|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
OP
|
$4,433.63
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$4,433.63 |
| Rate for Payer: Aetna Commercial |
$3,990.27
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$4,300.62
|
| Rate for Payer: ASR Commercial |
$4,300.62
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$3,630.70
|
| Rate for Payer: BCN Commercial |
$3,437.39
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cofinity Commercial |
$4,167.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,546.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$4,433.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,300.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$3,990.27
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,768.59
|
| Rate for Payer: Nomi Health Commercial |
$3,635.58
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,881.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,082.38
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,665.90
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,901.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT ABDOMEN AND PELVIS WO W CON
|
Facility
|
IP
|
$4,433.63
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
35200028
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,881.86 |
| Max. Negotiated Rate |
$4,433.63 |
| Rate for Payer: Aetna Commercial |
$3,990.27
|
| Rate for Payer: ASR ASR |
$4,300.62
|
| Rate for Payer: ASR Commercial |
$4,300.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,612.97
|
| Rate for Payer: BCN Commercial |
$3,437.39
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cofinity Commercial |
$4,167.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,546.90
|
| Rate for Payer: Healthscope Commercial |
$4,433.63
|
| Rate for Payer: Healthscope Whirlpool |
$4,300.62
|
| Rate for Payer: Mclaren Commercial |
$3,990.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,768.59
|
| Rate for Payer: Nomi Health Commercial |
$3,635.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,881.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,901.59
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
OP
|
$1,097.42
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,097.42 |
| Rate for Payer: Aetna Commercial |
$987.68
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,064.50
|
| Rate for Payer: ASR Commercial |
$1,064.50
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$898.68
|
| Rate for Payer: BCN Commercial |
$850.83
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$1,031.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,097.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$987.68
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: Nomi Health Commercial |
$899.88
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$907.51
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$726.01
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT ABDOMEN ANGIO
|
Facility
|
IP
|
$1,097.42
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
35200025
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$713.32 |
| Max. Negotiated Rate |
$1,097.42 |
| Rate for Payer: Aetna Commercial |
$987.68
|
| Rate for Payer: ASR ASR |
$1,064.50
|
| Rate for Payer: ASR Commercial |
$1,064.50
|
| Rate for Payer: BCBS Trust/PPO |
$894.29
|
| Rate for Payer: BCN Commercial |
$850.83
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$1,031.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Healthscope Commercial |
$1,097.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.50
|
| Rate for Payer: Mclaren Commercial |
$987.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: Nomi Health Commercial |
$899.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.73
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
IP
|
$1,959.75
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,273.84 |
| Max. Negotiated Rate |
$1,959.75 |
| Rate for Payer: Aetna Commercial |
$1,763.78
|
| Rate for Payer: ASR ASR |
$1,900.96
|
| Rate for Payer: ASR Commercial |
$1,900.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,597.00
|
| Rate for Payer: BCN Commercial |
$1,519.39
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cofinity Commercial |
$1,842.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.80
|
| Rate for Payer: Healthscope Commercial |
$1,959.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.96
|
| Rate for Payer: Mclaren Commercial |
$1,763.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.79
|
| Rate for Payer: Nomi Health Commercial |
$1,607.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.58
|
|
|
HC CT ABDOMEN W CON
|
Facility
|
OP
|
$1,959.75
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
35200023
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,959.75 |
| Rate for Payer: Aetna Commercial |
$1,763.78
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,900.96
|
| Rate for Payer: ASR Commercial |
$1,900.96
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,604.84
|
| Rate for Payer: BCN Commercial |
$1,519.39
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cash Price |
$1,567.80
|
| Rate for Payer: Cofinity Commercial |
