|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,335.48 |
| Max. Negotiated Rate |
$1,780.64 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: ASR ASR |
$1,727.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.26
|
| Rate for Payer: BCN Commercial |
$1,462.26
|
| 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: Healthscope Commercial |
$1,727.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.64
|
| Rate for Payer: Mclaren Commercial |
$1,602.58
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,566.96
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,102.56
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,576.92 |
| Max. Negotiated Rate |
$2,102.56 |
| Rate for Payer: Aetna Commercial |
$1,892.30
|
| Rate for Payer: ASR ASR |
$2,039.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,726.62
|
| Rate for Payer: BCN Commercial |
$1,726.62
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$1,976.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.05
|
| Rate for Payer: Healthscope Commercial |
$2,039.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,102.56
|
| Rate for Payer: Mclaren Commercial |
$1,892.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,787.18
|
| Rate for Payer: Nomi Health Commercial |
$1,724.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,850.25
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
OP
|
$2,102.56
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,102.56 |
| Rate for Payer: Aetna Commercial |
$1,892.30
|
| 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 |
$2,039.48
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,733.56
|
| Rate for Payer: BCN Commercial |
$1,733.56
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cash Price |
$1,682.05
|
| Rate for Payer: Cofinity Commercial |
$1,976.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,682.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,039.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,102.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,892.30
|
| 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 |
$1,787.18
|
| Rate for Payer: Nomi Health Commercial |
$1,724.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.92
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$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 |
$1,850.25
|
| 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 BIL WO CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,335.48 |
| Max. Negotiated Rate |
$1,780.64 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: ASR ASR |
$1,727.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.26
|
| Rate for Payer: BCN Commercial |
$1,462.26
|
| 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: Healthscope Commercial |
$1,727.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.64
|
| Rate for Payer: Mclaren Commercial |
$1,602.58
|
| 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: UHC All Payor (Choice/PPO) + Core |
$1,566.96
|
|
|
HC CT LOWER EXTREM BIL WO CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200031
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,780.64 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| 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 |
$1,727.22
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.14
|
| Rate for Payer: BCN Commercial |
$1,468.14
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$1,673.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,727.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,602.58
|
| 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 |
$1,513.54
|
| 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 |
$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 |
$1,566.96
|
| 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 EXTREMITY WO W CON
|
Facility
|
OP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,780.64 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: Aetna Commercial |
$2,403.86
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,727.22
|
| Rate for Payer: ASR ASR |
$2,590.83
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,202.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.14
|
| Rate for Payer: BCN Commercial |
$2,202.21
|
| Rate for Payer: BCN Commercial |
$1,468.14
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cofinity Commercial |
$1,673.80
|
| Rate for Payer: Cofinity Commercial |
$2,510.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,727.22
|
| Rate for Payer: Healthscope Commercial |
$2,590.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,670.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$2,403.86
|
| Rate for Payer: Mclaren Commercial |
$1,602.58
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.32
|
| Rate for Payer: Nomi Health Commercial |
$2,190.19
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.22
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,612.46
|
| 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 Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.97
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,350.44
|
| 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 Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT LOWER EXTREMITY WO W CON
|
Facility
|
IP
|
$1,780.64
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,335.48 |
| Max. Negotiated Rate |
$1,780.64 |
| Rate for Payer: Aetna Commercial |
$1,602.58
|
| Rate for Payer: Aetna Commercial |
$2,403.86
|
| Rate for Payer: ASR ASR |
$1,727.22
|
| Rate for Payer: ASR ASR |
$2,590.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,462.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,193.39
|
| Rate for Payer: BCN Commercial |
$1,462.26
|
| Rate for Payer: BCN Commercial |
$2,193.39
|
| Rate for Payer: Cash Price |
$2,136.77
|
| Rate for Payer: Cash Price |
$1,424.51
|
| Rate for Payer: Cofinity Commercial |
$2,510.70
|
| Rate for Payer: Cofinity Commercial |
$1,673.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,424.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.77
|
| Rate for Payer: Healthscope Commercial |
