|
HC CT ABDOMEN W CON
|
Facility
|
OP
|
$1,998.95
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,998.95 |
| Rate for Payer: Aetna Commercial |
$1,799.06
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,938.98
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,648.13
|
| Rate for Payer: BCN Commercial |
$1,648.13
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,599.16
|
| Rate for Payer: Cash Price |
$1,599.16
|
| Rate for Payer: Cofinity Commercial |
$1,879.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,938.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,998.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,799.06
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$1,699.11
|
| Rate for Payer: Nomi Health Commercial |
$1,639.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.21
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$1,147.62
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$918.09
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,759.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
IP
|
$1,998.95
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,499.21 |
| Max. Negotiated Rate |
$1,998.95 |
| Rate for Payer: Aetna Commercial |
$1,799.06
|
| Rate for Payer: ASR ASR |
$1,938.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.54
|
| Rate for Payer: BCN Commercial |
$1,641.54
|
| Rate for Payer: Cash Price |
$1,599.16
|
| Rate for Payer: Cofinity Commercial |
$1,879.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,599.16
|
| Rate for Payer: Healthscope Commercial |
$1,938.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,998.95
|
| Rate for Payer: Mclaren Commercial |
$1,799.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,699.11
|
| Rate for Payer: Nomi Health Commercial |
$1,639.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,499.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,759.08
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
IP
|
$1,639.04
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,229.28 |
| Max. Negotiated Rate |
$1,639.04 |
| Rate for Payer: Aetna Commercial |
$1,475.14
|
| Rate for Payer: ASR ASR |
$1,589.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,345.98
|
| Rate for Payer: BCN Commercial |
$1,345.98
|
| Rate for Payer: Cash Price |
$1,311.23
|
| Rate for Payer: Cofinity Commercial |
$1,540.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.23
|
| Rate for Payer: Healthscope Commercial |
$1,589.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,639.04
|
| Rate for Payer: Mclaren Commercial |
$1,475.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.18
|
| Rate for Payer: Nomi Health Commercial |
$1,344.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,442.36
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
OP
|
$1,639.04
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$1,639.04 |
| Rate for Payer: Aetna Commercial |
$1,475.14
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$1,589.87
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.39
|
| Rate for Payer: BCN Commercial |
$1,351.39
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$1,311.23
|
| Rate for Payer: Cash Price |
$1,311.23
|
| Rate for Payer: Cofinity Commercial |
$1,540.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,311.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$1,589.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,639.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$1,475.14
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,393.18
|
| Rate for Payer: Nomi Health Commercial |
$1,344.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.28
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,076.19
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$860.95
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,442.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
IP
|
$2,502.70
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,877.03 |
| Max. Negotiated Rate |
$2,502.70 |
| Rate for Payer: Aetna Commercial |
$2,252.43
|
| Rate for Payer: ASR ASR |
$2,427.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,055.22
|
| Rate for Payer: BCN Commercial |
$2,055.22
|
| Rate for Payer: Cash Price |
$2,002.16
|
| Rate for Payer: Cofinity Commercial |
$2,352.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,002.16
|
| Rate for Payer: Healthscope Commercial |
$2,427.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.70
|
| Rate for Payer: Mclaren Commercial |
$2,252.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,127.30
|
| Rate for Payer: Nomi Health Commercial |
$2,052.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,877.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,202.38
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
OP
|
$2,502.70
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,502.70 |
| Rate for Payer: Aetna Commercial |
$2,252.43
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$2,427.62
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,063.48
|
| Rate for Payer: BCN Commercial |
$2,063.48
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$2,002.16
|
| Rate for Payer: Cash Price |
$2,002.16
|
| Rate for Payer: Cofinity Commercial |
