|
HC CT ABDOMEN ANGIO
|
Facility
|
IP
|
$1,075.90
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$677.82 |
| Max. Negotiated Rate |
$968.31 |
| Rate for Payer: Aetna Commercial |
$914.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.34
|
| Rate for Payer: Cash Price |
$860.72
|
| Rate for Payer: Cofinity Commercial |
$753.13
|
| Rate for Payer: Cofinity Commercial |
$925.27
|
| Rate for Payer: Healthscope Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$914.52
|
| Rate for Payer: PHP Commercial |
$914.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.13
|
| Rate for Payer: Priority Health SBD |
$677.82
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
IP
|
$1,921.32
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,210.43 |
| Max. Negotiated Rate |
$1,729.19 |
| Rate for Payer: Aetna Commercial |
$1,633.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.86
|
| Rate for Payer: Cash Price |
$1,537.06
|
| Rate for Payer: Cofinity Commercial |
$1,652.34
|
| Rate for Payer: Cofinity Commercial |
$1,344.92
|
| Rate for Payer: Healthscope Commercial |
$1,729.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,633.12
|
| Rate for Payer: PHP Commercial |
$1,633.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.92
|
| Rate for Payer: Priority Health SBD |
$1,210.43
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
OP
|
$1,921.32
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,729.19 |
| Rate for Payer: Aetna Commercial |
$1,633.12
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$304.48
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,537.06
|
| Rate for Payer: Cash Price |
$1,537.06
|
| Rate for Payer: Cofinity Commercial |
$1,344.92
|
| Rate for Payer: Cofinity Commercial |
$1,652.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,729.19
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,633.12
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,633.12
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.92
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$1,210.43
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$235.10
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
OP
|
$1,575.39
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,417.85 |
| Rate for Payer: Aetna Commercial |
$1,339.08
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$141.20
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,260.31
|
| Rate for Payer: Cash Price |
$1,260.31
|
| Rate for Payer: Cofinity Commercial |
$1,354.84
|
| Rate for Payer: Cofinity Commercial |
$1,102.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,417.85
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,339.08
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,339.08
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.77
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$992.50
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$137.53
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
IP
|
$1,575.39
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$992.50 |
| Max. Negotiated Rate |
$1,417.85 |
| Rate for Payer: Aetna Commercial |
$1,339.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,260.31
|
| Rate for Payer: Cofinity Commercial |
$1,102.77
|
| Rate for Payer: Cofinity Commercial |
$1,354.84
|
| Rate for Payer: Healthscope Commercial |
$1,417.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,339.08
|
| Rate for Payer: PHP Commercial |
$1,339.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.77
|
| Rate for Payer: Priority Health SBD |
$992.50
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
IP
|
$2,405.52
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,515.48 |
| Max. Negotiated Rate |
$2,164.97 |
| Rate for Payer: Aetna Commercial |
$2,044.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.59
|
| Rate for Payer: Cash Price |
$1,924.42
|
| Rate for Payer: Cofinity Commercial |
$1,683.86
|
| Rate for Payer: Cofinity Commercial |
$2,068.75
|
| Rate for Payer: Healthscope Commercial |
$2,164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,044.69
|
| Rate for Payer: PHP Commercial |
$2,044.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,683.86
|
| Rate for Payer: Priority Health SBD |
$1,515.48
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
OP
|
$2,405.52
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$2,164.97 |
| Rate for Payer: Aetna Commercial |
$2,044.69
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$344.20
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,924.42
|
| Rate for Payer: Cash Price |
$1,924.42
|
| Rate for Payer: Cofinity Commercial |
$2,068.75
|
| Rate for Payer: Cofinity Commercial |
$1,683.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$2,164.97
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,044.69
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$2,044.69
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,683.86
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$1,515.48
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$264.25
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
IP
|
$1,075.90
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$677.82 |
| Max. Negotiated Rate |
$968.31 |
| Rate for Payer: Aetna Commercial |
$914.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.34
|
| Rate for Payer: Cash Price |
$860.72
|
| Rate for Payer: Cofinity Commercial |
$753.13
|
| Rate for Payer: Cofinity Commercial |
$925.27
|
| Rate for Payer: Healthscope Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$914.52
|
| Rate for Payer: PHP Commercial |
$914.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.13
|
| Rate for Payer: Priority Health SBD |
$677.82
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
OP
|
$1,075.90
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$430.36 |
| Max. Negotiated Rate |
$968.31 |
| Rate for Payer: Aetna Commercial |
$914.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.34
|
| Rate for Payer: BCBS Complete |
$430.36
|
| Rate for Payer: BCBS Trust/PPO |
$504.71
|
| Rate for Payer: Cash Price |
$860.72
|