$1,727.22
|
| Rate for Payer: Healthscope Commercial |
$2,590.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,670.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,780.64
|
| Rate for Payer: Mclaren Commercial |
$2,403.86
|
| Rate for Payer: Mclaren Commercial |
$1,602.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,513.54
|
| Rate for Payer: Nomi Health Commercial |
$2,190.19
|
| Rate for Payer: Nomi Health Commercial |
$1,460.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,335.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,350.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.96
|
|
|
HC CT LOWER EXTREM W CON
|
Facility
|
OP
|
$1,576.53
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,576.53 |
| Rate for Payer: Aetna Commercial |
$1,418.88
|
| 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 |
$1,529.23
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,299.85
|
| Rate for Payer: BCN Commercial |
$1,299.85
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cofinity Commercial |
$1,481.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,529.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,576.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,418.88
|
| 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 |
$1,340.05
|
| Rate for Payer: Nomi Health Commercial |
$1,292.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.40
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$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 |
$1,387.35
|
| 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 W CON
|
Facility
|
IP
|
$1,576.53
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,182.40 |
| Max. Negotiated Rate |
$1,576.53 |
| Rate for Payer: Aetna Commercial |
$1,418.88
|
| Rate for Payer: ASR ASR |
$1,529.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,294.65
|
| Rate for Payer: BCN Commercial |
$1,294.65
|
| Rate for Payer: Cash Price |
$1,261.22
|
| Rate for Payer: Cofinity Commercial |
$1,481.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.22
|
| Rate for Payer: Healthscope Commercial |
$1,529.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,576.53
|
| Rate for Payer: Mclaren Commercial |
$1,418.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.05
|
| Rate for Payer: Nomi Health Commercial |
$1,292.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,387.35
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
IP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,032.34 |
| Max. Negotiated Rate |
$1,376.45 |
| Rate for Payer: Aetna Commercial |
$1,238.81
|
| Rate for Payer: Aetna Commercial |
$1,858.20
|
| Rate for Payer: ASR ASR |
$1,335.16
|
| Rate for Payer: ASR ASR |
$2,002.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,695.51
|
| Rate for Payer: BCN Commercial |
$1,130.34
|
| Rate for Payer: BCN Commercial |
$1,695.51
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$1,940.79
|
| Rate for Payer: Cofinity Commercial |
$1,293.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,651.74
|
| Rate for Payer: Healthscope Commercial |
$1,335.16
|
| Rate for Payer: Healthscope Commercial |
$2,002.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,064.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.45
|
| Rate for Payer: Mclaren Commercial |
$1,858.20
|
| Rate for Payer: Mclaren Commercial |
$1,238.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,754.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Nomi Health Commercial |
$1,693.03
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,548.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,816.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.28
|
|
|
HC CT LOWER EXTREM WO CON
|
Facility
|
OP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200016
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,442.97 |
| Rate for Payer: Aetna Commercial |
$1,238.81
|
| Rate for Payer: Aetna Commercial |
$1,858.20
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,335.16
|
| Rate for Payer: ASR ASR |
$2,002.73
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,702.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.88
|
| Rate for Payer: BCN Commercial |
$1,702.32
|
| Rate for Payer: BCN Commercial |
$1,134.88
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cash Price |
$1,651.74
|
| Rate for Payer: Cofinity Commercial |
$1,293.86
|
| Rate for Payer: Cofinity Commercial |
$1,940.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,651.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,335.16
|
| Rate for Payer: Healthscope Commercial |
$2,002.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,376.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,064.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,858.20
|
| Rate for Payer: Mclaren Commercial |
$1,238.81
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,754.97
|
| Rate for Payer: Nomi Health Commercial |
$1,693.03
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,548.50
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,442.97
|
| 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 Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,154.38
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,816.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
IP
|
$1,058.24
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$793.68 |
| Max. Negotiated Rate |
$1,058.24 |
| Rate for Payer: Aetna Commercial |
$952.42
|
| Rate for Payer: Aetna Commercial |
$634.94
|
| Rate for Payer: ASR ASR |
$1,026.49
|
| Rate for Payer: ASR ASR |
$684.33
|
| Rate for Payer: BCBS Trust/PPO |
$869.03
|
| Rate for Payer: BCBS Trust/PPO |
$579.35
|
| Rate for Payer: BCN Commercial |
$869.03
|
| Rate for Payer: BCN Commercial |
$579.35
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$846.59
|
| Rate for Payer: Cofinity Commercial |
$663.16
|
| Rate for Payer: Cofinity Commercial |
$994.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Healthscope Commercial |
$1,026.49
|
| Rate for Payer: Healthscope Commercial |
$684.33
|