$1,842.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,959.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,900.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,763.78
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.79
|
| Rate for Payer: Nomi Health Commercial |
$1,607.00
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,040.92
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$832.74
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,724.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
IP
|
$1,606.90
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,044.48 |
| Max. Negotiated Rate |
$1,606.90 |
| Rate for Payer: Aetna Commercial |
$1,446.21
|
| Rate for Payer: ASR ASR |
$1,558.69
|
| Rate for Payer: ASR Commercial |
$1,558.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.46
|
| Rate for Payer: BCN Commercial |
$1,245.83
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cofinity Commercial |
$1,510.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.52
|
| Rate for Payer: Healthscope Commercial |
$1,606.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.69
|
| Rate for Payer: Mclaren Commercial |
$1,446.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.86
|
| Rate for Payer: Nomi Health Commercial |
$1,317.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,414.07
|
|
|
HC CT ABDOMEN WO CON
|
Facility
|
OP
|
$1,606.90
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
35200022
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,606.90 |
| Rate for Payer: Aetna Commercial |
$1,446.21
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,558.69
|
| Rate for Payer: ASR Commercial |
$1,558.69
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,315.89
|
| Rate for Payer: BCN Commercial |
$1,245.83
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cash Price |
$1,285.52
|
| Rate for Payer: Cofinity Commercial |
$1,510.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,606.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,558.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,446.21
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,365.86
|
| Rate for Payer: Nomi Health Commercial |
$1,317.66
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,044.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$976.13
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$780.90
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,414.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
IP
|
$2,453.63
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,594.86 |
| Max. Negotiated Rate |
$2,453.63 |
| Rate for Payer: Aetna Commercial |
$2,208.27
|
| Rate for Payer: ASR ASR |
$2,380.02
|
| Rate for Payer: ASR Commercial |
$2,380.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,999.46
|
| Rate for Payer: BCN Commercial |
$1,902.30
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cofinity Commercial |
$2,306.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,962.90
|
| Rate for Payer: Healthscope Commercial |
$2,453.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,380.02
|
| Rate for Payer: Mclaren Commercial |
$2,208.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.59
|
| Rate for Payer: Nomi Health Commercial |
$2,011.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,159.19
|
|
|
HC CT ABDOMEN WO W CON
|
Facility
|
OP
|
$2,453.63
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
35200024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$2,453.63 |
| Rate for Payer: Aetna Commercial |
$2,208.27
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$2,380.02
|
| Rate for Payer: ASR Commercial |
$2,380.02
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.28
|
| Rate for Payer: BCN Commercial |
$1,902.30
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cash Price |
$1,962.90
|
| Rate for Payer: Cofinity Commercial |
$2,306.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,962.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$2,453.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,380.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$2,208.27
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.59
|
| Rate for Payer: Nomi Health Commercial |
$2,011.98
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,594.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.77
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$916.62
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,159.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
IP
|
$1,097.42
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$713.32 |
| Max. Negotiated Rate |
$1,097.42 |
| Rate for Payer: Aetna Commercial |
$987.68
|
| Rate for Payer: ASR ASR |
$1,064.50
|
| Rate for Payer: ASR Commercial |
$1,064.50
|
| Rate for Payer: BCBS Trust/PPO |
$894.29
|
| Rate for Payer: BCN Commercial |
$850.83
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$1,031.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Healthscope Commercial |
$1,097.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.50
|
| Rate for Payer: Mclaren Commercial |
$987.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: Nomi Health Commercial |
$899.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.73
|
|
|
HC CT ABLATION PROCEDURE
|
Facility
|
OP
|
$1,097.42
|
|
|
Service Code
|
CPT 77013
|
