|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
OP
|
$3,147.33
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,832.60 |
| Rate for Payer: Aetna Commercial |
$2,675.23
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$641.30
|
| Rate for Payer: BCN Commercial |
$641.30
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,517.86
|
| Rate for Payer: Cash Price |
$2,517.86
|
| Rate for Payer: Cofinity Advantage |
$2,203.13
|
| Rate for Payer: Cofinity Commercial |
$2,706.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,517.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,832.60
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,675.23
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,360.50
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,675.23
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$1,982.82
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,045.76
|
| Rate for Payer: UHC Core |
$1,639.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,236.90
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
IP
|
$1,343.28
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$846.27 |
| Max. Negotiated Rate |
$1,208.95 |
| Rate for Payer: Aetna Commercial |
$1,141.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.13
|
| Rate for Payer: Cash Price |
$1,074.62
|
| Rate for Payer: Cofinity Advantage |
$940.30
|
| Rate for Payer: Cofinity Commercial |
$1,155.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.62
|
| Rate for Payer: Healthscope Commercial |
$1,208.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,007.46
|
| Rate for Payer: PHP Commercial |
$1,141.79
|
| Rate for Payer: Priority Health SBD |
$846.27
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,343.28
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,208.95 |
| Rate for Payer: Aetna Commercial |
$1,141.79
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$489.87
|
| Rate for Payer: BCN Commercial |
$489.87
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,074.62
|
| Rate for Payer: Cash Price |
$1,074.62
|
| Rate for Payer: Cofinity Advantage |
$940.30
|
| Rate for Payer: Cofinity Commercial |
$1,155.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,208.95
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.79
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,007.46
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,141.79
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$846.27
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$873.13
|
| Rate for Payer: UHC Core |
$699.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$527.91
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,199.56
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,385.72 |
| Max. Negotiated Rate |
$1,979.60 |
| Rate for Payer: Aetna Commercial |
$1,869.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,429.71
|
| Rate for Payer: Cash Price |
$1,759.65
|
| Rate for Payer: Cofinity Advantage |
$1,539.69
|
| Rate for Payer: Cofinity Commercial |
$1,891.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.65
|
| Rate for Payer: Healthscope Commercial |
$1,979.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,869.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,649.67
|
| Rate for Payer: PHP Commercial |
$1,869.63
|
| Rate for Payer: Priority Health SBD |
$1,385.72
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,199.56
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,979.60 |
| Rate for Payer: Aetna Commercial |
$1,869.63
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,429.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$694.30
|
| Rate for Payer: BCN Commercial |
$694.30
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,759.65
|
| Rate for Payer: Cash Price |
$1,759.65
|
| Rate for Payer: Cofinity Advantage |
$1,539.69
|
| Rate for Payer: Cofinity Commercial |
$1,891.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,979.60
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,869.63
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,649.67
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,869.63
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,385.72
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,429.71
|
| Rate for Payer: UHC Core |
$1,145.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$864.43
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$705.54
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$444.49 |
| Max. Negotiated Rate |
$634.99 |
| Rate for Payer: Aetna Commercial |
$599.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.60
|
| Rate for Payer: Cash Price |
$564.43
|
| Rate for Payer: Cofinity Advantage |
$493.88
|
| Rate for Payer: Cofinity Commercial |
$606.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.43
|
| Rate for Payer: Healthscope Commercial |
$634.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.15
|
| Rate for Payer: PHP Commercial |
$599.71
|
| Rate for Payer: Priority Health SBD |
$444.49
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$705.54
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$634.99 |
| Rate for Payer: Aetna Commercial |
$599.71
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$73.44
|
| Rate for Payer: BCN Commercial |
$73.44
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$564.43
|
| Rate for Payer: Cash Price |
$564.43
|
| Rate for Payer: Cofinity Advantage |
$493.88
|
| Rate for Payer: Cofinity Commercial |
$606.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$634.99
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.71
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.15
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$599.71
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$444.49
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.60
|
| Rate for Payer: UHC Core |
$367.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$277.28
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WITH CONCURR CT/CTA
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
35100013
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$421.69 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna Commercial |
$912.05
|
| Rate for Payer: Aetna Medicare |
$536.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.45
|
| Rate for Payer: BCBS Complete |
$429.20
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Cofinity Advantage |
$751.10
|
| Rate for Payer: Cofinity Commercial |
$922.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.40
|
| Rate for Payer: Healthscope Commercial |
$965.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$858.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.75
|
| Rate for Payer: PHP Commercial |
$912.05
|
| Rate for Payer: Priority Health SBD |
$675.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.45
|
| Rate for Payer: UHC Core |
$559.03
|
| Rate for Payer: UHC Exchange |
$421.69
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WITH CONCURR CT/CTA
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
35100013
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$675.99 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Aetna Commercial |
