|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,114.27 |
| Max. Negotiated Rate |
$1,591.81 |
| Rate for Payer: Aetna Commercial |
$1,503.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,149.64
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,238.08
|
| Rate for Payer: Cofinity Commercial |
$1,521.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,591.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: PHP Commercial |
$1,503.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health SBD |
$1,114.27
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.11 |
| Max. Negotiated Rate |
$398.73 |
| Rate for Payer: Aetna Commercial |
$376.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.97
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$310.12
|
| Rate for Payer: Cofinity Commercial |
$381.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Healthscope Commercial |
$398.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: PHP Commercial |
$376.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health SBD |
$279.11
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Commercial |
$376.58
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$381.01
|
| Rate for Payer: Cofinity Commercial |
$310.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$398.73
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$376.58
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$279.11
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$133.54
|
| Rate for Payer: VA VA |
$237.20
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Commercial |
$13,342.62
|
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,203.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$10,988.04
|
| Rate for Payer: Cofinity Commercial |
$13,499.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,988.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$14,127.48
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$13,342.62
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health SBD |
$9,889.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$6,226.91
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,889.24 |
| Max. Negotiated Rate |
$14,127.48 |
| Rate for Payer: Aetna Commercial |
$13,342.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,203.18
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$10,988.04
|
| Rate for Payer: Cofinity Commercial |
$13,499.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,988.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Healthscope Commercial |
$14,127.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: PHP Commercial |
$13,342.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health SBD |
$9,889.24
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,795.60 |
| Max. Negotiated Rate |
$15,290.10 |
| Rate for Payer: Aetna Commercial |
$14,440.65
|
| Rate for Payer: Aetna Medicare |
$8,494.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,042.85
|
| Rate for Payer: BCBS Complete |
$6,795.60
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$11,892.30
|
| Rate for Payer: Cofinity Commercial |
$14,610.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,892.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$15,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: PHP Commercial |
$14,440.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health SBD |
$10,703.07
|
| Rate for Payer: UHC Core |
$12,571.86
|
| Rate for Payer: UHC Exchange |
$12,571.86
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10,703.07 |
| Max. Negotiated Rate |
$15,290.10 |
| Rate for Payer: Aetna Commercial |
$14,440.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,042.85
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$11,892.30
|
| Rate for Payer: Cofinity Commercial |
$14,610.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,892.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$15,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: PHP Commercial |
$14,440.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health SBD |
$10,703.07
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.79
|
| Rate for Payer: BCBS Complete |
$34.33
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health SBD |
$54.07
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.07 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Aetna Commercial |
$72.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.79
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$73.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: PHP Commercial |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health SBD |
$54.07
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.66 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$137.65
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health SBD |
$123.88
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.88 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$137.65
|
| Rate for Payer: Cofinity Commercial |
$169.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: PHP Commercial |
$167.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health SBD |
$123.88
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$4,779.74 |
| Rate for Payer: Aetna Commercial |
$4,514.20
|
| Rate for Payer: Aetna Medicare |
$1,479.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,452.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$4,567.31
|
| Rate for Payer: Cofinity Commercial |
$3,717.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,717.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$4,779.74
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$4,514.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health SBD |
$3,345.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,004.28
|
| Rate for Payer: UHC Core |
$3,930.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$3,930.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$800.88
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,345.82 |
| Max. Negotiated Rate |
$4,779.74 |
| Rate for Payer: Aetna Commercial |
$4,514.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,452.03
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$3,717.57
|
| Rate for Payer: Cofinity Commercial |
$4,567.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,717.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Healthscope Commercial |
$4,779.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: PHP Commercial |
$4,514.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health SBD |
$3,345.82
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna Commercial |
$5,014.21
|
| Rate for Payer: Aetna Medicare |
$1,479.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,834.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$5,073.20
|
| Rate for Payer: Cofinity Commercial |
$4,129.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,309.16
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$5,014.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health SBD |
$3,716.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,004.28
