|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
IP
|
$2,027.45
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,277.29 |
| Max. Negotiated Rate |
$1,824.70 |
| Rate for Payer: Aetna Commercial |
$1,723.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,317.84
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cofinity Commercial |
$1,419.22
|
| Rate for Payer: Cofinity Commercial |
$1,743.61
|
| Rate for Payer: Healthscope Commercial |
$1,824.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,723.33
|
| Rate for Payer: PHP Commercial |
$1,723.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,419.22
|
| Rate for Payer: Priority Health SBD |
$1,277.29
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
OP
|
$2,027.45
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,824.70 |
| Rate for Payer: Aetna Commercial |
$1,723.33
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,317.84
|
| 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 |
$340.89
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cofinity Commercial |
$1,419.22
|
| Rate for Payer: Cofinity Commercial |
$1,743.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,824.70
|
| 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 |
$1,723.33
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,723.33
|
| 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 |
$1,419.22
|
| 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 |
$1,277.29
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$283.56
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
OP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$454.53 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.27
|
| 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 |
$151.13
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$353.52
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| 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 |
$429.28
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$429.28
|
| 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 |
$353.52
|
| 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 |
$318.17
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$138.51
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
IP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$318.17 |
| Max. Negotiated Rate |
$454.53 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.27
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$353.52
|
| Rate for Payer: Cofinity Commercial |
$434.33
|
| Rate for Payer: Healthscope Commercial |
$454.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.28
|
| Rate for Payer: PHP Commercial |
$429.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.52
|
| Rate for Payer: Priority Health SBD |
$318.17
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,703.09
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,532.78 |
| Rate for Payer: Aetna Commercial |
$1,447.63
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.01
|
| 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 |
$194.71
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cofinity Commercial |
$1,192.16
|
| Rate for Payer: Cofinity Commercial |
$1,464.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,532.78
|
| 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 |
$1,447.63
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,447.63
|
| 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 |
$1,192.16
|
| 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 |
$1,072.95
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$168.31
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,703.09
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.95 |
| Max. Negotiated Rate |
$1,532.78 |
| Rate for Payer: Aetna Commercial |
$1,447.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.01
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cofinity Commercial |
$1,192.16
|
| Rate for Payer: Cofinity Commercial |
$1,464.66
|
| Rate for Payer: Healthscope Commercial |
$1,532.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,447.63
|
| Rate for Payer: PHP Commercial |
$1,447.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.16
|
| Rate for Payer: Priority Health SBD |
$1,072.95
|
|
|
HC CT CHEST WO CON
|
Facility
|
IP
|
$1,484.40
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$935.17 |
| Max. Negotiated Rate |
$1,335.96 |
| Rate for Payer: Aetna Commercial |
$1,261.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.86
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cofinity Commercial |
$1,039.08
|
| Rate for Payer: Cofinity Commercial |
$1,276.58
|
| Rate for Payer: Healthscope Commercial |
$1,335.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.74
|
| Rate for Payer: PHP Commercial |
$1,261.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.08
|
| Rate for Payer: Priority Health SBD |
$935.17
|
|
|
HC CT CHEST WO CON
|
Facility
|
OP
|
$1,484.40
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,335.96 |
| Rate for Payer: Aetna Commercial |
$1,261.74
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.86
|
| 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 |
$143.42
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cofinity Commercial |
$1,276.58
|
| Rate for Payer: Cofinity Commercial |
$1,039.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,335.96
|
| 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 |
$1,261.74
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,261.74
|
| 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 |
$1,039.08
|
| 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 |
$935.17
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$133.92
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT CHEST WO W CON
|
Facility
|
OP
|
$2,015.62
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,814.06 |
| Rate for Payer: Aetna Commercial |
