|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,087.02 |
| Max. Negotiated Rate |
$14,410.03 |
| Rate for Payer: Aetna Commercial |
$13,609.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,407.24
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Advantage |
$11,207.80
|
| Rate for Payer: Cofinity Commercial |
$13,769.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Healthscope Commercial |
$14,410.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PHP Commercial |
$13,609.47
|
| Rate for Payer: Priority Health SBD |
$10,087.02
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$178.73 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$13,609.47
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,407.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$178.73
|
| Rate for Payer: BCN Commercial |
$178.73
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Advantage |
$11,207.80
|
| Rate for Payer: Cofinity Commercial |
$13,769.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$14,410.03
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$13,609.47
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$10,087.02
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10,917.13 |
| Max. Negotiated Rate |
$15,595.90 |
| Rate for Payer: Aetna Commercial |
$14,729.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,263.71
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Advantage |
$12,130.15
|
| Rate for Payer: Cofinity Commercial |
$14,902.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$15,595.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: PHP Commercial |
$14,729.46
|
| Rate for Payer: Priority Health SBD |
$10,917.13
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,810.21 |
| Max. Negotiated Rate |
$15,595.90 |
| Rate for Payer: Aetna Commercial |
$14,729.46
|
| Rate for Payer: Aetna Medicare |
$8,664.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,263.71
|
| Rate for Payer: BCBS Complete |
$6,931.51
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Advantage |
$12,130.15
|
| Rate for Payer: Cofinity Commercial |
$14,902.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$15,595.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,863.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: PHP Commercial |
$14,729.46
|
| Rate for Payer: Priority Health SBD |
$10,917.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,263.71
|
| Rate for Payer: UHC Core |
$9,028.29
|
| Rate for Payer: UHC Exchange |
$6,810.21
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$74.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.91
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Advantage |
$61.28
|
| Rate for Payer: Cofinity Commercial |
$75.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: PHP Commercial |
$74.42
|
| Rate for Payer: Priority Health SBD |
$55.16
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$197.78 |
| Rate for Payer: Aetna Commercial |
$74.42
|
| Rate for Payer: Aetna Medicare |
$43.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.91
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: BCBS Trust/PPO |
$197.78
|
| Rate for Payer: BCN Commercial |
$197.78
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Advantage |
$61.28
|
| Rate for Payer: Cofinity Commercial |
$75.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$78.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: PHP Commercial |
$74.42
|
| Rate for Payer: Priority Health SBD |
$55.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.91
|
| Rate for Payer: UHC Core |
$45.61
|
| Rate for Payer: UHC Exchange |
$34.41
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.82 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna Commercial |
$170.48
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.37
|
| Rate for Payer: BCBS Complete |
$80.23
|
| Rate for Payer: BCBS Trust/PPO |
$79.61
|
| Rate for Payer: BCN Commercial |
$79.61
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Advantage |
$140.40
|
| Rate for Payer: Cofinity Commercial |
$172.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$180.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: PHP Commercial |
$170.48
|
| Rate for Payer: Priority Health SBD |
$126.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.37
|
| Rate for Payer: UHC Core |
$104.50
|
| Rate for Payer: UHC Exchange |
$78.82
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$180.51 |
| Rate for Payer: Aetna Commercial |
$170.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.37
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Advantage |
$140.40
|
| Rate for Payer: Cofinity Commercial |
$172.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$180.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: PHP Commercial |
$170.48
|
| Rate for Payer: Priority Health SBD |
$126.36
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
IP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,365.94 |
| Max. Negotiated Rate |
$4,808.48 |
| Rate for Payer: Aetna Commercial |
$4,541.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.79
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Advantage |
$3,739.93
|
| Rate for Payer: Cofinity Commercial |
$4,594.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$4,808.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: PHP Commercial |
$4,541.35
|
| Rate for Payer: Priority Health SBD |
$3,365.94
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
OP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,099.70 |
| Max. Negotiated Rate |
$4,808.48 |
| Rate for Payer: Aetna Commercial |
$4,541.35
|
| Rate for Payer: Aetna Medicare |
$2,671.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.79
|
| Rate for Payer: BCBS Complete |
$2,137.10
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Advantage |
$3,739.93
|
| Rate for Payer: Cofinity Commercial |
$4,594.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$4,808.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,274.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: PHP Commercial |
$4,541.35
|
| Rate for Payer: Priority Health SBD |
$3,365.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,472.79
|
| Rate for Payer: UHC Core |
$2,783.58
|
| Rate for Payer: UHC Exchange |
$2,099.70
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,875.34 |
| Rate for Payer: Aetna Commercial |
$4,604.48
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,521.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Advantage |
$3,791.93
|
| Rate for Payer: Cofinity Commercial |
$4,658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$4,875.34
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,604.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,412.74
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,521.08
|
| Rate for Payer: UHC Core |
$2,822.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,128.90
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,412.74 |
| Max. Negotiated Rate |
$4,875.34 |
| Rate for Payer: Aetna Commercial |
$4,604.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,521.08
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Advantage |
$3,791.93
|
| Rate for Payer: Cofinity Commercial |
$4,658.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Healthscope Commercial |
$4,875.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PHP Commercial |
$4,604.48
|
| Rate for Payer: Priority Health SBD |
$3,412.74
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,415.35 |
| Rate for Payer: Aetna Commercial |
$5,114.49
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Advantage |
$4,211.94
|
| Rate for Payer: Cofinity Commercial |
$5,174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,415.35
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$5,114.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,790.74
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,911.08
|
| Rate for Payer: UHC Core |
$3,134.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,364.70
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,790.74 |
| Max. Negotiated Rate |
$5,415.35 |
| Rate for Payer: Aetna Commercial |
$5,114.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,911.08
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Advantage |
$4,211.94
|
