|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,291.12
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,291.12 |
| Rate for Payer: Aetna Commercial |
$1,162.01
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,252.39
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.01
|
| Rate for Payer: BCN Commercial |
$1,001.01
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cash Price |
$1,032.90
|
| Rate for Payer: Cofinity Commercial |
$1,213.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,291.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,252.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,162.01
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,097.45
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.92
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$916.70
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,136.19
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,114.15
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,114.15 |
| Rate for Payer: Aetna Commercial |
$1,902.74
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$2,050.73
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.10
|
| Rate for Payer: BCN Commercial |
$1,639.10
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cofinity Commercial |
$1,987.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,114.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,050.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,902.74
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.03
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,056.97
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$845.58
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.45
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,114.15
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,479.90 |
| Max. Negotiated Rate |
$2,114.15 |
| Rate for Payer: Aetna Commercial |
$1,902.74
|
| Rate for Payer: ASR ASR |
$2,050.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.10
|
| Rate for Payer: BCN Commercial |
$1,639.10
|
| Rate for Payer: Cash Price |
$1,691.32
|
| Rate for Payer: Cofinity Commercial |
$1,987.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.32
|
| Rate for Payer: Healthscope Commercial |
$2,114.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,050.73
|
| Rate for Payer: Mclaren Commercial |
$1,902.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.45
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$678.15
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$474.70 |
| Max. Negotiated Rate |
$678.15 |
| Rate for Payer: Aetna Commercial |
$610.34
|
| Rate for Payer: ASR ASR |
$657.81
|
| Rate for Payer: BCBS Trust/PPO |
$525.77
|
| Rate for Payer: BCN Commercial |
$525.77
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cofinity Commercial |
$637.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.52
|
| Rate for Payer: Healthscope Commercial |
$678.15
|
| Rate for Payer: Healthscope Whirlpool |
$657.81
|
| Rate for Payer: Mclaren Commercial |
$610.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.77
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$678.15
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$678.15 |
| Rate for Payer: Aetna Commercial |
$610.34
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$657.81
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$525.77
|
| Rate for Payer: BCN Commercial |
$525.77
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cash Price |
$542.52
|
| Rate for Payer: Cofinity Commercial |
$637.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$678.15
|
| Rate for Payer: Healthscope Whirlpool |
$657.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$610.34
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.43
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.93
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$170.34
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$596.77
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,031.42
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$412.57 |
| Max. Negotiated Rate |
$1,031.42 |
| Rate for Payer: Aetna Commercial |
$928.28
|
| Rate for Payer: ASR ASR |
$1,000.48
|
| Rate for Payer: BCBS Complete |
$412.57
|
| Rate for Payer: BCBS Trust/PPO |
$799.66
|
| Rate for Payer: BCN Commercial |
$799.66
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cofinity Commercial |
$969.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.14
|
| Rate for Payer: Healthscope Commercial |
$1,031.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.48
|
| Rate for Payer: Mclaren Commercial |
$928.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.59
|
| Rate for Payer: Priority Health Narrow Network |
$732.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.65
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,031.42
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$721.99 |
| Max. Negotiated Rate |
$1,031.42 |
| Rate for Payer: Aetna Commercial |
$928.28
|
| Rate for Payer: ASR ASR |
$1,000.48
|
| Rate for Payer: BCBS Trust/PPO |
$799.66
|
| Rate for Payer: BCN Commercial |
$799.66
|
| Rate for Payer: Cash Price |
$825.14
|
| Rate for Payer: Cofinity Commercial |
$969.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.14
|
| Rate for Payer: Healthscope Commercial |
$1,031.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.48
|
| Rate for Payer: Mclaren Commercial |
$928.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$876.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$721.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.65
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,590.89
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,590.89 |
| Rate for Payer: Aetna Commercial |
$1,431.80
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,543.16
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.42
|
| Rate for Payer: BCN Commercial |
$1,233.42
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cofinity Commercial |
$1,495.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,590.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,543.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,431.80
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.26
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$746.55
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$597.24
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,399.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT BRAIN W CON
|
Facility
|
IP
|
$1,590.89
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,113.62 |
| Max. Negotiated Rate |
$1,590.89 |
| Rate for Payer: Aetna Commercial |
$1,431.80
|
| Rate for Payer: ASR ASR |
$1,543.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.42
|
| Rate for Payer: BCN Commercial |
$1,233.42
|
| Rate for Payer: Cash Price |
$1,272.71
|
| Rate for Payer: Cofinity Commercial |
$1,495.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.71
|
| Rate for Payer: Healthscope Commercial |
$1,590.89
|
| Rate for Payer: Healthscope Whirlpool |
$1,543.16
|
| Rate for Payer: Mclaren Commercial |
$1,431.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,399.98
