|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
OP
|
$1,477.52
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$546.68 |
| Max. Negotiated Rate |
$1,477.52 |
| Rate for Payer: Aetna Commercial |
$1,329.77
|
| Rate for Payer: Aetna Medicare |
$546.68
|
| Rate for Payer: ASR ASR |
$1,433.19
|
| Rate for Payer: BCBS Complete |
$591.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.22
|
| Rate for Payer: BCN Commercial |
$1,218.22
|
| Rate for Payer: Cash Price |
$1,182.02
|
| Rate for Payer: Cash Price |
$1,182.02
|
| Rate for Payer: Cofinity Commercial |
$1,388.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.02
|
| Rate for Payer: Healthscope Commercial |
$1,433.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,477.52
|
| Rate for Payer: Mclaren Commercial |
$1,329.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,182.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.89
|
| Rate for Payer: Nomi Health Commercial |
$1,211.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$726.34
|
| Rate for Payer: Priority Health Narrow Network |
$581.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,300.22
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,477.52
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,108.14 |
| Max. Negotiated Rate |
$1,477.52 |
| Rate for Payer: Aetna Commercial |
$1,329.77
|
| Rate for Payer: ASR ASR |
$1,433.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.34
|
| Rate for Payer: BCN Commercial |
$1,213.34
|
| Rate for Payer: Cash Price |
$1,182.02
|
| Rate for Payer: Cofinity Commercial |
$1,388.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.02
|
| Rate for Payer: Healthscope Commercial |
$1,433.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,477.52
|
| Rate for Payer: Mclaren Commercial |
$1,329.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.89
|
| Rate for Payer: Nomi Health Commercial |
$1,211.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,300.22
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,337.12
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,002.84 |
| Max. Negotiated Rate |
$1,337.12 |
| Rate for Payer: Aetna Commercial |
$1,203.41
|
| Rate for Payer: ASR ASR |
$1,297.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.04
|
| Rate for Payer: BCN Commercial |
$1,098.04
|
| Rate for Payer: Cash Price |
$1,069.70
|
| Rate for Payer: Cofinity Commercial |
$1,256.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.70
|
| Rate for Payer: Healthscope Commercial |
$1,297.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,337.12
|
| Rate for Payer: Mclaren Commercial |
$1,203.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.55
|
| Rate for Payer: Nomi Health Commercial |
$1,096.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,176.67
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,337.12
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$494.73 |
| Max. Negotiated Rate |
$1,337.12 |
| Rate for Payer: Aetna Commercial |
$1,203.41
|
| Rate for Payer: Aetna Medicare |
$494.73
|
| Rate for Payer: ASR ASR |
$1,297.01
|
| Rate for Payer: BCBS Complete |
$534.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.46
|
| Rate for Payer: BCN Commercial |
$1,102.46
|
| Rate for Payer: Cash Price |
$1,069.70
|
| Rate for Payer: Cash Price |
$1,069.70
|
| Rate for Payer: Cofinity Commercial |
$1,256.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.70
|
| Rate for Payer: Healthscope Commercial |
$1,297.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,337.12
|
| Rate for Payer: Mclaren Commercial |
$1,203.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.55
|
| Rate for Payer: Nomi Health Commercial |
$1,096.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$726.34
|
| Rate for Payer: Priority Health Narrow Network |
$581.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,176.67
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$268.18 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: Aetna Medicare |
$268.18
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$597.60
|
| Rate for Payer: BCN Commercial |
$597.60
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$635.07
|
| Rate for Payer: Priority Health Narrow Network |
$508.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$543.60 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Trust/PPO |
$595.21
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$1,221.45
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$916.09 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: ASR ASR |
$1,184.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.05
|
| Rate for Payer: BCN Commercial |
$1,003.05
|
| Rate for Payer: Cash Price |
$977.16
|
| Rate for Payer: Cofinity Commercial |
$1,148.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.16
|
| Rate for Payer: Healthscope Commercial |
$1,184.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.45
|
| Rate for Payer: Mclaren Commercial |
$1,099.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.23
|
| Rate for Payer: Nomi Health Commercial |
$1,001.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,074.88
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,221.45
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: Aetna Medicare |
$451.94
|
| Rate for Payer: ASR ASR |
$1,184.81
|
| Rate for Payer: BCBS Complete |
$488.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.09
|
| Rate for Payer: BCN Commercial |
$1,007.09
|
| Rate for Payer: Cash Price |
$977.16
|
| Rate for Payer: Cofinity Commercial |
$1,148.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.16
|
| Rate for Payer: Healthscope Commercial |
$1,184.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,221.45
|
| Rate for Payer: Mclaren Commercial |
$1,099.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$977.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.23
|
| Rate for Payer: Nomi Health Commercial |
$1,001.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,070.23
|
| Rate for Payer: Priority Health Narrow Network |
$856.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,074.88
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,114.27
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$835.70 |
| Max. Negotiated Rate |
$1,114.27 |
| Rate for Payer: Aetna Commercial |
$1,002.84
|
| Rate for Payer: ASR ASR |
$1,080.84
|
| Rate for Payer: BCBS Trust/PPO |
$915.04
