|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,310.90
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$852.08 |
| Max. Negotiated Rate |
$1,310.90 |
| Rate for Payer: Aetna Commercial |
$1,179.81
|
| Rate for Payer: ASR ASR |
$1,271.57
|
| Rate for Payer: ASR Commercial |
$1,271.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.25
|
| Rate for Payer: BCN Commercial |
$1,016.34
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cofinity Commercial |
$1,232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.72
|
| Rate for Payer: Healthscope Commercial |
$1,310.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,271.57
|
| Rate for Payer: Mclaren Commercial |
$1,179.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.26
|
| Rate for Payer: Nomi Health Commercial |
$1,074.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,153.59
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,310.90
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$524.36 |
| Max. Negotiated Rate |
$1,310.90 |
| Rate for Payer: Aetna Commercial |
$1,179.81
|
| Rate for Payer: Aetna Medicare |
$655.45
|
| Rate for Payer: ASR ASR |
$1,271.57
|
| Rate for Payer: ASR Commercial |
$1,271.57
|
| Rate for Payer: BCBS Complete |
$524.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.50
|
| Rate for Payer: BCN Commercial |
$1,016.34
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cash Price |
$1,048.72
|
| Rate for Payer: Cofinity Commercial |
$1,232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.72
|
| Rate for Payer: Healthscope Commercial |
$1,310.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,271.57
|
| Rate for Payer: Mclaren Commercial |
$1,179.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,114.26
|
| Rate for Payer: Nomi Health Commercial |
$1,074.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$658.81
|
| Rate for Payer: Priority Health Narrow Network |
$527.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,153.59
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$710.59 |
| Rate for Payer: Aetna Commercial |
$639.53
|
| Rate for Payer: Aetna Medicare |
$355.30
|
| Rate for Payer: ASR ASR |
$689.27
|
| Rate for Payer: ASR Commercial |
$689.27
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS Trust/PPO |
$581.90
|
| Rate for Payer: BCN Commercial |
$550.92
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$667.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$710.59
|
| Rate for Payer: Healthscope Whirlpool |
$689.27
|
| Rate for Payer: Mclaren Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.62
|
| Rate for Payer: Priority Health Narrow Network |
$498.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.32
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$710.59 |
| Rate for Payer: Aetna Commercial |
$639.53
|
| Rate for Payer: ASR ASR |
$689.27
|
| Rate for Payer: ASR Commercial |
$689.27
|
| Rate for Payer: BCBS Trust/PPO |
$579.06
|
| Rate for Payer: BCN Commercial |
$550.92
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$667.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$710.59
|
| Rate for Payer: Healthscope Whirlpool |
$689.27
|
| Rate for Payer: Mclaren Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.32
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,197.50
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$479.00 |
| Max. Negotiated Rate |
$1,197.50 |
| Rate for Payer: Aetna Commercial |
$1,077.75
|
| Rate for Payer: Aetna Medicare |
$598.75
|
| Rate for Payer: ASR ASR |
$1,161.58
|
| Rate for Payer: ASR Commercial |
$1,161.58
|
| Rate for Payer: BCBS Complete |
$479.00
|
| Rate for Payer: BCBS Trust/PPO |
$980.63
|
| Rate for Payer: BCN Commercial |
$928.42
|
| Rate for Payer: Cash Price |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$1,125.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.00
|
| Rate for Payer: Healthscope Commercial |
$1,197.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.58
|
| Rate for Payer: Mclaren Commercial |
$1,077.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.88
|
| Rate for Payer: Nomi Health Commercial |
$981.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,049.25
|
| Rate for Payer: Priority Health Narrow Network |
$839.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.80
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$1,197.50
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$778.38 |
| Max. Negotiated Rate |
$1,197.50 |
| Rate for Payer: Aetna Commercial |
$1,077.75
|
| Rate for Payer: ASR ASR |
$1,161.58
|
| Rate for Payer: ASR Commercial |
$1,161.58
|
| Rate for Payer: BCBS Trust/PPO |
$975.84
|
| Rate for Payer: BCN Commercial |
$928.42
|
| Rate for Payer: Cash Price |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$1,125.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$958.00
|
| Rate for Payer: Healthscope Commercial |
$1,197.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,161.58
|
| Rate for Payer: Mclaren Commercial |
$1,077.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.88
|
| Rate for Payer: Nomi Health Commercial |
$981.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,053.80
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$710.07 |
| Max. Negotiated Rate |
$1,092.42 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: ASR ASR |
$1,059.65
|
| Rate for Payer: ASR Commercial |
$1,059.65
|
| Rate for Payer: BCBS Trust/PPO |
$890.21
|
| Rate for Payer: BCN Commercial |
$846.95
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$1,026.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$1,092.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,059.65
|
| Rate for Payer: Mclaren Commercial |
$983.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.33
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,092.42 |
| Rate for Payer: Aetna Commercial |
$983.18
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,059.65
|
| Rate for Payer: ASR Commercial |
$1,059.65
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$894.58
|
| Rate for Payer: BCN Commercial |
$846.95
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$1,026.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,092.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,059.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$983.18
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.72
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$741.38
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$961.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT HEART SCAN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: ASR Commercial |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$162.98
|
| Rate for Payer: BCN Commercial |
$155.06
|
| 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 |
$200.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.00
|
| 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: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.00
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: ASR Commercial |