| Hospital Charge Code |
35000030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$438.97 |
| Max. Negotiated Rate |
$1,097.42 |
| Rate for Payer: Aetna Commercial |
$987.68
|
| Rate for Payer: Aetna Medicare |
$548.71
|
| Rate for Payer: ASR ASR |
$1,064.50
|
| Rate for Payer: ASR Commercial |
$1,064.50
|
| Rate for Payer: BCBS Complete |
$438.97
|
| Rate for Payer: BCBS Trust/PPO |
$898.68
|
| Rate for Payer: BCN Commercial |
$850.83
|
| Rate for Payer: Cash Price |
$877.94
|
| Rate for Payer: Cofinity Commercial |
$1,031.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$877.94
|
| Rate for Payer: Healthscope Commercial |
$1,097.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,064.50
|
| Rate for Payer: Mclaren Commercial |
$987.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$932.81
|
| Rate for Payer: Nomi Health Commercial |
$899.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$961.56
|
| Rate for Payer: Priority Health Narrow Network |
$769.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$965.73
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
IP
|
$3,085.62
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,005.65 |
| Max. Negotiated Rate |
$3,085.62 |
| Rate for Payer: Aetna Commercial |
$2,777.06
|
| Rate for Payer: ASR ASR |
$2,993.05
|
| Rate for Payer: ASR Commercial |
$2,993.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,514.47
|
| Rate for Payer: BCN Commercial |
$2,392.28
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cofinity Commercial |
$2,900.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.50
|
| Rate for Payer: Healthscope Commercial |
$3,085.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,993.05
|
| Rate for Payer: Mclaren Commercial |
$2,777.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,622.78
|
| Rate for Payer: Nomi Health Commercial |
$2,530.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,715.35
|
|
|
HC CT ANGIO ABD AND PELVIS
|
Facility
|
OP
|
$3,085.62
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$3,085.62 |
| Rate for Payer: Aetna Commercial |
$2,777.06
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$2,993.05
|
| Rate for Payer: ASR Commercial |
$2,993.05
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.81
|
| Rate for Payer: BCN Commercial |
$2,392.28
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cofinity Commercial |
$2,900.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$3,085.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,993.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$2,777.06
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,622.78
|
| Rate for Payer: Nomi Health Commercial |
$2,530.21
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,799.10
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,439.28
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,715.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,316.94
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,316.94 |
| Rate for Payer: Aetna Commercial |
$1,185.25
|
| Rate for Payer: Aetna Medicare |
$349.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.39
|
| Rate for Payer: ASR ASR |
$1,277.43
|
| Rate for Payer: ASR Commercial |
$1,277.43
|
| Rate for Payer: BCBS Complete |
$196.93
|
| Rate for Payer: BCBS MAPPO |
$349.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,078.44
|
| Rate for Payer: BCN Commercial |
$1,021.02
|
| Rate for Payer: BCN Medicare Advantage |
$349.91
|
| Rate for Payer: Cash Price |
$1,053.55
|
| Rate for Payer: Cash Price |
$1,053.55
|
| Rate for Payer: Cofinity Commercial |
$1,237.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.91
|
| Rate for Payer: Healthscope Commercial |
$1,316.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,277.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$349.91
|
| Rate for Payer: Mclaren Commercial |
$1,185.25
|
| Rate for Payer: Mclaren Medicaid |
$187.55
|
| Rate for Payer: Mclaren Medicare |
$349.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.41
|
| Rate for Payer: Meridian Medicaid |
$196.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.40
|
| Rate for Payer: Nomi Health Commercial |
$1,079.89
|
| Rate for Payer: PACE Medicare |
$332.41
|
| Rate for Payer: PACE SWMI |
$349.91
|
| Rate for Payer: PHP Commercial |
$384.90
|
| Rate for Payer: PHP Medicaid |
$187.55
|
| Rate for Payer: PHP Medicare Advantage |
$349.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.90
|
| Rate for Payer: Priority Health Medicare |
$349.91
|
| Rate for Payer: Priority Health Narrow Network |
$923.17
|
| Rate for Payer: Railroad Medicare Medicare |
$349.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.91
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UHC Medicare Advantage |
$349.91
|
| Rate for Payer: UHCCP DNSP |
$349.91
|
| Rate for Payer: UHCCP Medicaid |
$187.55
|
| Rate for Payer: VA VA |
$349.91
|
|
|
HC CT ANGIO CORONARY DISCONTINUED
|
Facility
|
IP
|
$1,316.94
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$856.01 |
| Max. Negotiated Rate |
$1,316.94 |
| Rate for Payer: Aetna Commercial |
$1,185.25
|
| Rate for Payer: ASR ASR |
$1,277.43
|
| Rate for Payer: ASR Commercial |
$1,277.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.17
|
| Rate for Payer: BCN Commercial |