|
|
|
HC CT BRAIN WO CON
|
Facility
|
IP
|
$1,484.45
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,039.12 |
| Max. Negotiated Rate |
$1,484.45 |
| Rate for Payer: Aetna Commercial |
$1,336.00
|
| Rate for Payer: ASR ASR |
$1,439.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.89
|
| Rate for Payer: BCN Commercial |
$1,150.89
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cofinity Commercial |
$1,395.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.56
|
| Rate for Payer: Healthscope Commercial |
$1,484.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,439.92
|
| Rate for Payer: Mclaren Commercial |
$1,336.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,306.32
|
|
|
HC CT BRAIN WO CON
|
Facility
|
OP
|
$1,484.45
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,484.45 |
| Rate for Payer: Aetna Commercial |
$1,336.00
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,439.92
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.89
|
| Rate for Payer: BCN Commercial |
$1,150.89
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cash Price |
$1,187.56
|
| Rate for Payer: Cofinity Commercial |
$1,395.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,484.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,439.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,336.00
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.78
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$635.72
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$508.58
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,306.32
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
IP
|
$1,790.10
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,253.07 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Commercial |
$1,611.09
|
| Rate for Payer: ASR ASR |
$1,736.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.86
|
| Rate for Payer: BCN Commercial |
$1,387.86
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cofinity Commercial |
$1,682.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.08
|
| Rate for Payer: Healthscope Commercial |
$1,790.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,736.40
|
| Rate for Payer: Mclaren Commercial |
$1,611.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,521.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,575.29
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
OP
|
$1,790.10
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Commercial |
$1,611.09
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,736.40
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.86
|
| Rate for Payer: BCN Commercial |
$1,387.86
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cash Price |
$1,432.08
|
| Rate for Payer: Cofinity Commercial |
$1,682.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,790.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,736.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,611.09
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,521.58
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$889.18
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$711.34
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,575.29
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
OP
|
$2,027.45
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,027.45 |
| Rate for Payer: Aetna Commercial |
$1,824.70
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,966.63
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.88
|
| Rate for Payer: BCN Commercial |
$1,571.88
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cofinity Commercial |
$1,905.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,621.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,027.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,966.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,824.70
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,723.33
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,419.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$857.37
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$685.90
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,784.16
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
IP
|
$2,027.45
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,419.22 |
| Max. Negotiated Rate |
$2,027.45 |
| Rate for Payer: Aetna Commercial |
$1,824.70
|
| Rate for Payer: ASR ASR |
$1,966.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.88
|
| Rate for Payer: BCN Commercial |
$1,571.88
|
| Rate for Payer: Cash Price |
$1,621.96
|
| Rate for Payer: Cofinity Commercial |
$1,905.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,621.96
|
| Rate for Payer: Healthscope Commercial |
$2,027.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,966.63
|
| Rate for Payer: Mclaren Commercial |
$1,824.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,723.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,419.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,784.16
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
OP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$505.03 |
| Rate for Payer: Aetna Commercial |
$454.53
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$489.88
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$391.55
|
| Rate for Payer: BCN Commercial |
$391.55
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$474.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$505.03
|
| Rate for Payer: Healthscope Whirlpool |
$489.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$454.53
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.28
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.58
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$358.57
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.43
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT CHEST SCREENING LUNG CANCER
|
Facility
|
IP
|
$505.03
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
35000040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$353.52 |
| Max. Negotiated Rate |
$505.03 |
| Rate for Payer: Aetna Commercial |
$454.53
|
| Rate for Payer: ASR ASR |
$489.88
|
| Rate for Payer: BCBS Trust/PPO |
$391.55
|
| Rate for Payer: BCN Commercial |
$391.55
|
| Rate for Payer: Cash Price |
$404.02
|
| Rate for Payer: Cofinity Commercial |
$474.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.02
|
| Rate for Payer: Healthscope Commercial |
$505.03
|
| Rate for Payer: Healthscope Whirlpool |
$489.88
|
| Rate for Payer: Mclaren Commercial |
$454.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.43
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,703.09
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,703.09 |
| Rate for Payer: Aetna Commercial |
$1,532.78
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,652.00
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.41
|
| Rate for Payer: BCN Commercial |
$1,320.41
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cofinity Commercial |
$1,600.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,703.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,652.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,532.78