$194.00
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$163.78
|
| Rate for Payer: BCN Commercial |
$155.06
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$160.00
|
| 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: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$200.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.71
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$131.77
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$879.67 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: ASR Commercial |
$1,312.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.84
|
| Rate for Payer: BCN Commercial |
$1,049.24
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,353.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.74
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
|
|
HC CT HEART W CON CONGEN HEART DI
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
35000017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: ASR Commercial |
$1,312.74
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.25
|
| Rate for Payer: BCN Commercial |
$1,049.24
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,353.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,185.80
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$948.69
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
IP
|
$1,380.41
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$897.27 |
| 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: ASR Commercial |
$1,339.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.90
|
| Rate for Payer: BCN Commercial |
$1,070.23
|
| 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 |
$1,380.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,339.00
|
| 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: Priority Health Cigna Priority Health |
$897.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.76
|
|
|
HC CT HEART WITH CONTRAST
|
Facility
|
OP
|
$1,380.41
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,380.41 |
| Rate for Payer: Aetna Commercial |
$1,242.37
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,339.00
|
| Rate for Payer: ASR Commercial |
$1,339.00
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.42
|
| Rate for Payer: BCN Commercial |
$1,070.23
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| 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 |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,380.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,339.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,242.37
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.35
|
| Rate for Payer: Nomi Health Commercial |
$1,131.94
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,209.52
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$967.67
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,214.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
OP
|
$705.49
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$705.49 |
| Rate for Payer: Aetna Commercial |
$634.94
|
| Rate for Payer: Aetna Medicare |
$86.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.84
|
| Rate for Payer: ASR ASR |
$684.33
|
| Rate for Payer: ASR Commercial |
$684.33
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$86.27
|
| Rate for Payer: BCBS Trust/PPO |
$577.73
|
| Rate for Payer: BCN Commercial |
$546.97
|
| Rate for Payer: BCN Medicare Advantage |
$86.27
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Commercial |
$663.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.27
|
| Rate for Payer: Healthscope Commercial |
$705.49
|
| Rate for Payer: Healthscope Whirlpool |
$684.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.27
|
| Rate for Payer: Mclaren Commercial |
$634.94
|
| Rate for Payer: Mclaren Medicaid |
$46.24
|
| Rate for Payer: Mclaren Medicare |
$86.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.58
|
| Rate for Payer: Meridian Medicaid |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Nomi Health Commercial |
$578.50
|
| Rate for Payer: PACE Medicare |
$81.96
|
| Rate for Payer: PACE SWMI |
$86.27
|
| Rate for Payer: PHP Commercial |
$94.90
|
| Rate for Payer: PHP Medicaid |
$46.24
|
| Rate for Payer: PHP Medicare Advantage |
$86.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.56
|
| Rate for Payer: Priority Health Medicare |
$86.27
|
| Rate for Payer: Priority Health Narrow Network |
$506.85
|
| Rate for Payer: Railroad Medicare Medicare |
$86.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.27
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$86.27
|
| Rate for Payer: UHCCP DNSP |
$86.27
|
| Rate for Payer: UHCCP Medicaid |
$46.24
|
| Rate for Payer: VA VA |
$86.27
|
|
|
HC CT LIMITED OR FOLLOW-UP
|
Facility
|
IP
|
$705.49
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
35000022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$458.57 |
| Max. Negotiated Rate |
$705.49 |
| Rate for Payer: Aetna Commercial |
$634.94
|
| Rate for Payer: ASR ASR |
$684.33
|
| Rate for Payer: ASR Commercial |
$684.33
|
| Rate for Payer: BCBS Trust/PPO |
$574.90
|
| Rate for Payer: BCN Commercial |
$546.97
|
| Rate for Payer: Cash Price |
$564.39
|
| Rate for Payer: Cofinity Commercial |
$663.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.39
|
| Rate for Payer: Healthscope Commercial |
$705.49
|
| Rate for Payer: Healthscope Whirlpool |
$684.33
|
| Rate for Payer: Mclaren Commercial |
$634.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.67
|
| Rate for Payer: Nomi Health Commercial |
$578.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.83
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
OP
|
$1,904.14
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,904.14 |
| Rate for Payer: Aetna Commercial |
$1,713.73
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,847.02
|
| Rate for Payer: ASR Commercial |
$1,847.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,559.30
|
| Rate for Payer: BCN Commercial |
$1,476.28
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cofinity Commercial |
$1,789.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,904.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,847.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,713.73
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,618.52
|
| Rate for Payer: Nomi Health Commercial |
$1,561.39
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$848.21
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$678.57
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,675.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT LOWER EXTREM ANGIO
|
Facility
|
IP
|
$1,904.14
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
35000011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,237.69 |
| Max. Negotiated Rate |
$1,904.14 |
| Rate for Payer: Aetna Commercial |
$1,713.73
|
| Rate for Payer: ASR ASR |
$1,847.02
|
| Rate for Payer: ASR Commercial |
$1,847.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.68