$2,352.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,002.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,427.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,502.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$2,252.43
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$2,127.30
|
| Rate for Payer: Nomi Health Commercial |
$2,052.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,877.03
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$1,263.21
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,010.57
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,202.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
OP
|
$1,156.81
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$428.02 |
| Max. Negotiated Rate |
$1,156.81 |
| Rate for Payer: Aetna Commercial |
$1,041.13
|
| Rate for Payer: Aetna Medicare |
$428.02
|
| Rate for Payer: ASR ASR |
$1,122.11
|
| Rate for Payer: BCBS Complete |
$462.72
|
| Rate for Payer: BCBS Trust/PPO |
$953.79
|
| Rate for Payer: BCN Commercial |
$953.79
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cofinity Commercial |
$1,087.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.45
|
| Rate for Payer: Healthscope Commercial |
$1,122.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,156.81
|
| Rate for Payer: Mclaren Commercial |
$1,041.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$925.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.29
|
| Rate for Payer: Nomi Health Commercial |
$948.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$867.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,013.60
|
| Rate for Payer: Priority Health Narrow Network |
$810.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,017.99
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
IP
|
$1,156.81
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$867.61 |
| Max. Negotiated Rate |
$1,156.81 |
| Rate for Payer: Aetna Commercial |
$1,041.13
|
| Rate for Payer: ASR ASR |
$1,122.11
|
| Rate for Payer: BCBS Trust/PPO |
$949.97
|
| Rate for Payer: BCN Commercial |
$949.97
|
| Rate for Payer: Cash Price |
$925.45
|
| Rate for Payer: Cofinity Commercial |
$1,087.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$925.45
|
| Rate for Payer: Healthscope Commercial |
$1,122.11
|
| Rate for Payer: Healthscope Whirlpool |
$1,156.81
|
| Rate for Payer: Mclaren Commercial |
$1,041.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.29
|
| Rate for Payer: Nomi Health Commercial |
$948.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$867.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,017.99
|
|
|
HC CTA HEAD/NECK W CONTRAST
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
35100012
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,640.25 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Aetna Commercial |
$1,968.30
|
| Rate for Payer: ASR ASR |
$2,121.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,795.96
|
| Rate for Payer: BCN Commercial |
$1,795.96
|
| Rate for Payer: Cash Price |
$1,749.60
|
| Rate for Payer: Cofinity Commercial |
$2,055.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,749.60
|
| Rate for Payer: Healthscope Commercial |
$2,121.39
|
| Rate for Payer: Healthscope Whirlpool |
$2,187.00
|
| Rate for Payer: Mclaren Commercial |
$1,968.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,858.95
|
| Rate for Payer: Nomi Health Commercial |
$1,793.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,640.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,924.56
|
|
|
HC CTA HEAD/NECK W CONTRAST
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 70471
|
| Hospital Charge Code |
35100012
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Aetna Commercial |
$1,968.30
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$2,121.39
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.18
|
| Rate for Payer: BCN Commercial |
$1,803.18
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,749.60
|
| Rate for Payer: Cofinity Commercial |
$2,055.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,749.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,121.39
|
| Rate for Payer: Healthscope Whirlpool |
$2,187.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,968.30
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,858.95
|
| Rate for Payer: Nomi Health Commercial |
$1,793.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,640.25
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$374.25
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$299.40
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,924.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
OP
|
$3,147.33
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$3,147.33 |
| Rate for Payer: Aetna Commercial |
$2,832.60
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$3,052.91
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,594.97
|
| Rate for Payer: BCN Commercial |
$2,594.97
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$2,517.86
|
| Rate for Payer: Cash Price |
$2,517.86
|
| Rate for Payer: Cofinity Commercial |
$2,958.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,517.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$3,052.91