$1,021.02
|
| Rate for Payer: Cash Price |
$1,053.55
|
| Rate for Payer: Cofinity Commercial |
$1,237.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,053.55
|
| Rate for Payer: Healthscope Commercial |
$1,316.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,277.43
|
| Rate for Payer: Mclaren Commercial |
$1,185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.40
|
| Rate for Payer: Nomi Health Commercial |
$1,079.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.91
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
IP
|
$2,156.43
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,401.68 |
| Max. Negotiated Rate |
$2,156.43 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: ASR ASR |
$2,091.74
|
| Rate for Payer: ASR Commercial |
$2,091.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.27
|
| Rate for Payer: BCN Commercial |
$1,671.88
|
| Rate for Payer: Cash Price |
$1,725.14
|
| Rate for Payer: Cofinity Commercial |
$2,027.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.14
|
| Rate for Payer: Healthscope Commercial |
$2,156.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,091.74
|
| Rate for Payer: Mclaren Commercial |
$1,940.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,832.97
|
| Rate for Payer: Nomi Health Commercial |
$1,768.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,897.66
|
|
|
HC CT AORTA W RUNOFF ANGIO
|
Facility
|
OP
|
$2,156.43
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
35000020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$2,156.43 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$2,091.74
|
| Rate for Payer: ASR Commercial |
$2,091.74
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,765.90
|
| Rate for Payer: BCN Commercial |
$1,671.88
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,725.14
|
| Rate for Payer: Cash Price |
$1,725.14
|
| Rate for Payer: Cofinity Commercial |
$2,027.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$2,156.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,091.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,940.79
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,832.97
|
| Rate for Payer: Nomi Health Commercial |
$1,768.27
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.96
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$904.77
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,897.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
OP
|
$691.71
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$691.71 |
| Rate for Payer: Aetna Commercial |
$622.54
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$670.96
|
| Rate for Payer: ASR Commercial |
$670.96
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$566.44
|
| Rate for Payer: BCN Commercial |
$536.28
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$553.37
|
| Rate for Payer: Cash Price |
$553.37
|
| Rate for Payer: Cofinity Commercial |
$650.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$691.71
|
| Rate for Payer: Healthscope Whirlpool |
$670.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$622.54
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.95
|
| Rate for Payer: Nomi Health Commercial |
$567.20
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.84
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$182.27
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
|
HC CT BONE LENGTH STUDY
|
Facility
|
IP
|
$691.71
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.61 |
| Max. Negotiated Rate |
$691.71 |
| Rate for Payer: Aetna Commercial |
$622.54
|
| Rate for Payer: ASR ASR |
$670.96
|
| Rate for Payer: ASR Commercial |
$670.96
|
| Rate for Payer: BCBS Trust/PPO |
$563.67
|
| Rate for Payer: BCN Commercial |
$536.28
|
| Rate for Payer: Cash Price |
$553.37
|
| Rate for Payer: Cofinity Commercial |
$650.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.37
|
| Rate for Payer: Healthscope Commercial |
$691.71
|
| Rate for Payer: Healthscope Whirlpool |
$670.96
|
| Rate for Payer: Mclaren Commercial |
$622.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.95
|
| Rate for Payer: Nomi Health Commercial |
$567.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.70
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
IP
|
$1,052.05
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$683.83 |
| Max. Negotiated Rate |
$1,052.05 |
| Rate for Payer: Aetna Commercial |
$946.84
|
| Rate for Payer: ASR ASR |
$1,020.49
|
| Rate for Payer: ASR Commercial |
$1,020.49
|
| Rate for Payer: BCBS Trust/PPO |
$857.32
|
| Rate for Payer: BCN Commercial |
$815.65
|
| Rate for Payer: Cash Price |
$841.64
|
| Rate for Payer: Cofinity Commercial |
$988.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.64
|
| Rate for Payer: Healthscope Commercial |
$1,052.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.49
|
| Rate for Payer: Mclaren Commercial |
$946.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.24
|
| Rate for Payer: Nomi Health Commercial |
$862.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.80
|
|
|
HC CT BRAIN PERFUSION
|
Facility
|
OP
|
$1,052.05
|
|
|
Service Code
|
CPT 0042T
|
| Hospital Charge Code |
35100011
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$420.82 |
| Max. Negotiated Rate |