$912.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.45
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Cofinity Advantage |
$751.10
|
| Rate for Payer: Cofinity Commercial |
$922.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.40
|
| Rate for Payer: Healthscope Commercial |
$965.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.75
|
| Rate for Payer: PHP Commercial |
$912.05
|
| Rate for Payer: Priority Health SBD |
$675.99
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WO CONCURR CT/CTA
|
Facility
|
OP
|
$1,033.50
|
|
|
Service Code
|
HCPCS 70473
|
| Hospital Charge Code |
35100014
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$930.15 |
| Rate for Payer: Aetna Commercial |
$878.48
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cofinity Advantage |
$723.45
|
| Rate for Payer: Cofinity Commercial |
$888.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$930.15
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.48
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.12
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$878.48
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$651.11
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.77
|
| Rate for Payer: UHC Core |
$538.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$406.17
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WO CONCURR CT/CTA
|
Facility
|
IP
|
$1,033.50
|
|
|
Service Code
|
HCPCS 70473
|
| Hospital Charge Code |
35100014
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$651.11 |
| Max. Negotiated Rate |
$930.15 |
| Rate for Payer: Aetna Commercial |
$878.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.77
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cofinity Advantage |
$723.45
|
| Rate for Payer: Cofinity Commercial |
$888.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.80
|
| Rate for Payer: Healthscope Commercial |
$930.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.12
|
| Rate for Payer: PHP Commercial |
$878.48
|
| Rate for Payer: Priority Health SBD |
$651.11
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,073.09
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$676.05 |
| Max. Negotiated Rate |
$965.78 |
| Rate for Payer: Aetna Commercial |
$912.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.51
|
| Rate for Payer: Cash Price |
$858.47
|
| Rate for Payer: Cofinity Advantage |
$751.16
|
| Rate for Payer: Cofinity Commercial |
$922.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.47
|
| Rate for Payer: Healthscope Commercial |
$965.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.82
|
| Rate for Payer: PHP Commercial |
$912.13
|
| Rate for Payer: Priority Health SBD |
$676.05
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,073.09
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$333.39 |
| Max. Negotiated Rate |
$965.78 |
| Rate for Payer: Aetna Commercial |
$912.13
|
| Rate for Payer: Aetna Medicare |
$536.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.51
|
| Rate for Payer: BCBS Complete |
$429.24
|
| Rate for Payer: BCBS Trust/PPO |
$333.39
|
| Rate for Payer: BCN Commercial |
$333.39
|
| Rate for Payer: Cash Price |
$858.47
|
| Rate for Payer: Cash Price |
$858.47
|
| Rate for Payer: Cofinity Advantage |
$751.16
|
| Rate for Payer: Cofinity Commercial |
$922.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.47
|
| Rate for Payer: Healthscope Commercial |
$965.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$858.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.82
|
| Rate for Payer: PHP Commercial |
$912.13
|
| Rate for Payer: Priority Health SBD |
$676.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.51
|
| Rate for Payer: UHC Core |
$559.08
|
| Rate for Payer: UHC Exchange |
$421.72
|
|
|
HC CT BRAIN W CON
|
Facility
|
IP
|
$1,655.16
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,042.75 |
| Max. Negotiated Rate |
$1,489.64 |
| Rate for Payer: Aetna Commercial |
$1,406.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.85
|
| Rate for Payer: Cash Price |
$1,324.13
|
| Rate for Payer: Cofinity Advantage |
$1,158.61
|
| Rate for Payer: Cofinity Commercial |
$1,423.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,324.13
|
| Rate for Payer: Healthscope Commercial |
$1,489.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,241.37
|
| Rate for Payer: PHP Commercial |
$1,406.89
|
| Rate for Payer: Priority Health SBD |
$1,042.75
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,655.16
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,489.64 |
| Rate for Payer: Aetna Commercial |
$1,406.89
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$221.84
|
| Rate for Payer: BCN Commercial |
$221.84
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,324.13
|
| Rate for Payer: Cash Price |
$1,324.13
|
| Rate for Payer: Cofinity Advantage |
$1,158.61
|
| Rate for Payer: Cofinity Commercial |
$1,423.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,324.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,489.64
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.89
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,241.37
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,406.89
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,042.75
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.85
|
| Rate for Payer: UHC Core |
$862.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$650.48
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT BRAIN WO CON
|
Facility
|
OP
|
$1,544.42
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,389.98 |
| Rate for Payer: Aetna Commercial |
$1,312.76
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$155.21
|
| Rate for Payer: BCN Commercial |
$155.21
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,235.54
|
| Rate for Payer: Cash Price |
$1,235.54
|
| Rate for Payer: Cofinity Advantage |
$1,081.09
|
| Rate for Payer: Cofinity Commercial |
$1,328.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,389.98
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,312.76
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,158.32
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,312.76
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$972.98
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,003.87
|
| Rate for Payer: UHC Core |
$804.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$606.96
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT BRAIN WO CON
|
Facility
|
IP
|
$1,544.42
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$972.98 |
| Max. Negotiated Rate |
$1,389.98 |
| Rate for Payer: Aetna Commercial |
$1,312.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.87
|
| Rate for Payer: Cash Price |
$1,235.54
|
| Rate for Payer: Cofinity Advantage |
$1,081.09
|
| Rate for Payer: Cofinity Commercial |
$1,328.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.54
|
| Rate for Payer: Healthscope Commercial |
$1,389.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,312.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,158.32
|
| Rate for Payer: PHP Commercial |
$1,312.76
|
