|
HC PET MYOCARD PERFUSION SINGLE STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
40400014
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,682.73 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Aetna Commercial |
$2,270.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,736.15
|
| 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: Healthscope Commercial |
$2,403.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.25
|
| Rate for Payer: PHP Commercial |
$2,270.35
|
| Rate for Payer: Priority Health SBD |
$1,682.73
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,960.63
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,607.70 |
| Rate for Payer: Aetna Commercial |
$4,216.54
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,224.41
|
| 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 |
$3,968.50
|
| Rate for Payer: Cash Price |
$3,968.50
|
| Rate for Payer: Cofinity Advantage |
$3,472.44
|
| Rate for Payer: Cofinity Commercial |
$4,266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,968.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$4,464.57
|
| 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 |
$4,216.54
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,720.47
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,216.54
|
| 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 |
$3,125.20
|
| 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) |
$3,224.41
|
| Rate for Payer: UHC Core |
$2,584.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$1,949.53
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,960.63
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,125.20 |
| Max. Negotiated Rate |
$4,464.57 |
| Rate for Payer: Aetna Commercial |
$4,216.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,224.41
|
| Rate for Payer: Cash Price |
$3,968.50
|
| Rate for Payer: Cofinity Advantage |
$3,472.44
|
| Rate for Payer: Cofinity Commercial |
$4,266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,968.50
|
| Rate for Payer: Healthscope Commercial |
$4,464.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,216.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,720.47
|
| Rate for Payer: PHP Commercial |
$4,216.54
|
| Rate for Payer: Priority Health SBD |
$3,125.20
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,414.62
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,607.70 |
| Rate for Payer: Aetna Commercial |
$3,752.43
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,869.50
|
| 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 |
$3,531.70
|
| Rate for Payer: Cash Price |
$3,531.70
|
| Rate for Payer: Cofinity Advantage |
$3,090.23
|
| Rate for Payer: Cofinity Commercial |
$3,796.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,531.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$3,973.16
|
| 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 |
$3,752.43
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,310.97
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$3,752.43
|
| 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 |
$2,781.21
|
| 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) |
$2,869.50
|
| Rate for Payer: UHC Core |
$2,300.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$1,734.95
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,414.62
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,781.21 |
| Max. Negotiated Rate |
$3,973.16 |
| Rate for Payer: Aetna Commercial |
$3,752.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,869.50
|
| Rate for Payer: Cash Price |
$3,531.70
|
| Rate for Payer: Cofinity Advantage |
$3,090.23
|
| Rate for Payer: Cofinity Commercial |
$3,796.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,531.70
|
| Rate for Payer: Healthscope Commercial |
$3,973.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,752.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,310.97
|
| Rate for Payer: PHP Commercial |
$3,752.43
|
| Rate for Payer: Priority Health SBD |
$2,781.21
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,816.48
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,234.83 |
| Rate for Payer: Aetna Commercial |
$4,944.01
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,780.71
|
| 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 |
$4,653.18
|
| Rate for Payer: Cash Price |
$4,653.18
|
| Rate for Payer: Cofinity Advantage |
$4,071.54
|
| Rate for Payer: Cofinity Commercial |
$5,002.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,653.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,234.83
|
| 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 |
$4,944.01
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,362.36
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$4,944.01
|
| 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 |
$3,664.38
|
| 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) |
$3,780.71
|
| Rate for Payer: UHC Core |
$3,030.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,285.88
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,816.48
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,664.38 |
| Max. Negotiated Rate |
$5,234.83 |
| Rate for Payer: Aetna Commercial |
$4,944.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,780.71
|
| Rate for Payer: Cash Price |
$4,653.18
|
| Rate for Payer: Cofinity Advantage |
$4,071.54
|
| Rate for Payer: Cofinity Commercial |
$5,002.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,653.18
|