| Rate for Payer: Cofinity Commercial |
$5,174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Healthscope Commercial |
$5,415.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PHP Commercial |
$5,114.49
|
| Rate for Payer: Priority Health SBD |
$3,790.74
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,596.86 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.05
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Advantage |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Advantage |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,711.05
|
| Rate for Payer: UHC Core |
$2,974.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,243.75
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,668.80 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,785.27
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Advantage |
$4,076.44
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: Priority Health SBD |
$3,668.80
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,785.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Advantage |
$4,076.44
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,668.80
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,785.27
|
| Rate for Payer: UHC Core |
$3,034.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,288.63
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,668.80 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,785.27
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Advantage |
$4,076.44
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: Priority Health SBD |
$3,668.80
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,823.49
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,241.14 |
| Rate for Payer: Aetna Commercial |
$4,949.97
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,785.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Advantage |
$4,076.44
|
| Rate for Payer: Cofinity Commercial |
$5,008.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,241.14
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,949.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$3,668.80
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,785.27
|
| Rate for Payer: UHC Core |
$3,034.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,288.63
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,679.83
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,688.29 |
| Max. Negotiated Rate |
$2,411.85 |
| Rate for Payer: Aetna Commercial |
$2,277.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.89
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cofinity Advantage |
$1,875.88
|
| Rate for Payer: Cofinity Commercial |
$2,304.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.86
|
| Rate for Payer: Healthscope Commercial |
$2,411.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.87
|
| Rate for Payer: PHP Commercial |
$2,277.86
|
| Rate for Payer: Priority Health SBD |
$1,688.29
|
|
|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,679.83
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$4,171.73 |
| Rate for Payer: Aetna Commercial |
$2,277.86
|
| Rate for Payer: Aetna Medicare |
$1,341.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.87
|
| Rate for Payer: BCN Commercial |
$1,855.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cofinity Advantage |
$1,875.88
|
| Rate for Payer: Cofinity Commercial |
$2,304.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$2,411.85
|
| Rate for Payer: Mclaren Medicaid |
$674.66
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$1,354.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.86
|
| Rate for Payer: Nomi Health Commercial |
$3,869.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.87
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$2,277.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,171.73
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health SBD |
$1,688.29
|
| Rate for Payer: Priority Health Tiered Network |
$3,337.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,741.89
|
| Rate for Payer: UHC Core |
$1,396.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$1,053.17
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,448.84
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,432.77 |
| Max. Negotiated Rate |
$4,903.96 |
| Rate for Payer: Aetna Commercial |
$4,631.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,541.75
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cofinity Advantage |
$3,814.19
|
| Rate for Payer: Cofinity Commercial |
$4,686.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,359.07
|
| Rate for Payer: Healthscope Commercial |
$4,903.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,086.63
|
| Rate for Payer: PHP Commercial |
$4,631.51
|
| Rate for Payer: Priority Health SBD |
$3,432.77
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,448.84
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,147.92 |
| Max. Negotiated Rate |
$6,584.61 |
| Rate for Payer: Aetna Commercial |
$4,631.51
|
| Rate for Payer: Aetna Medicare |
$2,282.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,541.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,743.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,743.59
|
| Rate for Payer: BCBS Complete |
$1,205.42
|
| Rate for Payer: BCBS MAPPO |
$2,194.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,199.31
|
| Rate for Payer: BCN Commercial |
$3,199.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,194.87
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cofinity Advantage |
$3,814.19
|
| Rate for Payer: Cofinity Commercial |
$4,686.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,359.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,194.87
|
| Rate for Payer: Healthscope Commercial |
$4,903.96
|
| Rate for Payer: Mclaren Medicaid |
$1,147.92
|
| Rate for Payer: Mclaren Medicare |
$2,194.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,304.61
|
| Rate for Payer: Meridian Medicaid |
$2,304.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,524.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,414.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.51
|
| Rate for Payer: Nomi Health Commercial |
$6,584.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,086.63
|
| Rate for Payer: PACE Medicare |
$2,085.13
|
| Rate for Payer: PACE SWMI |
$2,194.87
|
| Rate for Payer: PHP Commercial |
$4,631.51
|
| Rate for Payer: PHP Medicare Advantage |
$2,194.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,250.50
|
| Rate for Payer: Priority Health Medicare |
$2,194.87
|
| Rate for Payer: Priority Health SBD |
$3,432.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,800.40
|
| Rate for Payer: Railroad Medicare Medicare |
$2,194.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,541.75
|
| Rate for Payer: UHC Core |
$2,838.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,194.87
|
| Rate for Payer: UHC Exchange |
$2,141.39
|
| Rate for Payer: UHC Medicaid |
$1,147.92
|
| Rate for Payer: UHCCP Medicaid |
$1,147.92
|
| Rate for Payer: VA VA |
$2,194.87
|
|
|
HC PET MYOCARD PERFUSION SINGLE STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
40400014
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,607.70 |
| Rate for Payer: Aetna Commercial |
$2,270.35
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,736.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,073.53
|
| Rate for Payer: BCN Commercial |
$2,073.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cofinity Advantage |
$1,869.70
|
| Rate for Payer: Cofinity Commercial |
$2,297.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$2,403.90
|
| Rate for Payer: Mclaren Medicaid |
$745.18
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$1,496.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.35
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.25
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$2,270.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,607.70
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health SBD |
$1,682.73
|
| Rate for Payer: Priority Health Tiered Network |
$3,686.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,736.15
|
| Rate for Payer: UHC Core |
$1,391.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$1,049.70
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
