|
HC CT CHEST WO CON
|
Facility
|
OP
|
$1,544.37
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
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 |
$191.56
|
| Rate for Payer: BCN Commercial |
$191.56
|
| 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 WO CON
|
Facility
|
IP
|
$1,544.37
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
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 WO W CON
|
Facility
|
OP
|
$2,097.05
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,887.35 |
| Rate for Payer: Aetna Commercial |
$1,782.49
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.08
|
| 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 |
$318.75
|
| Rate for Payer: BCN Commercial |
$318.75
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,677.64
|
| Rate for Payer: Cash Price |
$1,677.64
|
| Rate for Payer: Cofinity Advantage |
$1,467.93
|
| Rate for Payer: Cofinity Commercial |
$1,803.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,887.35
|
| 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 |
$1,782.49
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,572.79
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,782.49
|
| 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 |
$1,321.14
|
| 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) |
$1,363.08
|
| Rate for Payer: UHC Core |
$1,092.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$824.14
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT CHEST WO W CON
|
Facility
|
IP
|
$2,097.05
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,321.14 |
| Max. Negotiated Rate |
$1,887.35 |
| Rate for Payer: Aetna Commercial |
$1,782.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.08
|
| Rate for Payer: Cash Price |
$1,677.64
|
| Rate for Payer: Cofinity Advantage |
$1,467.93
|
| Rate for Payer: Cofinity Commercial |
$1,803.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.64
|
| Rate for Payer: Healthscope Commercial |
$1,887.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,572.79
|
| Rate for Payer: PHP Commercial |
$1,782.49
|
| Rate for Payer: Priority Health SBD |
$1,321.14
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
OP
|
$1,408.02
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,267.22 |
| Rate for Payer: Aetna Commercial |
$1,196.82
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.21
|
| 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 |
$1,126.42
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Advantage |
$985.61
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,267.22
|
| 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 |
$1,196.82
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$1,196.82
|
| 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 |
$887.05
|
| 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) |
$915.21
|
| Rate for Payer: UHC Core |
$733.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$553.35
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
IP
|
$1,408.02
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$887.05 |
| Max. Negotiated Rate |
$1,267.22 |
| Rate for Payer: Aetna Commercial |
$1,196.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.21
|
| Rate for Payer: Cash Price |
$1,126.42
|
| Rate for Payer: Cofinity Advantage |
$985.61
|
| Rate for Payer: Cofinity Commercial |
$1,210.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.42
|
| Rate for Payer: Healthscope Commercial |
$1,267.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,196.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.02
|
| Rate for Payer: PHP Commercial |
$1,196.82
|
| Rate for Payer: Priority Health SBD |
$887.05
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
OP
|
$1,156.81
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.63 |
| Max. Negotiated Rate |
$1,041.13 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Aetna Medicare |
$578.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.93
|
| Rate for Payer: BCBS Complete |
$462.72
|
| Rate for Payer: BCBS Trust/PPO |
$689.01
|
| Rate for Payer: BCN Commercial |
$689.01
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cofinity Advantage |
$809.77
|
| Rate for Payer: Cofinity Commercial |
$994.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.45
|
| Rate for Payer: Healthscope Commercial |
$1,041.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$925.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$867.61
|
| Rate for Payer: PHP Commercial |
$983.29
|
| Rate for Payer: Priority Health SBD |
$728.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.93
|
| Rate for Payer: UHC Core |
$602.70
|
| Rate for Payer: UHC Exchange |
$454.63
|
|
|
HC CT CRYOABLATION GUIDANCE
|
Facility
|
IP
|
$1,156.81
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000041
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$728.79 |
| Max. Negotiated Rate |
$1,041.13 |
| Rate for Payer: Aetna Commercial |
$983.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.93
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cofinity Advantage |
$809.77
|
| Rate for Payer: Cofinity Commercial |
$994.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.45
|
| Rate for Payer: Healthscope Commercial |
$1,041.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$867.61
|
| Rate for Payer: PHP Commercial |
$983.29
|
| Rate for Payer: Priority Health SBD |
$728.79
|
|
|
HC CT FACIAL W CON
|
Facility
|
IP
|
$1,623.54
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,022.83 |
| Max. Negotiated Rate |
$1,461.19 |
| Rate for Payer: Aetna Commercial |
$1,380.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.30
|
| Rate for Payer: Cash Price |
$1,298.83
|
| Rate for Payer: Cofinity Advantage |
$1,136.48
|
| Rate for Payer: Cofinity Commercial |
$1,396.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,298.83
|
| Rate for Payer: Healthscope Commercial |
$1,461.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,217.65
|
| Rate for Payer: PHP Commercial |
$1,380.01
|
| Rate for Payer: Priority Health SBD |
$1,022.83
|
|
|
HC CT FACIAL W CON
|
Facility
|
OP
|
$1,623.54
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
