|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$691.66
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.11
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$473.69
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,866.80
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,306.76 |
| Max. Negotiated Rate |
$1,866.80 |
| Rate for Payer: Aetna Commercial |
$1,680.12
|
| Rate for Payer: ASR ASR |
$1,810.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,447.33
|
| Rate for Payer: BCN Commercial |
$1,447.33
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cofinity Commercial |
$1,754.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,493.44
|
| Rate for Payer: Healthscope Commercial |
$1,866.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,810.80
|
| Rate for Payer: Mclaren Commercial |
$1,680.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,586.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,642.78
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,866.80
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,866.80 |
| Rate for Payer: Aetna Commercial |
$1,680.12
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,810.80
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,447.33
|
| Rate for Payer: BCN Commercial |
$1,447.33
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cash Price |
$1,493.44
|
| Rate for Payer: Cofinity Commercial |
$1,754.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,493.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,866.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,810.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,680.12
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,586.78
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$792.72
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$634.18
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,642.78
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,579.78
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,579.78 |
| Rate for Payer: Aetna Commercial |
$1,421.80
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,532.39
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,224.80
|
| Rate for Payer: BCN Commercial |
$1,224.80
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cofinity Commercial |
$1,484.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,579.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,421.80
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.81
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,282.21
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,025.77
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.21
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,579.78
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,105.85 |
| Max. Negotiated Rate |
$1,579.78 |
| Rate for Payer: Aetna Commercial |
$1,421.80
|
| Rate for Payer: ASR ASR |
$1,532.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,224.80
|
| Rate for Payer: BCN Commercial |
$1,224.80
|
| Rate for Payer: Cash Price |
$1,263.82
|
| Rate for Payer: Cofinity Commercial |
$1,484.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,263.82
|
| Rate for Payer: Healthscope Commercial |
$1,579.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,532.39
|
| Rate for Payer: Mclaren Commercial |
$1,421.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,390.21
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$944.62 |
| Max. Negotiated Rate |
$1,349.46 |
| Rate for Payer: Aetna Commercial |
$1,214.51
|
| Rate for Payer: ASR ASR |
$1,308.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.24
|
| Rate for Payer: BCN Commercial |
$1,046.24
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,268.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Healthscope Commercial |
$1,349.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.98
|
| Rate for Payer: Mclaren Commercial |
$1,214.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.52
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,349.46
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,349.46 |
| Rate for Payer: Aetna Commercial |
$1,214.51
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,308.98
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.24
|
| Rate for Payer: BCN Commercial |
$1,046.24
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,268.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,349.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,214.51
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.20
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$978.56
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.52
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,711.50
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,198.05 |
| Max. Negotiated Rate |
$1,711.50 |
| Rate for Payer: Aetna Commercial |
$1,540.35
|
| Rate for Payer: ASR ASR |
$1,660.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.93
|
| Rate for Payer: BCN Commercial |
$1,326.93
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,608.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Healthscope Commercial |
$1,711.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,660.16
|
| Rate for Payer: Mclaren Commercial |
$1,540.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,506.12
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,711.50
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,711.50 |
| Rate for Payer: Aetna Commercial |
$1,540.35
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,660.16
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.93
|
| Rate for Payer: BCN Commercial |
$1,326.93
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,608.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,711.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,660.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,540.35
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.87
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,093.50
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,506.12
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,020.91
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,414.64 |
| Max. Negotiated Rate |
$2,020.91 |
| Rate for Payer: Aetna Commercial |
$1,818.82
|
| Rate for Payer: ASR ASR |
$1,960.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.81
|
| Rate for Payer: BCN Commercial |
$1,566.81
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cofinity Commercial |
$1,899.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,616.73
|
| Rate for Payer: Healthscope Commercial |
$2,020.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,960.28