$1,713.28
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.15
|
| 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 |
$239.94
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cofinity Commercial |
$1,410.93
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,814.06
|
| 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 |
$1,713.28
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,713.28
|
| 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 |
$1,410.93
|
| 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 |
$1,269.84
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$197.77
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT CHEST WO W CON
|
Facility
|
IP
|
$2,015.62
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,269.84 |
| Max. Negotiated Rate |
$1,814.06 |
| Rate for Payer: Aetna Commercial |
$1,713.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.15
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cofinity Commercial |
$1,410.93
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Healthscope Commercial |
$1,814.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,713.28
|
| Rate for Payer: PHP Commercial |
$1,713.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.93
|
| Rate for Payer: Priority Health SBD |
$1,269.84
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$852.60 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Cofinity Commercial |
$947.34
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: Priority Health SBD |
$852.60
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.67
|
| 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 |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Cofinity Commercial |
$947.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| 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 |
$1,150.34
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| 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 |
$947.34
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$852.60
|
| 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 CRYOABLATION GUIDANCE
|
Facility
|
IP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$677.30 |
| Max. Negotiated Rate |
$967.57 |
| Rate for Payer: Aetna Commercial |
$913.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.80
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$752.56
|
| Rate for Payer: Cofinity Commercial |
$924.57
|
| Rate for Payer: Healthscope Commercial |
$967.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: PHP Commercial |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: Priority Health SBD |
$677.30
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
OP
|
$1,075.08
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$430.03 |
| Max. Negotiated Rate |
$967.57 |
| Rate for Payer: Aetna Commercial |
$913.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.80
|
| Rate for Payer: BCBS Complete |
$430.03
|
| Rate for Payer: BCBS Trust/PPO |
$504.71
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cash Price |
$860.06
|
| Rate for Payer: Cofinity Commercial |
$752.56
|
| Rate for Payer: Cofinity Commercial |
$924.57
|
| Rate for Payer: Healthscope Commercial |
$967.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$913.82
|
| Rate for Payer: PHP Commercial |
$913.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.56
|
| Rate for Payer: Priority Health SBD |
$677.30
|
|
|
HC CT FACIAL W CON
|
Facility
|
IP
|
$1,560.50
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$983.12 |
| Max. Negotiated Rate |
$1,404.45 |
| Rate for Payer: Aetna Commercial |
$1,326.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.32
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cofinity Commercial |
$1,342.03
|
| Rate for Payer: Cofinity Commercial |
$1,092.35
|
| Rate for Payer: Healthscope Commercial |
$1,404.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,326.42
|
| Rate for Payer: PHP Commercial |
$1,326.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.35
|
| Rate for Payer: Priority Health SBD |
$983.12
|
|
|
HC CT FACIAL W CON
|
Facility
|
OP
|
$1,560.50
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,404.45 |
| Rate for Payer: Aetna Commercial |
$1,326.42
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.32
|
| 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 |
$172.10
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cash Price |
$1,248.40
|
| Rate for Payer: Cofinity Commercial |
$1,092.35
|
| Rate for Payer: Cofinity Commercial |
$1,342.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,404.45
|
| 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 |
$1,326.42
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,326.42
|
| 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 |
$1,092.35
|
| 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 |
$983.12
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$153.24
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT FACIAL WO CON
|
Facility
|
IP
|
$1,383.22
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$871.43 |
| Max. Negotiated Rate |
$1,244.90 |
| Rate for Payer: Aetna Commercial |
$1,175.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.09
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$968.25
|
| Rate for Payer: Cofinity Commercial |
$1,189.57
|
| Rate for Payer: Healthscope Commercial |
$1,244.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,175.74
|
| Rate for Payer: PHP Commercial |
$1,175.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$968.25
|
| Rate for Payer: Priority Health SBD |
$871.43
|
|
|
HC CT FACIAL WO CON
|
Facility
|
OP
|
$1,383.22
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,244.90 |
| Rate for Payer: Aetna Commercial |
$1,175.74
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.09
|
| 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 |
$152.79