|
| Rate for Payer: Healthscope Whirlpool |
$3,147.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$2,832.60
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,675.23
|
| Rate for Payer: Nomi Health Commercial |
$2,580.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,360.50
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,983.51
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.81
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,769.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
IP
|
$3,147.33
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,360.50 |
| Max. Negotiated Rate |
$3,147.33 |
| Rate for Payer: Aetna Commercial |
$2,832.60
|
| Rate for Payer: ASR ASR |
$3,052.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.59
|
| Rate for Payer: BCN Commercial |
$2,584.59
|
| Rate for Payer: Cash Price |
$2,517.86
|
| Rate for Payer: Cofinity Commercial |
$2,958.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,517.86
|
| Rate for Payer: Healthscope Commercial |
$3,052.91
|
| Rate for Payer: Healthscope Whirlpool |
$3,147.33
|
| Rate for Payer: Mclaren Commercial |
$2,832.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,675.23
|
| Rate for Payer: Nomi Health Commercial |
$2,580.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,360.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,769.65
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,343.28
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$1,343.28 |
| Rate for Payer: Aetna Commercial |
$1,208.95
|
| Rate for Payer: Aetna Medicare |
$347.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: ASR ASR |
$1,302.98
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.53
|
| Rate for Payer: BCN Commercial |
$1,107.53
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,074.62
|
| Rate for Payer: Cash Price |
$1,074.62
|
| Rate for Payer: Cofinity Commercial |
$1,262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$1,302.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$347.62
|
| Rate for Payer: Mclaren Commercial |
$1,208.95
|
| Rate for Payer: Mclaren Medicaid |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$190.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.79
|
| Rate for Payer: Nomi Health Commercial |
$1,101.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,007.46
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$382.38
|
| Rate for Payer: PHP Medicaid |
$186.32
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,176.98
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Narrow Network |
$941.64
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$538.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP DNSP |
$347.62
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
IP
|
$1,343.28
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,007.46 |
| Max. Negotiated Rate |
$1,343.28 |
| Rate for Payer: Aetna Commercial |
$1,208.95
|
| Rate for Payer: ASR ASR |
$1,302.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.10
|
| Rate for Payer: BCN Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$1,074.62
|
| Rate for Payer: Cofinity Commercial |
$1,262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.62
|
| Rate for Payer: Healthscope Commercial |
$1,302.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,343.28
|
| Rate for Payer: Mclaren Commercial |
$1,208.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.79
|
| Rate for Payer: Nomi Health Commercial |
$1,101.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,007.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.09
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,199.56
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$2,199.56 |
| Rate for Payer: Aetna Commercial |
$1,979.60
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$2,133.57
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,813.54
|
| Rate for Payer: BCN Commercial |
$1,813.54
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,759.65
|
| Rate for Payer: Cash Price |
$1,759.65
|
| Rate for Payer: Cofinity Commercial |
$2,067.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$2,133.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,199.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,979.60
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$1,869.63
|
| Rate for Payer: Nomi Health Commercial |
$1,803.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,649.67
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$1,246.89
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$997.51
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,935.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,199.56
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,649.67 |
| Max. Negotiated Rate |
$2,199.56 |
| Rate for Payer: Aetna Commercial |
$1,979.60
|
| Rate for Payer: ASR ASR |
$2,133.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,806.28
|
| Rate for Payer: BCN Commercial |
$1,806.28
|
| Rate for Payer: Cash Price |
$1,759.65
|
| Rate for Payer: Cofinity Commercial |
$2,067.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,759.65
|
| Rate for Payer: Healthscope Commercial |