|
| Rate for Payer: BCN Commercial |
$915.04
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cofinity Commercial |
$1,047.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.42
|
| Rate for Payer: Healthscope Commercial |
$1,080.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.27
|
| Rate for Payer: Mclaren Commercial |
$1,002.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.13
|
| Rate for Payer: Nomi Health Commercial |
$913.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$835.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$980.56
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,114.27
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,114.27 |
| Rate for Payer: Aetna Commercial |
$1,002.84
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,080.84
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$918.72
|
| Rate for Payer: BCN Commercial |
$918.72
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cofinity Commercial |
$1,047.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,080.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,114.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,002.84
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.13
|
| Rate for Payer: Nomi Health Commercial |
$913.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$835.70
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,021.71
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$817.37
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$980.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.24
|
| Rate for Payer: BCN Commercial |
$164.24
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$194.00
|
| Rate for Payer: Healthscope Whirlpool |
$200.00
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.90
|
| Rate for Payer: BCN Commercial |
$164.90
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$194.00
|
| Rate for Payer: Healthscope Whirlpool |
$200.00
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$175.24
|
| Rate for Payer: Priority Health Narrow Network |
$140.20
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,035.31 |
| Max. Negotiated Rate |
$1,380.41 |
| Rate for Payer: Aetna Commercial |
$1,242.37
|
| Rate for Payer: ASR ASR |
$1,339.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.59
|
| Rate for Payer: BCN Commercial |
$1,133.59
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Commercial |
$1,297.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Healthscope Commercial |
$1,339.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.41
|
| Rate for Payer: Mclaren Commercial |
$1,242.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,131.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.76
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,380.41 |
| Rate for Payer: Aetna Commercial |
$1,242.37
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$1,339.00
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,138.15
|
| Rate for Payer: BCN Commercial |
$1,138.15
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cash Price |
$1,104.33
|
| Rate for Payer: Cofinity Commercial |
$1,297.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,339.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,380.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,242.37
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,131.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.31
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,209.52
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$967.67
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,408.02
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.02 |
| Max. Negotiated Rate |
$1,408.02 |
| Rate for Payer: Aetna Commercial |
$1,267.22
|
| Rate for Payer: ASR ASR |
$1,365.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.27
|
| Rate for Payer: BCN Commercial |
$1,156.27
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Commercial |
$1,323.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Healthscope Commercial |
$1,365.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,408.02
|
| Rate for Payer: Mclaren Commercial |
$1,267.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Nomi Health Commercial |
$1,154.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.06
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,408.02
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,408.02 |
| Rate for Payer: Aetna Commercial |
$1,267.22
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$1,365.78
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.91
|
| Rate for Payer: BCN Commercial |
$1,160.91
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Commercial |
$1,323.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,365.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,408.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,267.22
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Nomi Health Commercial |
$1,154.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,233.71
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$987.02
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,239.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$539.70 |
| Max. Negotiated Rate |
$719.60 |
| Rate for Payer: Aetna Commercial |
$647.64
|
| Rate for Payer: ASR ASR |
$698.01
|
| Rate for Payer: BCBS Trust/PPO |
$590.94
|
| Rate for Payer: BCN Commercial |
$590.94
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Commercial |
$676.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Healthscope Commercial |
$698.01
|
| Rate for Payer: Healthscope Whirlpool |
$719.60
|
| Rate for Payer: Mclaren Commercial |
$647.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$590.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.25
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$719.60
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$719.60 |
| Rate for Payer: Aetna Commercial |
$647.64
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$698.01
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$593.31
|
| Rate for Payer: BCN Commercial |
$593.31
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cash Price |
$575.68
|
| Rate for Payer: Cofinity Commercial |
$676.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$698.01
|
| Rate for Payer: Healthscope Whirlpool |
$719.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$647.64