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,447.63
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$996.93
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$797.54
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,498.72
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,703.09
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,192.16 |
| Max. Negotiated Rate |
$1,703.09 |
| Rate for Payer: Aetna Commercial |
$1,532.78
|
| Rate for Payer: ASR ASR |
$1,652.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.41
|
| Rate for Payer: BCN Commercial |
$1,320.41
|
| Rate for Payer: Cash Price |
$1,362.47
|
| Rate for Payer: Cofinity Commercial |
$1,600.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.47
|
| Rate for Payer: Healthscope Commercial |
$1,703.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,652.00
|
| Rate for Payer: Mclaren Commercial |
$1,532.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,447.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,192.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,498.72
|
|
|
HC CT CHEST WO CON
|
Facility
|
IP
|
$1,484.40
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,039.08 |
| Max. Negotiated Rate |
$1,484.40 |
| Rate for Payer: Aetna Commercial |
$1,335.96
|
| Rate for Payer: ASR ASR |
$1,439.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.86
|
| Rate for Payer: BCN Commercial |
$1,150.86
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cofinity Commercial |
$1,395.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.52
|
| Rate for Payer: Healthscope Commercial |
$1,484.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,439.87
|
| Rate for Payer: Mclaren Commercial |
$1,335.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,306.27
|
|
|
HC CT CHEST WO CON
|
Facility
|
OP
|
$1,484.40
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$53.45 |
| Max. Negotiated Rate |
$1,484.40 |
| Rate for Payer: Aetna Commercial |
$1,335.96
|
| Rate for Payer: Aetna Medicare |
$97.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.15
|
| Rate for Payer: ASR ASR |
$1,439.87
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$97.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.86
|
| Rate for Payer: BCN Commercial |
$1,150.86
|
| Rate for Payer: BCN Medicare Advantage |
$97.72
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cash Price |
$1,187.52
|
| Rate for Payer: Cofinity Commercial |
$1,395.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.72
|
| Rate for Payer: Healthscope Commercial |
$1,484.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,439.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$97.72
|
| Rate for Payer: Mclaren Commercial |
$1,335.96
|
| Rate for Payer: Mclaren Medicaid |
$53.45
|
| Rate for Payer: Mclaren Medicare |
$97.72
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,261.74
|
| Rate for Payer: PACE Medicare |
$92.83
|
| Rate for Payer: PACE SWMI |
$97.72
|
| Rate for Payer: PHP Commercial |
$107.49
|
| Rate for Payer: PHP Medicaid |
$53.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,039.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.63
|
| Rate for Payer: Priority Health Medicare |
$97.72
|
| Rate for Payer: Priority Health Narrow Network |
$615.70
|
| Rate for Payer: Railroad Medicare Medicare |
$97.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,306.27
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: VA VA |
$97.72
|
|
|
HC CT CHEST WO W CON
|
Facility
|
OP
|
$2,015.62
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$2,015.62 |
| Rate for Payer: Aetna Commercial |
$1,814.06
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,955.15
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.71
|
| Rate for Payer: BCN Commercial |
$1,562.71
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cofinity Commercial |
$1,894.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$2,015.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,955.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,814.06
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,713.28
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,070.81
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$856.65
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,773.75
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
|
HC CT CHEST WO W CON
|
Facility
|
IP
|
$2,015.62
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
35200002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,410.93 |
| Max. Negotiated Rate |
$2,015.62 |
| Rate for Payer: Aetna Commercial |
$1,814.06
|
| Rate for Payer: ASR ASR |
$1,955.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.71
|
| Rate for Payer: BCN Commercial |
$1,562.71
|
| Rate for Payer: Cash Price |
$1,612.50
|
| Rate for Payer: Cofinity Commercial |
$1,894.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.50
|
| Rate for Payer: Healthscope Commercial |
$2,015.62
|
| Rate for Payer: Healthscope Whirlpool |
$1,955.15
|
| Rate for Payer: Mclaren Commercial |
$1,814.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,713.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,773.75
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$947.34 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.24
|
| Rate for Payer: BCN Commercial |
$1,049.24
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,353.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.74
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
|
|
HC CT CORONARY ANGIO
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000019
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$1,353.34 |
| Rate for Payer: Aetna Commercial |
$1,218.01
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.15
|
| Rate for Payer: ASR ASR |
$1,312.74
|
| Rate for Payer: BCBS Complete |
$93.81
|
| Rate for Payer: BCBS MAPPO |
$163.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.24
|
| Rate for Payer: BCN Commercial |
$1,049.24
|
| Rate for Payer: BCN Medicare Advantage |
$163.32
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,272.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.32
|
| Rate for Payer: Healthscope Commercial |
$1,353.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,312.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$163.32
|
| Rate for Payer: Mclaren Commercial |
$1,218.01
|
| Rate for Payer: Mclaren Medicaid |
$89.34
|
| Rate for Payer: Mclaren Medicare |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$93.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.34
|
| Rate for Payer: PACE Medicare |
$155.15
|
| Rate for Payer: PACE SWMI |
$163.32
|
| Rate for Payer: PHP Commercial |
$179.65
|
| Rate for Payer: PHP Medicaid |
$89.34
|
| Rate for Payer: PHP Medicare Advantage |
$163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.54
|
| Rate for Payer: Priority Health Medicare |
$163.32
|
| Rate for Payer: Priority Health Narrow Network |
$960.87
|
| Rate for Payer: Railroad Medicare Medicare |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,190.94
|
| Rate for Payer: UHC Medicare Advantage |
$168.22
|
| Rate for Payer: VA VA |
$163.32
|
|