| Rate for Payer: Cash Price |
$860.72
|
| Rate for Payer: Cofinity Commercial |
$753.13
|
| Rate for Payer: Cofinity Commercial |
$925.27
|
| Rate for Payer: Healthscope Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$914.52
|
| Rate for Payer: PHP Commercial |
$914.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$753.13
|
| Rate for Payer: Priority Health SBD |
$677.82
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
IP
|
$3,025.12
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,905.83 |
| Max. Negotiated Rate |
$2,722.61 |
| Rate for Payer: Aetna Commercial |
$2,571.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,966.33
|
| Rate for Payer: Cash Price |
$2,420.10
|
| Rate for Payer: Cofinity Commercial |
$2,117.58
|
| Rate for Payer: Cofinity Commercial |
$2,601.60
|
| Rate for Payer: Healthscope Commercial |
$2,722.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,571.35
|
| Rate for Payer: PHP Commercial |
$2,571.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,117.58
|
| Rate for Payer: Priority Health SBD |
$1,905.83
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
OP
|
$3,025.12
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$2,722.61 |
| Rate for Payer: Aetna Commercial |
$2,571.35
|
| Rate for Payer: Aetna Medicare |
$355.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,966.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.74
|
| Rate for Payer: BCBS Complete |
$196.55
|
| Rate for Payer: BCBS MAPPO |
$342.19
|
| Rate for Payer: BCBS Trust/PPO |
$483.75
|
| Rate for Payer: BCN Medicare Advantage |
$342.19
|
| Rate for Payer: Cash Price |
$2,420.10
|
| Rate for Payer: Cash Price |
$2,420.10
|
| Rate for Payer: Cofinity Commercial |
$2,117.58
|
| Rate for Payer: Cofinity Commercial |
$2,601.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.19
|
| Rate for Payer: Healthscope Commercial |
$2,722.61
|
| Rate for Payer: Mclaren Medicaid |
$187.18
|
| Rate for Payer: Mclaren Medicare |
$342.19
|
| Rate for Payer: Meridian Medicaid |
$196.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$359.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,571.35
|
| Rate for Payer: PACE Medicare |
$325.08
|
| Rate for Payer: PACE SWMI |
$342.19
|
| Rate for Payer: PHP Commercial |
$2,571.35
|
| Rate for Payer: PHP Medicare Advantage |
$342.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,117.58
|
| Rate for Payer: Priority Health Medicare |
$342.19
|
| Rate for Payer: Priority Health SBD |
$1,905.83
|
| Rate for Payer: Railroad Medicare Medicare |
$342.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.19
|
| Rate for Payer: UHC Exchange |
$383.43
|
| Rate for Payer: UHC Medicare Advantage |
$352.46
|
| Rate for Payer: VA VA |
$342.19
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
IP
|
$1,291.12
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$813.41 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Aetna Commercial |
$1,097.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.23
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cofinity Commercial |
$1,110.36
|
| Rate for Payer: Cofinity Commercial |
$903.78
|
| Rate for Payer: Healthscope Commercial |
$1,162.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,097.45
|
| Rate for Payer: PHP Commercial |
$1,097.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.78
|
| Rate for Payer: Priority Health SBD |
$813.41
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,291.12
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Aetna Commercial |
$1,097.45
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$839.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$362.40
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cofinity Commercial |
$1,110.36
|
| Rate for Payer: Cofinity Commercial |
$903.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,162.01
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,097.45
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,097.45
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.78
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$813.41
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$324.17
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,114.15
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,331.91 |
| Max. Negotiated Rate |
$1,902.74 |
| Rate for Payer: Aetna Commercial |
$1,797.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.20
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cofinity Commercial |
$1,479.90
|
| Rate for Payer: Cofinity Commercial |
$1,818.17
|
| Rate for Payer: Healthscope Commercial |
$1,902.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.03
|
| Rate for Payer: PHP Commercial |
$1,797.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.90
|
| Rate for Payer: Priority Health SBD |
$1,331.91
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,114.15
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,902.74 |
| Rate for Payer: Aetna Commercial |
$1,797.03
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$518.50
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cofinity Commercial |
$1,818.17
|
| Rate for Payer: Cofinity Commercial |
$1,479.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,902.74
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.03
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,797.03
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,331.91
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$413.89
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$678.15
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$427.23 |
| Max. Negotiated Rate |
$610.34 |
| Rate for Payer: Aetna Commercial |
$576.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.80
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cofinity Commercial |
$474.70
|
| Rate for Payer: Cofinity Commercial |
$583.21
|
| Rate for Payer: Healthscope Commercial |
$610.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.43
|
| Rate for Payer: PHP Commercial |
$576.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.70
|
| Rate for Payer: Priority Health SBD |
$427.23