| Rate for Payer: Healthscope Whirlpool |
$705.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.24
|
| Rate for Payer: Mclaren Commercial |
$634.94
|
| Rate for Payer: Mclaren Commercial |
$952.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.50
|
| Rate for Payer: Nomi Health Commercial |
$578.50
|
| Rate for Payer: Nomi Health Commercial |
$867.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$931.25
|
|
|
HC CT LOWER EXTREM WO W CON
|
Facility
|
OP
|
$1,058.24
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200029
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,612.46 |
| Rate for Payer: Aetna Commercial |
$952.42
|
| Rate for Payer: Aetna Commercial |
$634.94
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,026.49
|
| Rate for Payer: ASR ASR |
$684.33
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$581.68
|
| Rate for Payer: BCBS Trust/PPO |
$872.52
|
| Rate for Payer: BCN Commercial |
$581.68
|
| Rate for Payer: BCN Commercial |
$872.52
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$846.59
|
| Rate for Payer: Cash Price |
$846.59
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Commercial |
$994.75
|
| Rate for Payer: Cofinity Commercial |
$663.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,026.49
|
| Rate for Payer: Healthscope Commercial |
$684.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,058.24
|
| Rate for Payer: Healthscope Whirlpool |
$705.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$634.94
|
| Rate for Payer: Mclaren Commercial |
$952.42
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: Meridian Medicaid |
$95.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Nomi Health Commercial |
$578.50
|
| Rate for Payer: Nomi Health Commercial |
$867.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.12
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,612.46
|
| 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 Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,289.97
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$931.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT NECK ANGIO
|
Facility
|
OP
|
$1,114.27
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 |
$1,022.92
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$818.34
|
| 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 NECK ANGIO
|
Facility
|
IP
|
$1,114.27
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| 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 NEEDLE PLACE HEAD AND NECK
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,752.46 |
| Max. Negotiated Rate |
$9,142.74 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: Aetna Medicare |
$5,898.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,237.37
|
| Rate for Payer: BCN Commercial |
$3,237.37
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,898.54
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$3,239.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Commercial |
$6,488.39
|
| Rate for Payer: PHP Medicaid |
$3,161.62
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,440.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Narrow Network |
$2,752.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Exchange |
$9,142.74
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP DNSP |
$5,898.54
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
HC CT NEEDLE PLACE HEAD AND NECK
|
Facility
|
IP
|
$3,926.47
|
|
|
Service Code
|
CPT 41019
|
| Hospital Charge Code |
36100396
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,944.85 |
| Max. Negotiated Rate |
$3,926.47 |
| Rate for Payer: Aetna Commercial |
$3,533.82
|
| Rate for Payer: ASR ASR |
$3,808.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,224.42
|
| Rate for Payer: BCN Commercial |
$3,224.42
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Commercial |
$3,690.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Healthscope Commercial |
$3,808.68
|
| Rate for Payer: Healthscope Whirlpool |
$3,926.47
|
| Rate for Payer: Mclaren Commercial |
$3,533.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$3,219.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,455.29
|
|
|
HC CTO CATHETER
|
Facility
|
OP
|
$6,591.31
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,438.78 |
| Max. Negotiated Rate |
$6,591.31 |
| Rate for Payer: Aetna Commercial |
$5,932.18
|
| Rate for Payer: Aetna Medicare |
$2,438.78
|
| Rate for Payer: ASR ASR |
$6,393.57
|
| Rate for Payer: BCBS Complete |
$2,636.52
|
| Rate for Payer: BCBS Trust/PPO |
$5,434.54
|
| Rate for Payer: BCN Commercial |
$5,434.54
|
| Rate for Payer: Cash Price |
$5,273.05
|
| Rate for Payer: Cofinity Commercial |
$6,195.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,273.05
|
| Rate for Payer: Healthscope Commercial |
$6,393.57
|
| Rate for Payer: Healthscope Whirlpool |
$6,591.31
|
| Rate for Payer: Mclaren Commercial |
$5,932.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,273.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,602.61
|
| Rate for Payer: Nomi Health Commercial |
$5,404.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,943.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,775.31
|
| Rate for Payer: Priority Health Narrow Network |
$4,620.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,800.35
|
|
|
HC CTO CATHETER
|
Facility
|
IP
|
$6,591.31
|
|
| Hospital Charge Code |
27200117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,943.48 |
| Max. Negotiated Rate |
$6,591.31 |
| Rate for Payer: Aetna Commercial |
$5,932.18
|
| Rate for Payer: ASR ASR |
$6,393.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,412.78
|
| Rate for Payer: BCN Commercial |
$5,412.78
|
| Rate for Payer: Cash Price |
$5,273.05
|
| Rate for Payer: Cofinity Commercial |
$6,195.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,273.05
|
| Rate for Payer: Healthscope Commercial |
$6,393.57
|
| Rate for Payer: Healthscope Whirlpool |
$6,591.31
|
| Rate for Payer: Mclaren Commercial |
$5,932.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,602.61
|
| Rate for Payer: Nomi Health Commercial |
