099.81
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,937.76
|
| Rate for Payer: UHC Core |
$1,291.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,937.76
|
| Rate for Payer: UHC Exchange |
$1,291.84
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
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 Commercial |
$2,225.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.08
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$1,222.01
|
| Rate for Payer: Cofinity Commercial |
$1,833.01
|
| Rate for Payer: Cofinity Commercial |
$2,251.99
|
| Rate for Payer: Cofinity Commercial |
$1,501.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,833.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,222.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Healthscope Commercial |
$1,571.16
|
| Rate for Payer: Healthscope Commercial |
$2,356.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,225.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: PHP Commercial |
$1,483.87
|
| Rate for Payer: PHP Commercial |
$2,225.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health SBD |
$1,099.81
|
| Rate for Payer: Priority Health SBD |
$1,649.71
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
IP
|
$1,545.62
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$973.74 |
| Max. Negotiated Rate |
$1,391.06 |
| Rate for Payer: Aetna Commercial |
$1,313.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.65
|
| Rate for Payer: Cash Price |
$1,236.50
|
| Rate for Payer: Cofinity Commercial |
$1,081.93
|
| Rate for Payer: Cofinity Commercial |
$1,329.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,081.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.50
|
| Rate for Payer: Healthscope Commercial |
$1,391.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,313.78
|
| Rate for Payer: PHP Commercial |
$1,313.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.65
|
| Rate for Payer: Priority Health SBD |
$973.74
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,545.62
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,391.06 |
| Rate for Payer: Aetna Commercial |
$1,313.78
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.65
|
| 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 |
$1,236.50
|
| Rate for Payer: Cash Price |
$1,236.50
|
| Rate for Payer: Cofinity Commercial |
$1,329.23
|
| Rate for Payer: Cofinity Commercial |
$1,081.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,081.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,236.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,391.06
|
| 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 |
$1,313.78
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,313.78
|
| 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 |
$1,004.65
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$973.74
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,143.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,143.76
|
| 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 WO CON
|
Facility
|
OP
|
$2,024.19
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Commercial |
$1,147.04
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Cofinity Commercial |
$944.62
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,416.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,720.56
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$877.15
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
| Rate for Payer: Priority Health SBD |
$850.16
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,497.90
|
| Rate for Payer: UHC Core |
$998.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$1,497.90
|
| Rate for Payer: UHC Exchange |
$998.60
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
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 Commercial |
$1,720.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,160.54
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$944.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,416.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$944.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Healthscope Commercial |
$1,214.51
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,720.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,147.04
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,315.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$877.15
|
| Rate for Payer: Priority Health SBD |
$850.16
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,037.49
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$653.62 |
| Max. Negotiated Rate |
$933.74 |
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.58
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$484.16
|
| Rate for Payer: Cofinity Commercial |
$594.83
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health SBD |
$653.62
|
| Rate for Payer: Priority Health SBD |
$435.75
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$622.49 |
| Rate for Payer: Aetna Commercial |
$587.91
|
| Rate for Payer: Aetna Commercial |
$881.87
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$829.99
|
| 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 |
$726.24
|
| Rate for Payer: Cofinity Commercial |
$892.24
|
| Rate for Payer: Cofinity Commercial |
$484.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$622.49
|
| Rate for Payer: Healthscope Commercial |
$933.74
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.91
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$881.87
|
| Rate for Payer: PHP Commercial |
$587.91
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.37
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$435.75
|
| Rate for Payer: Priority Health SBD |
$653.62
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$511.83
|
| Rate for Payer: UHC Core |
$767.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$511.83
|
| Rate for Payer: UHC Exchange |
$767.74
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT NECK ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NECK ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.17 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.17 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,502.16
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$2,694.64
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,694.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health SBD |
$2,425.17
|
|
|
HC CTO CATHETER
|
Facility
|
OP
|
$6,462.07
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,584.83 |
| Max. Negotiated Rate |
$5,815.86 |
| Rate for Payer: Aetna Commercial |
$5,492.76
|
| Rate for Payer: Aetna Medicare |
$3,231.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: BCBS Complete |
$2,584.83
|
| Rate for Payer: Cash Price |
$5,169.66
|
| Rate for Payer: Cofinity Commercial |
$4,523.45
|
| Rate for Payer: Cofinity Commercial |
$5,557.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,523.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,169.66
|
| Rate for Payer: Healthscope Commercial |
$5,815.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.76
|
| Rate for Payer: PHP Commercial |