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cash Price |
$1,106.58
|
| Rate for Payer: Cofinity Commercial |
$968.25
|
| Rate for Payer: Cofinity Commercial |
$1,189.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$1,244.90
|
| 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 |
$1,175.74
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$1,175.74
|
| 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 |
$968.25
|
| 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 |
$871.43
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$129.01
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
OP
|
$1,469.30
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$1,322.37 |
| Rate for Payer: Aetna Commercial |
$1,248.90
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.04
|
| 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 |
$217.88
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,263.60
|
| Rate for Payer: Cofinity Commercial |
$1,028.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$1,322.37
|
| 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 |
$1,248.90
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$1,248.90
|
| 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 |
$1,028.51
|
| 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 |
$925.66
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$185.66
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
IP
|
$1,469.30
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$925.66 |
| Max. Negotiated Rate |
$1,322.37 |
| Rate for Payer: Aetna Commercial |
$1,248.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$955.04
|
| Rate for Payer: Cash Price |
$1,175.44
|
| Rate for Payer: Cofinity Commercial |
$1,028.51
|
| Rate for Payer: Cofinity Commercial |
$1,263.60
|
| Rate for Payer: Healthscope Commercial |
$1,322.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,248.90
|
| Rate for Payer: PHP Commercial |
$1,248.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.51
|
| Rate for Payer: Priority Health SBD |
$925.66
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
OP
|
$1,420.15
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,278.14 |
| Rate for Payer: Aetna Commercial |
$1,207.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.10
|
| Rate for Payer: BCBS Complete |
$568.06
|
| Rate for Payer: BCBS Trust/PPO |
$119.14
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,221.33
|
| Rate for Payer: Cofinity Commercial |
$994.10
|
| Rate for Payer: Healthscope Commercial |
$1,278.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.13
|
| Rate for Payer: PHP Commercial |
$1,207.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.10
|
| Rate for Payer: Priority Health SBD |
$894.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.19
|
| Rate for Payer: UHC Exchange |
$136.54
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,420.15
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$894.69 |
| Max. Negotiated Rate |
$1,278.14 |
| Rate for Payer: Aetna Commercial |
$1,207.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.10
|
| Rate for Payer: Cash Price |
$1,136.12
|
| Rate for Payer: Cofinity Commercial |
$1,221.33
|
| Rate for Payer: Cofinity Commercial |
$994.10
|
| Rate for Payer: Healthscope Commercial |
$1,278.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.13
|
| Rate for Payer: PHP Commercial |
$1,207.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.10
|
| Rate for Payer: Priority Health SBD |
$894.69
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,285.20
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$1,156.68 |
| Rate for Payer: Aetna Commercial |
$1,092.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.38
|
| Rate for Payer: BCBS Complete |
$514.08
|
| Rate for Payer: BCBS Trust/PPO |
$119.14
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cofinity Commercial |
$899.64
|
| Rate for Payer: Cofinity Commercial |
$1,105.27
|
| Rate for Payer: Healthscope Commercial |
$1,156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,092.42
|
| Rate for Payer: PHP Commercial |
$1,092.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.64
|
| Rate for Payer: Priority Health SBD |
$809.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.19
|
| Rate for Payer: UHC Exchange |
$136.54
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,285.20
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$809.68 |
| Max. Negotiated Rate |
$1,156.68 |
| Rate for Payer: Aetna Commercial |
$1,092.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.38
|
| Rate for Payer: Cash Price |
$1,028.16
|
| Rate for Payer: Cofinity Commercial |
$1,105.27
|
| Rate for Payer: Cofinity Commercial |
$899.64
|
| Rate for Payer: Healthscope Commercial |
$1,156.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,092.42
|
| Rate for Payer: PHP Commercial |
$1,092.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.64
|
| Rate for Payer: Priority Health SBD |
$809.68
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.55 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna Commercial |
$870.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.60
|
| Rate for Payer: BCBS Complete |
$409.60
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$125.76
|
| Rate for Payer: BCBS Trust/PPO |
$125.76
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Cofinity Commercial |
$880.64
|
| Rate for Payer: Cofinity Commercial |
$716.80
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$921.60
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$870.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$870.40
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$645.12
|
| Rate for Payer: Priority Health SBD |
$438.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.30
|
| Rate for Payer: UHC Exchange |
$117.55
|
| Rate for Payer: UHC Exchange |
$117.55
|
|