| Rate for Payer: Healthscope Commercial |
$5,234.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,944.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,362.36
|
| Rate for Payer: PHP Commercial |
$4,944.01
|
| Rate for Payer: Priority Health SBD |
$3,664.38
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$7,381.64
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$6,643.48 |
| Rate for Payer: Aetna Commercial |
$6,274.39
|
| Rate for Payer: Aetna Medicare |
$1,481.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,798.07
|
| 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 |
$5,905.31
|
| Rate for Payer: Cash Price |
$5,905.31
|
| Rate for Payer: Cofinity Advantage |
$5,167.15
|
| Rate for Payer: Cofinity Commercial |
$6,348.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,905.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$6,643.48
|
| 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 |
$6,274.39
|
| Rate for Payer: Nomi Health Commercial |
$4,274.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,536.23
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$6,274.39
|
| 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 |
$4,650.43
|
| 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) |
$4,798.07
|
| Rate for Payer: UHC Core |
$3,845.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,900.98
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,381.64
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,650.43 |
| Max. Negotiated Rate |
$6,643.48 |
| Rate for Payer: Aetna Commercial |
$6,274.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,798.07
|
| Rate for Payer: Cash Price |
$5,905.31
|
| Rate for Payer: Cofinity Advantage |
$5,167.15
|
| Rate for Payer: Cofinity Commercial |
$6,348.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,905.31
|
| Rate for Payer: Healthscope Commercial |
$6,643.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,274.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,536.23
|
| Rate for Payer: PHP Commercial |
$6,274.39
|
| Rate for Payer: Priority Health SBD |
$4,650.43
|
|
|
HC PFO
|
Facility
|
IP
|
$29,599.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,647.41 |
| Max. Negotiated Rate |
$26,639.15 |
| Rate for Payer: Aetna Commercial |
$25,159.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,239.39
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cofinity Advantage |
$20,719.34
|
| Rate for Payer: Cofinity Commercial |
$25,455.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,679.25
|
| Rate for Payer: Healthscope Commercial |
$26,639.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,159.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,199.29
|
| Rate for Payer: PHP Commercial |
$25,159.20
|
| Rate for Payer: Priority Health SBD |
$18,647.41
|
|
|
HC PFO
|
Facility
|
OP
|
$29,599.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Commercial |
$25,159.20
|
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,239.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$10,224.75
|
| Rate for Payer: BCN Commercial |
$10,224.75
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cofinity Advantage |
$20,719.34
|
| Rate for Payer: Cofinity Commercial |
$25,455.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,679.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$26,639.15
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,159.20
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,199.29
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$25,159.20
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health SBD |
$18,647.41
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,699.82
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,598.03 |
| Max. Negotiated Rate |
$10,529.84 |
| Rate for Payer: Aetna Commercial |
$9,944.85
|
| Rate for Payer: Aetna Medicare |
$5,849.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,604.88
|
| Rate for Payer: BCBS Complete |
$4,679.93
|
| Rate for Payer: Cash Price |
$9,359.86
|
| Rate for Payer: Cofinity Advantage |
$8,189.87
|
| Rate for Payer: Cofinity Commercial |
$10,061.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,359.86
|
| Rate for Payer: Healthscope Commercial |
$10,529.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,359.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,944.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,774.86
|
| Rate for Payer: PHP Commercial |
$9,944.85
|
| Rate for Payer: Priority Health SBD |
$7,370.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,604.88
|
| Rate for Payer: UHC Core |
$6,095.61
|
| Rate for Payer: UHC Exchange |
$4,598.03
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,699.82
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,370.89 |
| Max. Negotiated Rate |
$10,529.84 |
| Rate for Payer: Aetna Commercial |
$9,944.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,604.88
|
| Rate for Payer: Cash Price |
$9,359.86
|
| Rate for Payer: Cofinity Advantage |
$8,189.87
|
| Rate for Payer: Cofinity Commercial |
$10,061.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,359.86
|
| Rate for Payer: Healthscope Commercial |
$10,529.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,944.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,774.86
|
| Rate for Payer: PHP Commercial |
$9,944.85
|
| Rate for Payer: Priority Health SBD |
$7,370.89
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,956.14
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$3,560.53 |