35100008
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,461.19 |
| Rate for Payer: Aetna Commercial |
$1,380.01
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.30
|
| 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 |
$230.17
|
| Rate for Payer: BCN Commercial |
$230.17
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,298.83
|
| Rate for Payer: Cash Price |
$1,298.83
|
| Rate for Payer: Cofinity Advantage |
$1,136.48
|
| Rate for Payer: Cofinity Commercial |
$1,396.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,298.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,461.19
|
| 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 |
$1,380.01
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,217.65
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,380.01
|
| 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 |
$1,022.83
|
| 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) |
$1,055.30
|
| Rate for Payer: UHC Core |
$845.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$638.05
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT FACIAL WO CON
|
Facility
|
IP
|
$1,439.10
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$906.63 |
| Max. Negotiated Rate |
$1,295.19 |
| Rate for Payer: Aetna Commercial |
$1,223.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$935.41
|
| Rate for Payer: Cash Price |
$1,151.28
|
| Rate for Payer: Cofinity Advantage |
$1,007.37
|
| Rate for Payer: Cofinity Commercial |
$1,237.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,151.28
|
| Rate for Payer: Healthscope Commercial |
$1,295.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,223.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,079.33
|
| Rate for Payer: PHP Commercial |
$1,223.23
|
| Rate for Payer: Priority Health SBD |
$906.63
|
|
|
HC CT FACIAL WO CON
|
Facility
|
OP
|
$1,439.10
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
35100007
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,295.19 |
| Rate for Payer: Aetna Commercial |
$1,223.23
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$935.41
|
| 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 |
$203.67
|
| Rate for Payer: BCN Commercial |
$203.67
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,151.28
|
| Rate for Payer: Cash Price |
$1,151.28
|
| Rate for Payer: Cofinity Advantage |
$1,007.37
|
| Rate for Payer: Cofinity Commercial |
$1,237.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,151.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,295.19
|
| 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 |
$1,223.23
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,079.33
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$1,223.23
|
| 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 |
$906.63
|
| 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) |
$935.41
|
| Rate for Payer: UHC Core |
$749.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$565.57
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
OP
|
$1,528.66
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,375.79 |
| Rate for Payer: Aetna Commercial |
$1,299.36
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.63
|
| 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 |
$289.22
|
| Rate for Payer: BCN Commercial |
$289.22
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cofinity Advantage |
$1,070.06
|
| Rate for Payer: Cofinity Commercial |
$1,314.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,375.79
|
| 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 |
$1,299.36
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.49
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$1,299.36
|
| 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 |
$963.06
|
| 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) |
$993.63
|
| Rate for Payer: UHC Core |
$796.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$600.76
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT FACIAL WO W CON
|
Facility
|
IP
|
$1,528.66
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
35101009
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$963.06 |
| Max. Negotiated Rate |
$1,375.79 |
| Rate for Payer: Aetna Commercial |
$1,299.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.63
|
| Rate for Payer: Cash Price |
$1,222.93
|
| Rate for Payer: Cofinity Advantage |
$1,070.06
|
| Rate for Payer: Cofinity Commercial |
$1,314.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,222.93
|
| Rate for Payer: Healthscope Commercial |
$1,375.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.49
|
| Rate for Payer: PHP Commercial |
$1,299.36
|
| Rate for Payer: Priority Health SBD |
$963.06
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
IP
|
$1,477.52
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$930.84 |
| Max. Negotiated Rate |
$1,329.77 |
| Rate for Payer: Aetna Commercial |
$1,255.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.39
|
| Rate for Payer: Cash Price |
$1,182.02
|
| Rate for Payer: Cofinity Advantage |
$1,034.26
|
| Rate for Payer: Cofinity Commercial |
$1,270.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.02
|
| Rate for Payer: Healthscope Commercial |
$1,329.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.14
|
| Rate for Payer: PHP Commercial |
$1,255.89
|
| Rate for Payer: Priority Health SBD |
$930.84
|
|
|
HC CT GUIDE JOINT ASP OR INJECTIO
|
Facility
|
OP
|
$1,477.52
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000029
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$130.23 |
| Max. Negotiated Rate |
$1,329.77 |
| Rate for Payer: Aetna Commercial |
$1,255.89
|
| Rate for Payer: Aetna Medicare |
$738.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.39
|
| Rate for Payer: BCBS Complete |
$591.01
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: Cash Price |
$1,182.02
|
| Rate for Payer: Cash Price |
$1,182.02
|
| Rate for Payer: Cofinity Advantage |
$1,034.26
|
| Rate for Payer: Cofinity Commercial |
$1,270.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.02
|
| Rate for Payer: Healthscope Commercial |