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.66
|
| Rate for Payer: Nomi Health Commercial |
$590.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.70
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$698.50
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$558.80
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$633.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,942.22
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,456.66 |
| Max. Negotiated Rate |
$1,942.22 |
| Rate for Payer: Aetna Commercial |
$1,748.00
|
| Rate for Payer: ASR ASR |
$1,883.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.95
|
| Rate for Payer: BCN Commercial |
$1,594.95
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cofinity Commercial |
$1,825.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.78
|
| Rate for Payer: Healthscope Commercial |
$1,883.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,942.22
|
| Rate for Payer: Mclaren Commercial |
$1,748.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.89
|
| Rate for Payer: Nomi Health Commercial |
$1,592.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,456.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.15
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,942.22
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,942.22 |
| Rate for Payer: Aetna Commercial |
$1,748.00
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,883.95
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.36
|
| Rate for Payer: BCN Commercial |
$1,601.36
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cash Price |
$1,553.78
|
| Rate for Payer: Cofinity Commercial |
$1,825.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,883.95
|
| Rate for Payer: Healthscope Whirlpool |
$1,942.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,748.00
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,650.89
|
| Rate for Payer: Nomi Health Commercial |
$1,592.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,456.66
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$935.15
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$748.12
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,643.61
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,643.61 |
| Rate for Payer: Aetna Commercial |
$1,479.25
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,594.30
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.16
|
| Rate for Payer: BCN Commercial |
$1,355.16
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cofinity Commercial |
$1,544.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,314.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,594.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,643.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,479.25
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.07
|
| Rate for Payer: Nomi Health Commercial |
$1,347.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,232.71
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,512.59
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,210.07
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,446.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,643.61
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,232.71 |
| Max. Negotiated Rate |
$1,643.61 |
| Rate for Payer: Aetna Commercial |
$1,479.25
|
| Rate for Payer: ASR ASR |
$1,594.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,349.73
|
| Rate for Payer: BCN Commercial |
$1,349.73
|
| Rate for Payer: Cash Price |
$1,314.89
|
| Rate for Payer: Cofinity Commercial |
$1,544.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,314.89
|
| Rate for Payer: Healthscope Commercial |
$1,594.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,643.61
|
| Rate for Payer: Mclaren Commercial |
$1,479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.07
|
| Rate for Payer: Nomi Health Commercial |
$1,347.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,232.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,446.38
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,403.98
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,442.97 |
| Rate for Payer: Aetna Commercial |
$1,263.58
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,361.86
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.58
|
| Rate for Payer: BCN Commercial |
$1,157.58
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cofinity Commercial |
$1,319.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,361.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,403.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,263.58
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.38
|
| Rate for Payer: Nomi Health Commercial |
$1,151.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.98
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,442.97
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.38
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,235.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,403.98
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,052.98 |
| Max. Negotiated Rate |
$1,403.98 |
| Rate for Payer: Aetna Commercial |
$1,263.58
|
| Rate for Payer: ASR ASR |
$1,361.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.95
|
| Rate for Payer: BCN Commercial |
$1,152.95
|
| Rate for Payer: Cash Price |
$1,123.18
|
| Rate for Payer: Cofinity Commercial |
$1,319.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.18
|
| Rate for Payer: Healthscope Commercial |
$1,361.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,403.98
|
| Rate for Payer: Mclaren Commercial |
$1,263.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.38
|
| Rate for Payer: Nomi Health Commercial |
$1,151.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,052.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,235.50
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,780.64 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,727.22
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.14
|
| Rate for Payer: BCN Commercial |
$1,468.14
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,673.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,727.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,602.58
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,612.46
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.97
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