| Rate for Payer: Aetna Commercial |
$3,362.72
|
| Rate for Payer: Aetna Medicare |
$1,978.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,571.49
|
| Rate for Payer: BCBS Complete |
$1,582.46
|
| Rate for Payer: BCBS Trust/PPO |
$376.40
|
| Rate for Payer: BCN Commercial |
$376.40
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Advantage |
$2,769.30
|
| Rate for Payer: Cofinity Commercial |
$3,402.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,560.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,164.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: PHP Commercial |
$3,362.72
|
| Rate for Payer: Priority Health SBD |
$2,492.37
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
IP
|
$3,956.14
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,492.37 |
| Max. Negotiated Rate |
$3,560.53 |
| Rate for Payer: Aetna Commercial |
$3,362.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,571.49
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Advantage |
$2,769.30
|
| Rate for Payer: Cofinity Commercial |
$3,402.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,560.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: PHP Commercial |
$3,362.72
|
| Rate for Payer: Priority Health SBD |
$2,492.37
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
OP
|
$282.36
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$565.19 |
| Rate for Payer: Aetna Commercial |
$240.01
|
| Rate for Payer: Aetna Medicare |
$181.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.53
|
| 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 |
$147.65
|
| Rate for Payer: BCN Commercial |
$147.65
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$225.89
|
| Rate for Payer: Cash Price |
$225.89
|
| Rate for Payer: Cofinity Advantage |
$197.65
|
| Rate for Payer: Cofinity Commercial |
$242.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$254.12
|
| 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 |
$240.01
|
| Rate for Payer: Nomi Health Commercial |
$524.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.77
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$240.01
|
| 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 |
$177.89
|
| 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) |
$183.53
|
| Rate for Payer: UHC Core |
$147.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$110.97
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
IP
|
$282.36
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.89 |
| Max. Negotiated Rate |
$254.12 |
| Rate for Payer: Aetna Commercial |
$240.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.53
|
| Rate for Payer: Cash Price |
$225.89
|
| Rate for Payer: Cofinity Advantage |
$197.65
|
| Rate for Payer: Cofinity Commercial |
$242.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.89
|
| Rate for Payer: Healthscope Commercial |
$254.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.77
|
| Rate for Payer: PHP Commercial |
$240.01
|
| Rate for Payer: Priority Health SBD |
$177.89
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Advantage |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Advantage |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
HC PH BLOOD
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.75
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS MAPPO |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.73
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: BCN Medicare Advantage |
$11.00
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$5.75
|
| Rate for Payer: Mclaren Medicare |
$11.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.55
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$16.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Medicare |
$10.45
|
| Rate for Payer: PACE SWMI |
$11.00
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$11.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.00
|
| Rate for Payer: Priority Health Medicare |
$11.00
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health Tiered Network |
$8.80
|
| Rate for Payer: Railroad Medicare Medicare |
$11.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.00
|
| Rate for Payer: UHC Exchange |
$16.50
|
| Rate for Payer: UHC Medicaid |
$5.75
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
| Rate for Payer: VA VA |
$11.00
|
|
|
HC PH BLOOD
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$25.67
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna Commercial |
$21.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Advantage |
$17.97
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PHP Commercial |
$21.82
|
| Rate for Payer: Priority Health SBD |
$16.17
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$25.67
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna Commercial |
$21.82
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Advantage |
$17.97
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$23.10
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.82
|
| Rate for Payer: Nomi Health Commercial |
$5.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$21.82
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health Tiered Network |
$2.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.37
|
| Rate for Payer: UHC Core |
$5.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.58
|
| Rate for Payer: UHC Exchange |
$5.37
|
| Rate for Payer: UHC Medicaid |
$1.87
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$3.58
|
|