$1,329.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,182.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.14
|
| Rate for Payer: PHP Commercial |
$1,255.89
|
| Rate for Payer: Priority Health SBD |
$930.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.39
|
| Rate for Payer: UHC Core |
$769.79
|
| Rate for Payer: UHC Exchange |
$580.67
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,337.12
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$842.39 |
| Max. Negotiated Rate |
$1,203.41 |
| Rate for Payer: Aetna Commercial |
$1,136.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.13
|
| Rate for Payer: Cash Price |
$1,069.70
|
| Rate for Payer: Cofinity Advantage |
$935.98
|
| Rate for Payer: Cofinity Commercial |
$1,149.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.70
|
| Rate for Payer: Healthscope Commercial |
$1,203.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.84
|
| Rate for Payer: PHP Commercial |
$1,136.55
|
| Rate for Payer: Priority Health SBD |
$842.39
|
|
|
HC CT GUIDE NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,337.12
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
35000028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$130.23 |
| Max. Negotiated Rate |
$1,203.41 |
| Rate for Payer: Aetna Commercial |
$1,136.55
|
| Rate for Payer: Aetna Medicare |
$668.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.13
|
| Rate for Payer: BCBS Complete |
$534.85
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: Cash Price |
$1,069.70
|
| Rate for Payer: Cash Price |
$1,069.70
|
| Rate for Payer: Cofinity Advantage |
$935.98
|
| Rate for Payer: Cofinity Commercial |
$1,149.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.70
|
| Rate for Payer: Healthscope Commercial |
$1,203.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.84
|
| Rate for Payer: PHP Commercial |
$1,136.55
|
| Rate for Payer: Priority Health SBD |
$842.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$869.13
|
| Rate for Payer: UHC Core |
$696.64
|
| Rate for Payer: UHC Exchange |
$525.49
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$168.09 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna Medicare |
$362.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$168.09
|
| Rate for Payer: BCN Commercial |
$168.09
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.12
|
| Rate for Payer: UHC Core |
$377.62
|
| Rate for Payer: UHC Exchange |
$284.85
|
|
|
HC CT GUIDE PLACEMENT OF THERAPY FIELDS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
OP
|
$1,221.45
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$356.61 |
| Max. Negotiated Rate |
$1,099.31 |
| Rate for Payer: Aetna Commercial |
$1,038.23
|
| Rate for Payer: Aetna Medicare |
$610.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.94
|
| Rate for Payer: BCBS Complete |
$488.58
|
| Rate for Payer: BCBS Trust/PPO |
$356.61
|
| Rate for Payer: BCN Commercial |
$356.61
|
| Rate for Payer: Cash Price |
$977.16
|
| Rate for Payer: Cash Price |
$977.16
|
| Rate for Payer: Cofinity Advantage |
$855.01
|
| Rate for Payer: Cofinity Commercial |
$1,050.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.16
|
| Rate for Payer: Healthscope Commercial |
$1,099.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$977.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.09
|
| Rate for Payer: PHP Commercial |
$1,038.23
|
| Rate for Payer: Priority Health SBD |
$769.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.94
|
| Rate for Payer: UHC Core |
$636.38
|
| Rate for Payer: UHC Exchange |
$480.03
|
|
|
HC CT GUIDE STEREOTACTIC LOCAL
|
Facility
|
IP
|
$1,221.45
|
|
|
Service Code
|
CPT 77011
|
| Hospital Charge Code |
35000033
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$769.51 |
| Max. Negotiated Rate |
$1,099.31 |
| Rate for Payer: Aetna Commercial |
$1,038.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.94
|
| Rate for Payer: Cash Price |
$977.16
|
| Rate for Payer: Cofinity Advantage |
$855.01
|
| Rate for Payer: Cofinity Commercial |
$1,050.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.16
|
| Rate for Payer: Healthscope Commercial |
$1,099.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.09
|
| Rate for Payer: PHP Commercial |
$1,038.23
|
| Rate for Payer: Priority Health SBD |
$769.51
|
|
|
HC CT HEAD ANGIO
|
Facility
|
IP
|
$1,114.27
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$701.99 |
| Max. Negotiated Rate |
$1,002.84 |
| Rate for Payer: Aetna Commercial |
$947.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.28
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cofinity Advantage |
$779.99
|
| Rate for Payer: Cofinity Commercial |
$958.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.42
|
| Rate for Payer: Healthscope Commercial |
$1,002.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$835.70
|
| Rate for Payer: PHP Commercial |
$947.13
|
| Rate for Payer: Priority Health SBD |
$701.99
|
|
|
HC CT HEAD ANGIO
|
Facility
|
OP
|
$1,114.27
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
35100010
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,002.84 |
| Rate for Payer: Aetna Commercial |
$947.13
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.28
|
| 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 |
$451.26
|
| Rate for Payer: BCN Commercial |
$451.26
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cash Price |
$891.42
|
| Rate for Payer: Cofinity Advantage |
$779.99
|
| Rate for Payer: Cofinity Commercial |
$958.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,002.84
|
| 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 |
$947.13
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$835.70
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$947.13
|
| 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 |
$701.99
|
| 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) |
$724.28
|
| Rate for Payer: UHC Core |
$580.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$437.91
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT HEART SCAN
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Advantage |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
|