$5,492.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,200.35
|
| Rate for Payer: Priority Health SBD |
$4,071.10
|
|
|
HC CTO CATHETER
|
Facility
|
IP
|
$6,462.07
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,071.10 |
| Max. Negotiated Rate |
$5,815.86 |
| Rate for Payer: Aetna Commercial |
$5,492.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: Cash Price |
$5,169.66
|
| Rate for Payer: Cofinity Commercial |
$4,523.45
|
| Rate for Payer: Cofinity Commercial |
$5,557.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,523.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,169.66
|
| Rate for Payer: Healthscope Commercial |
$5,815.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,492.76
|
| Rate for Payer: PHP Commercial |
$5,492.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,200.35
|
| Rate for Payer: Priority Health SBD |
$4,071.10
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
OP
|
$1,579.64
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,421.68 |
| Rate for Payer: Aetna Commercial |
$1,342.69
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.77
|
| 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 |
$1,263.71
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cofinity Commercial |
$1,358.49
|
| Rate for Payer: Cofinity Commercial |
$1,105.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,421.68
|
| 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 |
$1,342.69
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,342.69
|
| 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 |
$1,026.77
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$995.17
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,168.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,168.93
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
IP
|
$1,579.64
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$995.17 |
| Max. Negotiated Rate |
$1,421.68 |
| Rate for Payer: Aetna Commercial |
$1,342.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.77
|
| Rate for Payer: Cash Price |
$1,263.71
|
| Rate for Payer: Cofinity Commercial |
$1,105.75
|
| Rate for Payer: Cofinity Commercial |
$1,358.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.71
|
| Rate for Payer: Healthscope Commercial |
$1,421.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,342.69
|
| Rate for Payer: PHP Commercial |
$1,342.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,026.77
|
| Rate for Payer: Priority Health SBD |
$995.17
|
|
|
HC CT ORBIT WO CON
|
Facility
|
OP
|
$1,435.44
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,291.90 |
| Rate for Payer: Aetna Commercial |
$1,220.12
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.04
|
| 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 |
$1,148.35
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cofinity Commercial |
$1,234.48
|
| Rate for Payer: Cofinity Commercial |
$1,004.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,004.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,291.90
|
| 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 |
$1,220.12
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$1,220.12
|
| 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 |
$933.04
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$904.33
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$1,062.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$1,062.23
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CT ORBIT WO CON
|
Facility
|
IP
|
$1,435.44
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$904.33 |
| Max. Negotiated Rate |
$1,291.90 |
| Rate for Payer: Aetna Commercial |
$1,220.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.04
|
| Rate for Payer: Cash Price |
$1,148.35
|
| Rate for Payer: Cofinity Commercial |
$1,004.81
|
| Rate for Payer: Cofinity Commercial |
$1,234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,004.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,148.35
|
| Rate for Payer: Healthscope Commercial |
$1,291.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,220.12
|
| Rate for Payer: PHP Commercial |
$1,220.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.04
|
| Rate for Payer: Priority Health SBD |
$904.33
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
IP
|
$1,498.69
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$944.17 |
| Max. Negotiated Rate |
$1,348.82 |
| Rate for Payer: Aetna Commercial |
$1,273.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.15
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,049.08
|
| Rate for Payer: Cofinity Commercial |
$1,288.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,049.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Healthscope Commercial |
$1,348.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.89
|
| Rate for Payer: PHP Commercial |
$1,273.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.15
|
| Rate for Payer: Priority Health SBD |
$944.17
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
OP
|
$1,498.69
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,348.82 |
| Rate for Payer: Aetna Commercial |
$1,273.89
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.15
|
| 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 |
$1,198.95
|
| Rate for Payer: Cash Price |
$1,198.95
|
| Rate for Payer: Cofinity Commercial |
$1,288.87
|
| Rate for Payer: Cofinity Commercial |
$1,049.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,049.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,348.82
|
| 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 |
$1,273.89
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,273.89
|
| 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 |
$974.15
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$944.17
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,109.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,109.03
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT PELVIS ANGIO
|
Facility
|
OP
|
$1,949.22
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
35000009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,754.30 |
| Rate for Payer: Aetna Commercial |
$1,656.84
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.99
|
| 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 |
$1,559.38
|
| Rate for Payer: Cash Price |
$1,559.38
|
| Rate for Payer: Cofinity Commercial |
$1,676.33
|
| Rate for Payer: Cofinity Commercial |
$1,364.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,364.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,754.30
|
| 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 |
$1,656.84
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$1,656.84
|
| 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 |
$1,266.99
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health SBD |
$1,228.01
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.72
|
| Rate for Payer: UHC Core |
$1,442.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$1,442.42
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$97.75
|
| Rate for Payer: VA VA |
$173.62
|
|