$2,133.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,199.56
|
| Rate for Payer: Mclaren Commercial |
$1,979.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,869.63
|
| Rate for Payer: Nomi Health Commercial |
$1,803.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,649.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,935.61
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$705.54
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$705.54 |
| Rate for Payer: Aetna Commercial |
$634.99
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: ASR ASR |
$684.37
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$581.72
|
| Rate for Payer: BCN Commercial |
$581.72
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$564.43
|
| Rate for Payer: Cash Price |
$564.43
|
| Rate for Payer: Cofinity Commercial |
$663.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$684.37
|
| Rate for Payer: Healthscope Whirlpool |
$705.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.17
|
| Rate for Payer: Mclaren Commercial |
$634.99
|
| Rate for Payer: Mclaren Medicaid |
$104.17
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$57.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.71
|
| Rate for Payer: Nomi Health Commercial |
$578.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.15
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$114.59
|
| Rate for Payer: PHP Medicaid |
$55.84
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.19
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health Narrow Network |
$200.95
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$161.46
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP DNSP |
$104.17
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$705.54
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$529.15 |
| Max. Negotiated Rate |
$705.54 |
| Rate for Payer: Aetna Commercial |
$634.99
|
| Rate for Payer: ASR ASR |
$684.37
|
| Rate for Payer: BCBS Trust/PPO |
$579.39
|
| Rate for Payer: BCN Commercial |
$579.39
|
| Rate for Payer: Cash Price |
$564.43
|
| Rate for Payer: Cofinity Commercial |
$663.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.43
|
| Rate for Payer: Healthscope Commercial |
$684.37
|
| Rate for Payer: Healthscope Whirlpool |
$705.54
|
| Rate for Payer: Mclaren Commercial |
$634.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.71
|
| Rate for Payer: Nomi Health Commercial |
$578.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$620.88
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WITH CONCURR CT/CTA
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
35100013
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$804.75 |
| Max. Negotiated Rate |
$1,073.00 |
| Rate for Payer: Aetna Commercial |
$965.70
|
| Rate for Payer: ASR ASR |
$1,040.81
|
| Rate for Payer: BCBS Trust/PPO |
$881.15
|
| Rate for Payer: BCN Commercial |
$881.15
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Cofinity Commercial |
$1,008.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.40
|
| Rate for Payer: Healthscope Commercial |
$1,040.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.00
|
| Rate for Payer: Mclaren Commercial |
$965.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.05
|
| Rate for Payer: Nomi Health Commercial |
$879.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.24
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WITH CONCURR CT/CTA
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 70472
|
| Hospital Charge Code |
35100013
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$108.02 |
| Max. Negotiated Rate |
$1,073.00 |
| Rate for Payer: Aetna Commercial |
$965.70
|
| Rate for Payer: Aetna Medicare |
$397.01
|
| Rate for Payer: ASR ASR |
$1,040.81
|
| Rate for Payer: BCBS Complete |
$429.20
|
| Rate for Payer: BCBS Trust/PPO |
$884.69
|
| Rate for Payer: BCN Commercial |
$884.69
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Cash Price |
$858.40
|
| Rate for Payer: Cofinity Commercial |
$1,008.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.40
|
| Rate for Payer: Healthscope Commercial |
$1,040.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.00
|
| Rate for Payer: Mclaren Commercial |
$965.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$858.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.05
|
| Rate for Payer: Nomi Health Commercial |
$879.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$135.02
|
| Rate for Payer: Priority Health Narrow Network |
$108.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.24
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WO CONCURR CT/CTA
|
Facility
|
OP
|
$1,033.50
|
|
|
Service Code
|
HCPCS 70473
|
| Hospital Charge Code |
35100014
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,033.50 |
| Rate for Payer: Aetna Commercial |
$930.15
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,002.50
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$852.12
|
| Rate for Payer: BCN Commercial |
$852.12
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cofinity Commercial |
$971.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,002.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,033.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$930.15