$5,404.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,943.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,800.35
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
IP
|
$1,611.23
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,208.42 |
| Max. Negotiated Rate |
$1,611.23 |
| Rate for Payer: Aetna Commercial |
$1,450.11
|
| Rate for Payer: ASR ASR |
$1,562.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,323.14
|
| Rate for Payer: BCN Commercial |
$1,323.14
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cofinity Commercial |
$1,514.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,288.98
|
| Rate for Payer: Healthscope Commercial |
$1,562.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,611.23
|
| Rate for Payer: Mclaren Commercial |
$1,450.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.55
|
| Rate for Payer: Nomi Health Commercial |
$1,321.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,417.88
|
|
|
HC CT ORBIT/SELLA/POST FOSSA/EAR W CON
|
Facility
|
OP
|
$1,611.23
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
35100005
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,611.23 |
| Rate for Payer: Aetna Commercial |
$1,450.11
|
| 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 |
$1,562.89
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.46
|
| Rate for Payer: BCN Commercial |
$1,328.46
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cofinity Commercial |
$1,514.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,288.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,562.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,611.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,450.11
|
| 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 |
$1,369.55
|
| Rate for Payer: Nomi Health Commercial |
$1,321.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.42
|
| 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 |
$849.20
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$679.36
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,417.88
|
| 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 ORBIT WO CON
|
Facility
|
IP
|
$1,464.15
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,098.11 |
| Max. Negotiated Rate |
$1,464.15 |
| Rate for Payer: Aetna Commercial |
$1,317.73
|
| Rate for Payer: ASR ASR |
$1,420.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.36
|
| Rate for Payer: BCN Commercial |
$1,202.36
|
| Rate for Payer: Cash Price |
$1,171.32
|
| Rate for Payer: Cofinity Commercial |
$1,376.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,171.32
|
| Rate for Payer: Healthscope Commercial |
$1,420.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,464.15
|
| Rate for Payer: Mclaren Commercial |
$1,317.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,244.53
|
| Rate for Payer: Nomi Health Commercial |
$1,200.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,098.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,288.45
|
|
|
HC CT ORBIT WO CON
|
Facility
|
OP
|
$1,464.15
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
35100004
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,464.15 |
| Rate for Payer: Aetna Commercial |
$1,317.73
|
| 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 |
$1,420.23
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.19
|
| Rate for Payer: BCN Commercial |
$1,207.19
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,171.32
|
| Rate for Payer: Cash Price |
$1,171.32
|
| Rate for Payer: Cofinity Commercial |
$1,376.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,171.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,420.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,464.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,317.73
|
| 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 |
$1,244.53
|
| Rate for Payer: Nomi Health Commercial |
$1,200.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,098.11
|
| 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 |
$758.41
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$606.73
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,288.45
|
| 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 ORBIT WO W CON
|
Facility
|
IP
|
$1,528.66
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,146.49 |
| Max. Negotiated Rate |
$1,528.66 |
| Rate for Payer: Aetna Commercial |
$1,375.79
|
| Rate for Payer: ASR ASR |
$1,482.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.34
|
| Rate for Payer: BCN Commercial |
$1,255.34
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cofinity Commercial |
$1,436.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.93
|
| Rate for Payer: Healthscope Commercial |
$1,482.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,528.66
|
| Rate for Payer: Mclaren Commercial |
$1,375.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.36
|
| Rate for Payer: Nomi Health Commercial |
$1,253.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,345.22
|
|
|
HC CT ORBIT WO W CON
|
Facility
|
OP
|
$1,528.66
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
35100006
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,528.66 |
| Rate for Payer: Aetna Commercial |
$1,375.79
|
| 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 |
$1,482.80
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.38
|
| Rate for Payer: BCN Commercial |
$1,260.38
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cofinity Commercial |
$1,436.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,482.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,528.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,375.79
|
| 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 |
$1,299.36
|
| Rate for Payer: Nomi Health Commercial |
$1,253.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.49
|
| 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 |
$975.10
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$780.08
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,345.22
|
| 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
|
|