|
| Rate for Payer: Mclaren Commercial |
$1,818.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,778.40
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,020.91
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,020.91 |
| Rate for Payer: Aetna Commercial |
$1,818.82
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,960.28
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.81
|
| Rate for Payer: BCN Commercial |
$1,566.81
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cash Price |
$1,616.73
|
| Rate for Payer: Cofinity Commercial |
$1,899.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,616.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,020.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,960.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,818.82
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.77
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,282.21
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,025.77
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,778.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
IP
|
$1,711.50
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,198.05 |
| Max. Negotiated Rate |
$1,711.50 |
| Rate for Payer: Aetna Commercial |
$1,540.35
|
| Rate for Payer: ASR ASR |
$1,660.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.93
|
| Rate for Payer: BCN Commercial |
$1,326.93
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,608.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Healthscope Commercial |
$1,711.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,660.16
|
| Rate for Payer: Mclaren Commercial |
$1,540.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,506.12
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,711.50
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,711.50 |
| Rate for Payer: Aetna Commercial |
$1,540.35
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,660.16
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.93
|
| Rate for Payer: BCN Commercial |
$1,326.93
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cofinity Commercial |
$1,608.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,369.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,711.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,660.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,540.35
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,454.78
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,198.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.20
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$978.56
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,506.12
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$2,618.59
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,833.01 |
| Max. Negotiated Rate |
$2,618.59 |
| Rate for Payer: Aetna Commercial |
$2,356.73
|
| Rate for Payer: Aetna Commercial |
$1,571.16
|
| Rate for Payer: ASR ASR |
$1,693.36
|
| Rate for Payer: ASR ASR |
$2,540.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.19
|
| Rate for Payer: BCN Commercial |
$2,030.19
|
| Rate for Payer: BCN Commercial |
$1,353.46
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$2,461.47
|
| Rate for Payer: Cofinity Commercial |
$1,640.99
|
| 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 |
$1,745.73
|
| Rate for Payer: Healthscope Commercial |
$2,618.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,540.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,693.36
|
| Rate for Payer: Mclaren Commercial |
$1,571.16
|
| Rate for Payer: Mclaren Commercial |
$2,356.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,225.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,536.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,304.36
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,745.73 |
| Rate for Payer: Aetna Commercial |
$1,571.16
|
| Rate for Payer: Aetna Commercial |
$2,356.73
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,693.36
|
| Rate for Payer: ASR ASR |
$2,540.03
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.46
|
| Rate for Payer: BCN Commercial |
$1,353.46
|
| Rate for Payer: BCN Commercial |
$2,030.19
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$2,094.87
|
| Rate for Payer: Cofinity Commercial |
$1,640.99
|
| Rate for Payer: Cofinity Commercial |
$2,461.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,094.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,745.73
|
| Rate for Payer: Healthscope Commercial |
$2,618.59
|
| Rate for Payer: Healthscope Whirlpool |
$2,540.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,693.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$2,356.73
|
| Rate for Payer: Mclaren Commercial |
$1,571.16
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,225.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.87
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.87
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,093.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,093.50
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,304.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,536.24
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,515.31
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,515.31 |
| Rate for Payer: Aetna Commercial |
$1,363.78
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,469.85
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.82
|
| Rate for Payer: BCN Commercial |
$1,174.82
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,212.25
|
| Rate for Payer: Cash Price |
$1,212.25
|
| Rate for Payer: Cofinity Commercial |
$1,424.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,515.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,469.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,363.78
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.01
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,282.21
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,025.77
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,333.47
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
IP
|
$1,515.31
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,060.72 |
| Max. Negotiated Rate |
$1,515.31 |
| Rate for Payer: Aetna Commercial |
$1,363.78
|
| Rate for Payer: ASR ASR |
$1,469.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.82
|
| Rate for Payer: BCN Commercial |
$1,174.82
|
| Rate for Payer: Cash Price |
$1,212.25
|
| Rate for Payer: Cofinity Commercial |
$1,424.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.25
|
| Rate for Payer: Healthscope Commercial |
$1,515.31
|
| Rate for Payer: Healthscope Whirlpool |