$1,052.05 |
| Rate for Payer: Aetna Commercial |
$946.84
|
| Rate for Payer: Aetna Medicare |
$526.02
|
| Rate for Payer: ASR ASR |
$1,020.49
|
| Rate for Payer: ASR Commercial |
$1,020.49
|
| Rate for Payer: BCBS Complete |
$420.82
|
| Rate for Payer: BCBS Trust/PPO |
$861.52
|
| Rate for Payer: BCN Commercial |
$815.65
|
| Rate for Payer: Cash Price |
$841.64
|
| Rate for Payer: Cofinity Commercial |
$988.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.64
|
| Rate for Payer: Healthscope Commercial |
$1,052.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.49
|
| Rate for Payer: Mclaren Commercial |
$946.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.24
|
| Rate for Payer: Nomi Health Commercial |
$862.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.81
|
| Rate for Payer: Priority Health Narrow Network |
$737.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.80
|
|
|
HC CT BRAIN W CON
|
Facility
|
IP
|
$1,622.71
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,054.76 |
| Max. Negotiated Rate |
$1,622.71 |
| Rate for Payer: Aetna Commercial |
$1,460.44
|
| Rate for Payer: ASR ASR |
$1,574.03
|
| Rate for Payer: ASR Commercial |
$1,574.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.35
|
| Rate for Payer: BCN Commercial |
$1,258.09
|
| Rate for Payer: Cash Price |
$1,298.17
|
| Rate for Payer: Cofinity Commercial |
$1,525.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,298.17
|
| Rate for Payer: Healthscope Commercial |
$1,622.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,574.03
|
| Rate for Payer: Mclaren Commercial |
$1,460.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,379.30
|
| Rate for Payer: Nomi Health Commercial |
$1,330.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,427.98
|
|
|
HC CT BRAIN W CON
|
Facility
|
OP
|
$1,622.71
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
35100002
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$1,622.71 |
| Rate for Payer: Aetna Commercial |
$1,460.44
|
| Rate for Payer: Aetna Medicare |
$174.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.02
|
| Rate for Payer: ASR ASR |
$1,574.03
|
| Rate for Payer: ASR Commercial |
$1,574.03
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS MAPPO |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.84
|
| Rate for Payer: BCN Commercial |
$1,258.09
|
| Rate for Payer: BCN Medicare Advantage |
$174.42
|
| Rate for Payer: Cash Price |
$1,298.17
|
| Rate for Payer: Cash Price |
$1,298.17
|
| Rate for Payer: Cofinity Commercial |
$1,525.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,298.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.42
|
| Rate for Payer: Healthscope Commercial |
$1,622.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,574.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$174.42
|
| Rate for Payer: Mclaren Commercial |
$1,460.44
|
| Rate for Payer: Mclaren Medicaid |
$93.49
|
| Rate for Payer: Mclaren Medicare |
$174.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.14
|
| Rate for Payer: Meridian Medicaid |
$98.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,379.30
|
| Rate for Payer: Nomi Health Commercial |
$1,330.62
|
| Rate for Payer: PACE Medicare |
$165.70
|
| Rate for Payer: PACE SWMI |
$174.42
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicaid |
$93.49
|
| Rate for Payer: PHP Medicare Advantage |
$174.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$798.81
|
| Rate for Payer: Priority Health Medicare |
$174.42
|
| Rate for Payer: Priority Health Narrow Network |
$639.05
|
| Rate for Payer: Railroad Medicare Medicare |
$174.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,427.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.42
|
| Rate for Payer: UHC Exchange |
$270.35
|
| Rate for Payer: UHC Medicare Advantage |
$174.42
|
| Rate for Payer: UHCCP DNSP |
$174.42
|
| Rate for Payer: UHCCP Medicaid |
$93.49
|
| Rate for Payer: VA VA |
$174.42
|
|
|
HC CT BRAIN WO CON
|
Facility
|
OP
|
$1,514.14
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$1,514.14 |
| Rate for Payer: Aetna Commercial |
$1,362.73
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: ASR ASR |
$1,468.72
|
| Rate for Payer: ASR Commercial |
$1,468.72
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.93
|
| Rate for Payer: BCN Commercial |
$1,173.91
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$1,211.31
|
| Rate for Payer: Cash Price |
$1,211.31
|
| Rate for Payer: Cofinity Commercial |
$1,423.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$1,514.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,468.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$104.19
|
| Rate for Payer: Mclaren Commercial |
$1,362.73
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.02
|
| Rate for Payer: Nomi Health Commercial |
$1,241.59
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicaid |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$680.22
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$544.18
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,332.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$161.49
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP DNSP |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: VA VA |
$104.19
|
|