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$878.48
|
| Rate for Payer: Nomi Health Commercial |
$847.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.12
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$188.16
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$150.53
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$909.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
|
HC CT BRAIN PERF ANAL W CONTRAST WO CONCURR CT/CTA
|
Facility
|
IP
|
$1,033.50
|
|
|
Service Code
|
HCPCS 70473
|
| Hospital Charge Code |
35100014
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$775.12 |
| Max. Negotiated Rate |
$1,033.50 |
| Rate for Payer: Aetna Commercial |
$930.15
|
| Rate for Payer: ASR ASR |
$1,002.50
|
| Rate for Payer: BCBS Trust/PPO |
$848.71
|
| Rate for Payer: BCN Commercial |
$848.71
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cofinity Commercial |
$971.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$826.80
|
| Rate for Payer: Healthscope Commercial |
$1,002.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,033.50
|
| Rate for Payer: Mclaren Commercial |
$930.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$878.48
|
| Rate for Payer: Nomi Health Commercial |
$847.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$775.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$909.48
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,073.09
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$397.04 |
| Max. Negotiated Rate |
$1,073.09 |
| Rate for Payer: Aetna Commercial |
$965.78
|
| Rate for Payer: Aetna Medicare |
$397.04
|
| Rate for Payer: ASR ASR |
$1,040.90
|
| Rate for Payer: BCBS Complete |
$429.24
|
| Rate for Payer: BCBS Trust/PPO |
$884.76
|
| Rate for Payer: BCN Commercial |
$884.76
|
| Rate for Payer: Cash Price |
$858.47
|
| Rate for Payer: Cofinity Commercial |
$1,008.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.47
|
| Rate for Payer: Healthscope Commercial |
$1,040.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.09
|
| Rate for Payer: Mclaren Commercial |
$965.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$858.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.13
|
| Rate for Payer: Nomi Health Commercial |
$879.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$940.24
|
| Rate for Payer: Priority Health Narrow Network |
$752.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.32
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,073.09
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$804.82 |
| Max. Negotiated Rate |
$1,073.09 |
| Rate for Payer: Aetna Commercial |
$965.78
|
| Rate for Payer: ASR ASR |
$1,040.90
|
| Rate for Payer: BCBS Trust/PPO |
$881.22
|
| Rate for Payer: BCN Commercial |
$881.22
|
| Rate for Payer: Cash Price |
$858.47
|
| Rate for Payer: Cofinity Commercial |
$1,008.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.47
|
| Rate for Payer: Healthscope Commercial |
$1,040.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.09
|
| Rate for Payer: Mclaren Commercial |
$965.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.13
|
| Rate for Payer: Nomi Health Commercial |
$879.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.32
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,655.16
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Aetna Medicare |
$174.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.46
|
| Rate for Payer: ASR ASR |
$1,605.51
|
| Rate for Payer: BCBS Complete |
$95.98
|
| Rate for Payer: BCBS MAPPO |
$174.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,364.68
|
| Rate for Payer: BCN Commercial |
$1,364.68
|
| Rate for Payer: BCN Medicare Advantage |
$174.77
|
| Rate for Payer: Cash Price |
$1,324.13
|
| Rate for Payer: Cash Price |
$1,324.13
|
| Rate for Payer: Cofinity Commercial |
$1,555.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,324.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.77
|
| Rate for Payer: Healthscope Commercial |
$1,605.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,655.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.77
|
| Rate for Payer: Mclaren Commercial |
$1,489.64
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| 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 |
$95.98
|
| 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 |
$1,406.89
|
| Rate for Payer: Nomi Health Commercial |
$1,357.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,241.37
|
| Rate for Payer: PACE Medicare |
$166.03
|
| Rate for Payer: PACE SWMI |
$174.77
|
| Rate for Payer: PHP Commercial |
$192.25
|
| Rate for Payer: PHP Medicaid |
$93.68
|
| 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/Tiered Network |
$880.69
|
| Rate for Payer: Priority Health Medicare |
$174.77
|
| Rate for Payer: Priority Health Narrow Network |
$704.55
|
| Rate for Payer: Railroad Medicare Medicare |
$174.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,456.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.77
|
| Rate for Payer: UHC Exchange |
$270.89
|
| Rate for Payer: UHC Medicaid |
$91.40
|
| Rate for Payer: UHCCP DNSP |
$174.77
|
| Rate for Payer: UHCCP Medicaid |
$91.40
|
| Rate for Payer: VA VA |
$174.77
|
|