|
| Rate for Payer: UHC Core |
$4,365.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$4,365.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$800.88
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,716.41 |
| Max. Negotiated Rate |
$5,309.16 |
| Rate for Payer: Aetna Commercial |
$5,014.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,834.40
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$4,129.35
|
| Rate for Payer: Cofinity Commercial |
$5,073.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Healthscope Commercial |
$5,309.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: PHP Commercial |
$5,014.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health SBD |
$3,716.41
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,526.33 |
| Max. Negotiated Rate |
$5,037.61 |
| 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 |
$3,918.14
|
| Rate for Payer: Cofinity Commercial |
$4,813.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,918.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Healthscope Commercial |
$5,037.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,037.61 |
| Rate for Payer: Aetna Commercial |
$4,757.75
|
| Rate for Payer: Aetna Medicare |
$1,479.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,638.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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: Cofinity Medicare Advantage |
$3,918.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,037.61
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$4,757.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health SBD |
$3,526.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,004.28
|
| Rate for Payer: UHC Core |
$4,142.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$4,142.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$800.88
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,479.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.05
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,004.28
|
| Rate for Payer: UHC Core |
$4,224.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$4,224.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$800.88
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
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 Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| 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: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.05
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
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 Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| 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: PHP Commercial |
$4,852.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.05
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,138.37 |
| Rate for Payer: Aetna Commercial |
$4,852.90
|
| Rate for Payer: Aetna Medicare |
$1,479.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,711.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$4,910.00
|
| Rate for Payer: Cofinity Commercial |
$3,996.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,996.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$4,852.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.05
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health SBD |
$3,596.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,004.28
|
| Rate for Payer: UHC Core |
$4,224.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$4,224.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$800.88
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,655.19 |
| Max. Negotiated Rate |
$2,364.55 |
| Rate for Payer: Aetna Commercial |
$2,233.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.73
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$1,839.10
|
| Rate for Payer: Cofinity Commercial |
$2,259.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Healthscope Commercial |
$2,364.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: PHP Commercial |
$2,233.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health SBD |
$1,655.19
|
|
|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$3,583.96 |
| Rate for Payer: Aetna Commercial |
$2,233.19
|
| Rate for Payer: Aetna Medicare |
$1,324.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$2,259.46
|
| Rate for Payer: Cofinity Commercial |
$1,839.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$2,364.55
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$2,233.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health SBD |
$1,655.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,583.96
|
| Rate for Payer: UHC Core |
$1,944.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,944.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$716.82
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,365.46 |
| Max. Negotiated Rate |
$4,807.80 |
| Rate for Payer: Aetna Commercial |
$4,540.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.30
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$3,739.40
|
| Rate for Payer: Cofinity Commercial |
$4,594.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,739.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Healthscope Commercial |
$4,807.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: PHP Commercial |
$4,540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health SBD |
$3,365.46
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,176.45 |
| Max. Negotiated Rate |
$6,178.34 |
| Rate for Payer: Aetna Commercial |
$4,540.70
|
| Rate for Payer: Aetna Medicare |
$2,282.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,472.30
|
| 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 |
$1,235.27
|
| Rate for Payer: BCBS MAPPO |
$2,194.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,194.87
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$4,594.12
|
| Rate for Payer: Cofinity Commercial |
$3,739.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,739.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,194.87
|
| Rate for Payer: Healthscope Commercial |
$4,807.80
|
| Rate for Payer: Mclaren Medicaid |
$1,176.45
|
| 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 |
$1,235.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,524.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: PACE Medicare |
$2,085.13
|
| Rate for Payer: PACE SWMI |
$2,194.87
|
| Rate for Payer: PHP Commercial |
$4,540.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,194.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,176.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health Medicare |
$2,194.87
|
| Rate for Payer: Priority Health SBD |
$3,365.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,194.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,178.34
|
| Rate for Payer: UHC Core |
$3,953.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,194.87
|
| Rate for Payer: UHC Exchange |
$3,953.08
|
| Rate for Payer: UHC Medicare Advantage |
$2,194.87
|
| Rate for Payer: UHCCP Medicaid |
$1,235.71
|
| Rate for Payer: VA VA |
$2,194.87
|
|