|
| Rate for Payer: BCN Commercial |
$1,476.28
|
| Rate for Payer: Cash Price |
$1,523.31
|
| Rate for Payer: Cofinity Commercial |
$1,789.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.31
|
| Rate for Payer: Healthscope Commercial |
$1,904.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,847.02
|
| Rate for Payer: Mclaren Commercial |
$1,713.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,618.52
|
| Rate for Payer: Nomi Health Commercial |
$1,561.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,237.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,675.64
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
OP
|
$1,611.38
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,611.38 |
| Rate for Payer: Aetna Commercial |
$1,450.24
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,563.04
|
| Rate for Payer: ASR Commercial |
$1,563.04
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,319.56
|
| Rate for Payer: BCN Commercial |
$1,249.30
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cofinity Commercial |
$1,514.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,289.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,611.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,563.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,450.24
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.67
|
| Rate for Payer: Nomi Health Commercial |
$1,321.33
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,371.96
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,097.57
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,418.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT LOWER EXTREM BILAT W CON
|
Facility
|
IP
|
$1,611.38
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200030
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$1,611.38 |
| Rate for Payer: Aetna Commercial |
$1,450.24
|
| Rate for Payer: ASR ASR |
$1,563.04
|
| Rate for Payer: ASR Commercial |
$1,563.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,313.11
|
| Rate for Payer: BCN Commercial |
$1,249.30
|
| Rate for Payer: Cash Price |
$1,289.10
|
| Rate for Payer: Cofinity Commercial |
$1,514.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,289.10
|
| Rate for Payer: Healthscope Commercial |
$1,611.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,563.04
|
| Rate for Payer: Mclaren Commercial |
$1,450.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,369.67
|
| Rate for Payer: Nomi Health Commercial |
$1,321.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,418.01
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
OP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,376.45 |
| Rate for Payer: Aetna Commercial |
$1,238.80
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,335.16
|
| Rate for Payer: ASR Commercial |
$1,335.16
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.17
|
| Rate for Payer: BCN Commercial |
$1,067.16
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$1,293.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,376.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,238.80
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,308.82
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.06
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT LOWER EXTREM BILAT WO CON
|
Facility
|
IP
|
$1,376.45
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
35200017
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$894.69 |
| Max. Negotiated Rate |
$1,376.45 |
| Rate for Payer: Aetna Commercial |
$1,238.80
|
| Rate for Payer: ASR ASR |
$1,335.16
|
| Rate for Payer: ASR Commercial |
$1,335.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.67
|
| Rate for Payer: BCN Commercial |
$1,067.16
|
| Rate for Payer: Cash Price |
$1,101.16
|
| Rate for Payer: Cofinity Commercial |
$1,293.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.16
|
| Rate for Payer: Healthscope Commercial |
$1,376.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.16
|
| Rate for Payer: Mclaren Commercial |
$1,238.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.98
|
| Rate for Payer: Nomi Health Commercial |
$1,128.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,211.28
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
IP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.72 |
| Max. Negotiated Rate |
$1,745.73 |
| Rate for Payer: Aetna Commercial |
$1,571.16
|
| Rate for Payer: ASR ASR |
$1,693.36
|
| Rate for Payer: ASR Commercial |
$1,693.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.60
|
| Rate for Payer: BCN Commercial |
$1,353.46
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,640.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Healthscope Commercial |
$1,745.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,693.36
|
| Rate for Payer: Mclaren Commercial |
$1,571.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,536.24
|
|
|
HC CT LOWER EXTREM BILAT WO W CON
|
Facility
|
OP
|
$1,745.73
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
35200020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,745.73 |
| Rate for Payer: Aetna Commercial |
$1,571.16
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,693.36
|
| Rate for Payer: ASR Commercial |
$1,693.36
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,429.58
|
| Rate for Payer: BCN Commercial |
$1,353.46
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cash Price |
$1,396.58
|
| Rate for Payer: Cofinity Commercial |
$1,640.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,745.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,693.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,571.16
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,483.87
|
| Rate for Payer: Nomi Health Commercial |
$1,431.50
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,134.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,462.55
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,170.04
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,536.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT LOWER EXTREM BIL W CON
|
Facility
|
IP
|
$2,061.33
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
35200032
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,339.86 |
| Max. Negotiated Rate |
$2,061.33 |
| Rate for Payer: Aetna Commercial |
$1,855.20
|
| Rate for Payer: ASR ASR |
$1,999.49
|
| Rate for Payer: ASR Commercial |
$1,999.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.78
|
| Rate for Payer: BCN Commercial |
$1,598.15
|
| Rate for Payer: Cash Price |
$1,649.06
|
| Rate for Payer: Cofinity Commercial |
$1,937.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,649.06
|
| Rate for Payer: Healthscope Commercial |
$2,061.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,999.49
|
| Rate for Payer: Mclaren Commercial |
$1,855.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,752.13
|
| Rate for Payer: Nomi Health Commercial |
$1,690.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,813.97
|
|
