|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$192.78
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$173.50 |
| Rate for Payer: Aetna Commercial |
$163.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.31
|
| Rate for Payer: BCBS Complete |
$77.11
|
| Rate for Payer: BCBS Trust/PPO |
$79.21
|
| Rate for Payer: Cash Price |
$154.22
|
| Rate for Payer: Cash Price |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$165.79
|
| Rate for Payer: Cofinity Commercial |
$134.95
|
| Rate for Payer: Healthscope Commercial |
$173.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.86
|
| Rate for Payer: PHP Commercial |
$163.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.95
|
| Rate for Payer: Priority Health SBD |
$121.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.90
|
| Rate for Payer: UHC Exchange |
$33.25
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,206.69
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,280.21 |
| Max. Negotiated Rate |
$4,686.02 |
| Rate for Payer: Aetna Commercial |
$4,425.69
|
| Rate for Payer: Aetna Commercial |
$1,553.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,384.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,187.73
|
| Rate for Payer: Cash Price |
$4,165.35
|
| Rate for Payer: Cash Price |
$1,461.82
|
| Rate for Payer: Cofinity Commercial |
$1,571.46
|
| Rate for Payer: Cofinity Commercial |
$3,644.68
|
| Rate for Payer: Cofinity Commercial |
$4,477.75
|
| Rate for Payer: Cofinity Commercial |
$1,279.10
|
| Rate for Payer: Healthscope Commercial |
$4,686.02
|
| Rate for Payer: Healthscope Commercial |
$1,644.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,425.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.19
|
| Rate for Payer: PHP Commercial |
$1,553.19
|
| Rate for Payer: PHP Commercial |
$4,425.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,644.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.10
|
| Rate for Payer: Priority Health SBD |
$1,151.19
|
| Rate for Payer: Priority Health SBD |
$3,280.21
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$1,827.28
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$1,740.05 |
| Rate for Payer: Aetna Commercial |
$1,553.19
|
| Rate for Payer: Aetna Commercial |
$4,425.69
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,187.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,384.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$4,165.35
|
| Rate for Payer: Cash Price |
$1,461.82
|
| Rate for Payer: Cash Price |
$1,461.82
|
| Rate for Payer: Cash Price |
$4,165.35
|
| Rate for Payer: Cofinity Commercial |
$4,477.75
|
| Rate for Payer: Cofinity Commercial |
$3,644.68
|
| Rate for Payer: Cofinity Commercial |
$1,279.10
|
| Rate for Payer: Cofinity Commercial |
$1,571.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$4,686.02
|
| Rate for Payer: Healthscope Commercial |
$1,644.55
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,425.69
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$1,553.19
|
| Rate for Payer: PHP Commercial |
$4,425.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,644.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.10
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$1,151.19
|
| Rate for Payer: Priority Health SBD |
$3,280.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$5,783.40
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,643.54 |
| Max. Negotiated Rate |
$5,205.06 |
| Rate for Payer: Aetna Commercial |
$4,915.89
|
| Rate for Payer: Aetna Commercial |
$6,105.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,759.21
|
| Rate for Payer: Cash Price |
$4,626.72
|
| Rate for Payer: Cash Price |
$5,746.62
|
| Rate for Payer: Cofinity Commercial |
$4,973.72
|
| Rate for Payer: Cofinity Commercial |
$4,048.38
|
| Rate for Payer: Cofinity Commercial |
$5,028.30
|
| Rate for Payer: Cofinity Commercial |
$6,177.62
|
| Rate for Payer: Healthscope Commercial |
$6,464.95
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,105.79
|
| Rate for Payer: PHP Commercial |
$6,105.79
|
| Rate for Payer: PHP Commercial |
$4,915.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,028.30
|
| Rate for Payer: Priority Health SBD |
$3,643.54
|
| Rate for Payer: Priority Health SBD |
$4,525.47
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$5,783.40
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$5,205.06 |
| Rate for Payer: Aetna Commercial |
$4,915.89
|
| Rate for Payer: Aetna Commercial |
$6,105.79
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,759.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$5,746.62
|
| Rate for Payer: Cash Price |
$4,626.72
|
| Rate for Payer: Cash Price |
$5,746.62
|
| Rate for Payer: Cash Price |
$4,626.72
|
| Rate for Payer: Cofinity Commercial |
$6,177.62
|
| Rate for Payer: Cofinity Commercial |
$5,028.30
|
| Rate for Payer: Cofinity Commercial |
$4,048.38
|
| Rate for Payer: Cofinity Commercial |
$4,973.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Healthscope Commercial |
$6,464.95
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,915.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,105.79
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$4,915.89
|
| Rate for Payer: PHP Commercial |
$6,105.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,028.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,048.38
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$3,643.54
|
| Rate for Payer: Priority Health SBD |
$4,525.47
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,487.60
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$4,938.84 |
| Rate for Payer: Aetna Commercial |
$4,664.46
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,566.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$4,390.08
|
| Rate for Payer: Cash Price |
$4,390.08
|
| Rate for Payer: Cofinity Commercial |
$3,841.32
|
| Rate for Payer: Cofinity Commercial |
$4,719.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$4,938.84
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,664.46
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$4,664.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,841.32
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$3,457.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,487.60
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,457.19 |
| Max. Negotiated Rate |
$4,938.84 |
| Rate for Payer: Aetna Commercial |
$4,664.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,566.94
|
| Rate for Payer: Cash Price |
$4,390.08
|
| Rate for Payer: Cofinity Commercial |
$3,841.32
|
| Rate for Payer: Cofinity Commercial |
$4,719.34
|
| Rate for Payer: Healthscope Commercial |
$4,938.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,664.46