$1,469.85
|
| Rate for Payer: Mclaren Commercial |
$1,363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,333.47
|
|
|
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 |
$53.45 |
| Max. Negotiated Rate |
$2,024.19 |
| Rate for Payer: Aetna Commercial |
$1,821.77
|
| Rate for Payer: Aetna Commercial |
$1,214.51
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,308.98
|
| Rate for Payer: ASR ASR |
$1,963.46
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.35
|
| Rate for Payer: BCN Commercial |
$1,046.24
|
| Rate for Payer: BCN Commercial |
$1,569.35
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,902.74
|
| Rate for Payer: Cofinity Commercial |
$1,268.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,619.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,349.46
|
| Rate for Payer: Healthscope Commercial |
$2,024.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,963.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,214.51
|
| Rate for Payer: Mclaren Commercial |
$1,821.77
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.20
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$978.56
|
| Rate for Payer: Priority Health Narrow Network |
$978.56
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,781.29
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$2,024.19
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,024.19 |
| Rate for Payer: Aetna Commercial |
$1,821.77
|
| Rate for Payer: Aetna Commercial |
$1,214.51
|
| Rate for Payer: ASR ASR |
$1,308.98
|
| Rate for Payer: ASR ASR |
$1,963.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.35
|
| Rate for Payer: BCN Commercial |
$1,569.35
|
| Rate for Payer: BCN Commercial |
$1,046.24
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,079.57
|
| Rate for Payer: Cofinity Commercial |
$1,268.49
|
| Rate for Payer: Cofinity Commercial |
$1,902.74
|
| 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 |
$1,349.46
|
| Rate for Payer: Healthscope Commercial |
$2,024.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,963.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,308.98
|
| Rate for Payer: Mclaren Commercial |
$1,214.51
|
| Rate for Payer: Mclaren Commercial |
$1,821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,187.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,781.29
|
|
|
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 |
$89.34 |
| Max. Negotiated Rate |
$1,366.87 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: Aetna Commercial |
$933.74
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,006.37
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$804.37
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$804.37
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| 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 |
$163.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Commercial |
$1,037.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.37
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Mclaren Commercial |
$933.74
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.87
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,093.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,093.50
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$691.66
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$484.16 |
| Max. Negotiated Rate |
$691.66 |
| Rate for Payer: Aetna Commercial |
$622.49
|
| Rate for Payer: Aetna Commercial |
$933.74
|
| Rate for Payer: ASR ASR |
$1,006.37
|
| Rate for Payer: ASR ASR |
$670.91
|
| Rate for Payer: BCBS Trust/PPO |
$804.37
|
| Rate for Payer: BCBS Trust/PPO |
$536.24
|
| Rate for Payer: BCN Commercial |
$804.37
|
| Rate for Payer: BCN Commercial |
$536.24
|
| Rate for Payer: Cash Price |
$829.99
|
| Rate for Payer: Cash Price |
$553.33
|
| Rate for Payer: Cofinity Commercial |
$975.24
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.99
|
| Rate for Payer: Healthscope Commercial |
$1,037.49
|
| Rate for Payer: Healthscope Commercial |
$691.66
|
| Rate for Payer: Healthscope Whirlpool |
$670.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,006.37
|
| Rate for Payer: Mclaren Commercial |
$933.74
|
| Rate for Payer: Mclaren Commercial |
$622.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.66
|
|
|
HC CT NECK ANGIO
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
|
|
HC CT NECK ANGIO
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna Commercial |
$963.90
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,038.87
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$830.35
|
| Rate for Payer: BCN Commercial |
$830.35
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,006.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,071.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,038.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$963.90
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.12
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$693.70
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$942.48
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,641.80 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna Commercial |
$3,396.60
|
| Rate for Payer: ASR ASR |
$3,660.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.98
|
| Rate for Payer: BCN Commercial |
$2,925.98
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,547.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Healthscope Commercial |
$3,774.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.78
|
| Rate for Payer: Mclaren Commercial |
$3,396.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.12
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,641.80 |
| Max. Negotiated Rate |
$6,506.78 |
| Rate for Payer: Aetna Commercial |
$3,396.60
|
| Rate for Payer: Aetna Medicare |
$5,205.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: ASR ASR |
$3,660.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.98
|
| Rate for Payer: BCN Commercial |
$2,925.98
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cofinity Commercial |
$3,547.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Healthscope Commercial |
$3,774.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,205.42
|
| Rate for Payer: Mclaren Commercial |
$3,396.60
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,207.90
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Commercial |
$5,725.96
|
| Rate for Payer: PHP Medicaid |
$2,847.36
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,434.34
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,679.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,321.12
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