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$678.15
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$610.34 |
| Rate for Payer: Aetna Commercial |
$576.43
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.96
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cofinity Commercial |
$474.70
|
| Rate for Payer: Cofinity Commercial |
$583.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$610.34
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.43
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$576.43
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$427.23
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,031.42
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$928.28 |
| Rate for Payer: Aetna Commercial |
$876.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.42
|
| Rate for Payer: BCBS Complete |
$412.57
|
| Rate for Payer: BCBS Trust/PPO |
$244.86
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cofinity Commercial |
$721.99
|
| Rate for Payer: Cofinity Commercial |
$887.02
|
| Rate for Payer: Healthscope Commercial |
$928.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.71
|
| Rate for Payer: PHP Commercial |
$876.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.99
|
| Rate for Payer: Priority Health SBD |
$649.79
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,031.42
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$649.79 |
| Max. Negotiated Rate |
$928.28 |
| Rate for Payer: Aetna Commercial |
$876.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.42
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cofinity Commercial |
$721.99
|
| Rate for Payer: Cofinity Commercial |
$887.02
|
| Rate for Payer: Healthscope Commercial |
$928.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.71
|
| Rate for Payer: PHP Commercial |
$876.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.99
|
| Rate for Payer: Priority Health SBD |
$649.79
|
|
|
HC CT BRAIN W CON
|
Facility
|
IP
|
$1,590.89
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,002.26 |
| Max. Negotiated Rate |
$1,431.80 |
| Rate for Payer: Aetna Commercial |
$1,352.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.08
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cofinity Commercial |
$1,368.17
|
| Rate for Payer: Cofinity Commercial |
$1,113.62
|
| Rate for Payer: Healthscope Commercial |
$1,431.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.26
|
| Rate for Payer: PHP Commercial |
$1,352.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.62
|
| Rate for Payer: Priority Health SBD |
$1,002.26
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,590.89
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,431.80 |
| Rate for Payer: Aetna Commercial |
$1,352.26
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$164.93
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cofinity Commercial |
$1,113.62
|
| Rate for Payer: Cofinity Commercial |
$1,368.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,431.80
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.26
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,352.26
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,002.26
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$149.31
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT BRAIN WO CON
|
Facility
|
OP
|
$1,484.45
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$1,261.78
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$115.28
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cofinity Commercial |
$1,039.12
|
| Rate for Payer: Cofinity Commercial |
$1,276.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,336.00
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.78
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,261.78
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$935.20
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$106.75
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT BRAIN WO CON
|
Facility
|
IP
|
$1,484.45
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$935.20 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$1,261.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.89
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cofinity Commercial |
$1,039.12
|
| Rate for Payer: Cofinity Commercial |
$1,276.63
|
| Rate for Payer: Healthscope Commercial |
$1,336.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.78
|
| Rate for Payer: PHP Commercial |
$1,261.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.12
|
| Rate for Payer: Priority Health SBD |
$935.20
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
OP
|
$1,790.10
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,611.09 |
| Rate for Payer: Aetna Commercial |
$1,521.58
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,163.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$198.58
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cofinity Commercial |
$1,253.07
|
| Rate for Payer: Cofinity Commercial |
$1,539.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,611.09
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,521.58
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,521.58
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$556.17
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health Narrow Network |
$444.94
|
| Rate for Payer: Priority Health SBD |
$1,127.76
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$174.85
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
IP
|
$1,790.10
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,127.76 |
| Max. Negotiated Rate |
$1,611.09 |
| Rate for Payer: Aetna Commercial |
$1,521.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,163.56
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cofinity Commercial |
$1,253.07
|
| Rate for Payer: Cofinity Commercial |
$1,539.49
|
| Rate for Payer: Healthscope Commercial |
$1,611.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,521.58
|
| Rate for Payer: PHP Commercial |
$1,521.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.07
|
| Rate for Payer: Priority Health SBD |
$1,127.76
|
|