|
| Rate for Payer: PHP Commercial |
$4,664.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,841.32
|
| Rate for Payer: Priority Health SBD |
$3,457.19
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$8,146.00
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$7,331.40 |
| Rate for Payer: Aetna Commercial |
$6,924.10
|
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,294.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$6,516.80
|
| Rate for Payer: Cash Price |
$6,516.80
|
| Rate for Payer: Cofinity Commercial |
$3,918.14
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Commercial |
$5,702.20
|
| Rate for Payer: Cofinity Commercial |
$7,005.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Healthscope Commercial |
$7,331.40
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,924.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$6,924.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,702.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$5,131.98
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,526.33 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Commercial |
$6,924.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,294.90
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$6,516.80
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Commercial |
$5,702.20
|
| Rate for Payer: Cofinity Commercial |
$7,005.56
|
| Rate for Payer: Cofinity Commercial |
$3,918.14
|
| Rate for Payer: Healthscope Commercial |
$7,331.40
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,924.10
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$6,924.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,702.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health SBD |
$5,131.98
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Commercial |
$3,918.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,526.33 |
| Max. Negotiated Rate |
$5,037.62 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Commercial |
$3,918.14
|
| Rate for Payer: Healthscope Commercial |
$5,037.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.14
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
|
|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,575.76
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$691.12 |
| Max. Negotiated Rate |
$2,318.18 |
| Rate for Payer: Aetna Commercial |
$2,189.40
|
| Rate for Payer: Aetna Medicare |
$1,314.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,674.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,579.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,579.34
|
| Rate for Payer: BCBS Complete |
$725.74
|
| Rate for Payer: BCBS MAPPO |
$1,263.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,263.47
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cofinity Commercial |
$2,215.15
|
| Rate for Payer: Cofinity Commercial |
$1,803.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,263.47
|
| Rate for Payer: Healthscope Commercial |
$2,318.18
|
| Rate for Payer: Mclaren Medicaid |
$691.12
|
| Rate for Payer: Mclaren Medicare |
$1,263.47
|
| Rate for Payer: Meridian Medicaid |
$725.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,326.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,452.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,189.40
|
| Rate for Payer: PACE Medicare |
$1,200.30
|
| Rate for Payer: PACE SWMI |
$1,263.47
|
| Rate for Payer: PHP Commercial |
$2,189.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,263.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.03
|
| Rate for Payer: Priority Health Medicare |
$1,263.47
|
| Rate for Payer: Priority Health SBD |
$1,622.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,263.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,263.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.37
|
| Rate for Payer: VA VA |
$1,263.47
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,575.76
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,622.73 |
| Max. Negotiated Rate |
$2,318.18 |
| Rate for Payer: Aetna Commercial |
$2,189.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,674.24
|
| Rate for Payer: Cash Price |
$2,060.61
|
| Rate for Payer: Cofinity Commercial |
$2,215.15
|
| Rate for Payer: Cofinity Commercial |
$1,803.03
|
| Rate for Payer: Healthscope Commercial |
$2,318.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,189.40
|
| Rate for Payer: PHP Commercial |
$2,189.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.03
|
| Rate for Payer: Priority Health SBD |
$1,622.73
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,768.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,003.84 |
| Max. Negotiated Rate |
$4,291.20 |
| Rate for Payer: Aetna Commercial |
$4,052.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,099.20
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cofinity Commercial |
$3,337.60
|
| Rate for Payer: Cofinity Commercial |
$4,100.48
|
| Rate for Payer: Healthscope Commercial |
$4,291.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,052.80
|
| Rate for Payer: PHP Commercial |
$4,052.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,337.60
|
| Rate for Payer: Priority Health SBD |
$3,003.84
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,768.00
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$4,291.20 |
| Rate for Payer: Aetna Commercial |
$4,052.80
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,099.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cash Price |
$3,814.40
|
| Rate for Payer: Cofinity Commercial |
$4,100.48
|
| Rate for Payer: Cofinity Commercial |
$3,337.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$4,291.20
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,052.80
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$4,052.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,337.60
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$3,003.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,243.20
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,673.22 |
| Max. Negotiated Rate |
$3,818.88 |
| Rate for Payer: Aetna Commercial |
$3,606.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.08
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cofinity Commercial |
$2,970.24
|
| Rate for Payer: Cofinity Commercial |
$3,649.15
|
| Rate for Payer: Healthscope Commercial |
$3,818.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.72
|
| Rate for Payer: PHP Commercial |
$3,606.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.24
|
| Rate for Payer: Priority Health SBD |
$2,673.22
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,243.20
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$3,818.88 |
| Rate for Payer: Aetna Commercial |
$3,606.72