| Rate for Payer: Priority Health SBD |
$972.98
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
OP
|
$1,862.42
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,676.18 |
| Rate for Payer: Aetna Commercial |
$1,583.06
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,210.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$264.25
|
| Rate for Payer: BCN Commercial |
$264.25
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,489.94
|
| Rate for Payer: Cash Price |
$1,489.94
|
| Rate for Payer: Cofinity Advantage |
$1,303.69
|
| Rate for Payer: Cofinity Commercial |
$1,601.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,489.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,676.18
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,583.06
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,396.82
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,583.06
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,173.32
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,210.57
|
| Rate for Payer: UHC Core |
$970.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$731.93
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
IP
|
$1,862.42
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,173.32 |
| Max. Negotiated Rate |
$1,676.18 |
| Rate for Payer: Aetna Commercial |
$1,583.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,210.57
|
| Rate for Payer: Cash Price |
$1,489.94
|
| Rate for Payer: Cofinity Advantage |
$1,303.69
|
| Rate for Payer: Cofinity Commercial |
$1,601.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,489.94
|
| Rate for Payer: Healthscope Commercial |
$1,676.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,583.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,396.82
|
| Rate for Payer: PHP Commercial |
$1,583.06
|
| Rate for Payer: Priority Health SBD |
$1,173.32
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
IP
|
$2,109.36
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,328.90 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Aetna Commercial |
$1,792.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.08
|
| Rate for Payer: Cash Price |
$1,687.49
|
| Rate for Payer: Cofinity Advantage |
$1,476.55
|
| Rate for Payer: Cofinity Commercial |
$1,814.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,687.49
|
| Rate for Payer: Healthscope Commercial |
$1,898.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,582.02
|
| Rate for Payer: PHP Commercial |
$1,792.96
|
| Rate for Payer: Priority Health SBD |
$1,328.90
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
OP
|
$2,109.36
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,898.42 |
| Rate for Payer: Aetna Commercial |
$1,792.96
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$455.81
|
| Rate for Payer: BCN Commercial |
$455.81
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,687.49
|
| Rate for Payer: Cash Price |
$1,687.49
|
| Rate for Payer: Cofinity Advantage |
$1,476.55
|
| Rate for Payer: Cofinity Commercial |
$1,814.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,687.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,898.42
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.96
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,582.02
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,792.96
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,328.90
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,371.08
|
| Rate for Payer: UHC Core |
$1,098.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$828.98
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
OP
|
$1,544.37
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,389.93 |
| Rate for Payer: Aetna Commercial |
$1,312.71
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$202.15
|
| Rate for Payer: BCN Commercial |
$202.15
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,235.50
|
| Rate for Payer: Cash Price |
$1,235.50
|
| Rate for Payer: Cofinity Advantage |
$1,081.06
|
| Rate for Payer: Cofinity Commercial |
$1,328.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,389.93
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,312.71
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,158.28
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,312.71
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$972.95
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,003.84
|
| Rate for Payer: UHC Core |
$804.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$606.94
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
IP
|
$1,544.37
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$972.95 |
| Max. Negotiated Rate |
$1,389.93 |
| Rate for Payer: Aetna Commercial |
$1,312.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.84
|
| Rate for Payer: Cash Price |
$1,235.50
|
| Rate for Payer: Cofinity Advantage |
$1,081.06
|
| Rate for Payer: Cofinity Commercial |
$1,328.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.50
|
| Rate for Payer: Healthscope Commercial |
$1,389.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,312.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,158.28
|
| Rate for Payer: PHP Commercial |
$1,312.71
|
| Rate for Payer: Priority Health SBD |
$972.95
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,771.89
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,116.29 |
| Max. Negotiated Rate |
$1,594.70 |
| Rate for Payer: Aetna Commercial |
$1,506.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.73
|
| Rate for Payer: Cash Price |
$1,417.51
|
| Rate for Payer: Cofinity Advantage |
$1,240.32
|
| Rate for Payer: Cofinity Commercial |
$1,523.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.51
|
| Rate for Payer: Healthscope Commercial |
$1,594.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,328.92
|
| Rate for Payer: PHP Commercial |
$1,506.11
|
| Rate for Payer: Priority Health SBD |
$1,116.29
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,771.89
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,594.70 |
| Rate for Payer: Aetna Commercial |
$1,506.11
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$260.45
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,417.51
|
| Rate for Payer: Cash Price |
$1,417.51
|
| Rate for Payer: Cofinity Advantage |
$1,240.32
|
| Rate for Payer: Cofinity Commercial |
$1,523.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,594.70
|
| Rate for Payer: Mclaren Medicaid |
$91.40
|
| Rate for Payer: Mclaren Medicare |
$174.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.51
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.11
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,328.92
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,506.11
|
| Rate for Payer: PHP Medicare Advantage |
$174.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$565.19
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health SBD |
$1,116.29
|
| Rate for Payer: Priority Health Tiered Network |
$452.15
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.73
|
| Rate for Payer: UHC Core |
$923.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$696.35
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