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cash Price |
$3,394.56
|
| Rate for Payer: Cofinity Commercial |
$3,649.15
|
| Rate for Payer: Cofinity Commercial |
$2,970.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$3,818.88
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.72
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$3,606.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.24
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$2,673.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,590.62
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$5,031.56 |
| Rate for Payer: Aetna Commercial |
$4,752.03
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,633.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cofinity Commercial |
$4,807.93
|
| Rate for Payer: Cofinity Commercial |
$3,913.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$5,031.56
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,752.03
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$4,752.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,913.43
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$3,522.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,590.62
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,522.09 |
| Max. Negotiated Rate |
$5,031.56 |
| Rate for Payer: Aetna Commercial |
$4,752.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,633.90
|
| Rate for Payer: Cash Price |
$4,472.50
|
| Rate for Payer: Cofinity Commercial |
$3,913.43
|
| Rate for Payer: Cofinity Commercial |
$4,807.93
|
| Rate for Payer: Healthscope Commercial |
$5,031.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,752.03
|
| Rate for Payer: PHP Commercial |
$4,752.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,913.43
|
| Rate for Payer: Priority Health SBD |
$3,522.09
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$761.45 |
| Max. Negotiated Rate |
$6,513.21 |
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: Aetna Commercial |
$7,111.95
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna Medicare |
$1,447.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,438.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,703.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,740.05
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS Complete |
$799.59
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS MAPPO |
$1,392.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.04
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Cofinity Commercial |
$5,856.90
|
| Rate for Payer: Cofinity Commercial |
$5,065.83
|
| Rate for Payer: Cofinity Commercial |
$7,195.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.04
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Healthscope Commercial |
$7,530.30
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicaid |
$761.45
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Mclaren Medicare |
$1,392.04
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Medicaid |
$799.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,111.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,151.36
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE Medicare |
$1,322.44
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PACE SWMI |
$1,392.04
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$7,111.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,065.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,856.90
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health Medicare |
$1,392.04
|
| Rate for Payer: Priority Health SBD |
$4,559.25
|
| Rate for Payer: Priority Health SBD |
$5,271.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,392.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.80
|
| Rate for Payer: VA VA |
$1,392.04
|
| Rate for Payer: VA VA |
$1,392.04
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$8,367.00
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,271.21 |
| Max. Negotiated Rate |
$7,530.30 |
| Rate for Payer: Aetna Commercial |
$7,111.95
|
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,438.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,703.98
|
| Rate for Payer: Cash Price |
$6,693.60
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$7,195.62
|
| Rate for Payer: Cofinity Commercial |
$5,065.83
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Cofinity Commercial |
$5,856.90
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Healthscope Commercial |
$7,530.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,111.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: PHP Commercial |
$7,111.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,065.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,856.90
|
| Rate for Payer: Priority Health SBD |
$4,559.25
|
| Rate for Payer: Priority Health SBD |
$5,271.21
|
|
|
HC PFO
|
Facility
|
OP
|
$25,737.20
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$933.86 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Commercial |
$21,876.62
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,729.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$12,948.04
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cofinity Commercial |
$18,016.04
|
| Rate for Payer: Cofinity Commercial |
$22,133.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$23,163.48
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,876.62
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$21,876.62
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,016.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Priority Health SBD |
$16,214.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,027.25
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$933.86
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC PFO
|
Facility
|
IP
|
$25,737.20
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,214.44 |
| Max. Negotiated Rate |
$23,163.48 |
| Rate for Payer: Aetna Commercial |
$21,876.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,729.18
|
| Rate for Payer: Cash Price |
$20,589.76
|
| Rate for Payer: Cofinity Commercial |
$18,016.04
|
| Rate for Payer: Cofinity Commercial |
$22,133.99
|
| Rate for Payer: Healthscope Commercial |
$23,163.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,876.62
|
| Rate for Payer: PHP Commercial |
$21,876.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,016.04
|
| Rate for Payer: Priority Health SBD |
$16,214.44
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,498.20 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,309.58
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,084.66 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,309.58
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
|
