|
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 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 ANGIO ABD AND PELVIS
|
Facility
|
OP
|
$3,085.62
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
35000034
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$3,085.62 |
| Rate for Payer: Aetna Commercial |
$2,777.06
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$2,993.05
|
| Rate for Payer: ASR Commercial |
$2,993.05
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.81
|
| Rate for Payer: BCN Commercial |
$2,392.28
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| 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 |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$3,085.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,993.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$2,777.06
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| 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 |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,005.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,703.62
|
| Rate for Payer: Priority Health Medicare |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,163.02
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,715.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
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 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 ANGIO CORONARY DISCONTINUED
|
Facility
|
OP
|
$1,316.94
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
35000018
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$1,316.94 |
| Rate for Payer: Aetna Commercial |
$1,185.25
|
| Rate for Payer: Aetna Medicare |
$348.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.38
|
| Rate for Payer: ASR ASR |
$1,277.43
|
| Rate for Payer: ASR Commercial |
$1,277.43
|
| Rate for Payer: BCBS Complete |
$196.02
|
| Rate for Payer: BCBS MAPPO |
$348.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,078.44
|
| Rate for Payer: BCN Commercial |
$1,021.02
|
| Rate for Payer: BCN Medicare Advantage |
$348.30
|
| 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 |
$348.30
|
| Rate for Payer: Healthscope Commercial |
$1,316.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,277.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.30
|
| Rate for Payer: Mclaren Commercial |
$1,185.25
|
| Rate for Payer: Mclaren Medicaid |
$186.69
|
| Rate for Payer: Mclaren Medicare |
$348.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.71
|
| Rate for Payer: Meridian Medicaid |
$196.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.55
|
| 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 |
$330.88
|
| Rate for Payer: PACE SWMI |
$348.30
|
| Rate for Payer: PHP Commercial |
$383.13
|
| Rate for Payer: PHP Medicaid |
$186.69
|
| Rate for Payer: PHP Medicare Advantage |
$348.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.69
|
| 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 |
$348.30
|
| Rate for Payer: Priority Health Narrow Network |
$923.17
|
| Rate for Payer: Railroad Medicare Medicare |
$348.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,158.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.30
|
| Rate for Payer: UHC Exchange |
$539.87
|
| Rate for Payer: UHC Medicare Advantage |
$348.30
|
| Rate for Payer: UHCCP DNSP |
$348.30
|
| Rate for Payer: UHCCP Medicaid |
$186.69
|
| Rate for Payer: VA VA |
$348.30
|
|
|
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 |
$93.06 |
| Max. Negotiated Rate |
$2,156.43 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$2,091.74
|
| Rate for Payer: ASR Commercial |
$2,091.74
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,765.90
|
| Rate for Payer: BCN Commercial |
$1,671.88
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| 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 |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,156.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,091.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,940.79
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| 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 |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,889.46
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,511.66
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,897.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
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 BONE LENGTH STUDY
|
Facility
|
OP
|
$691.71
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
32000255
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$691.71 |
| Rate for Payer: Aetna Commercial |
$622.54
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$670.96
|
| Rate for Payer: ASR Commercial |
$670.96
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$566.44
|
| Rate for Payer: BCN Commercial |
$536.28
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$691.71
|
| Rate for Payer: Healthscope Whirlpool |
$670.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$622.54
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.95
|
| Rate for Payer: Nomi Health Commercial |
$567.20
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.08
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$484.89
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
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 |
$946.85
|
| 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 |
$946.85
|
| 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 |
$946.85
|
| 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 |
$946.85
|
| 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 |
$93.06 |
| Max. Negotiated Rate |
$1,622.71 |
| Rate for Payer: Aetna Commercial |
$1,460.44
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$1,574.03
|
| Rate for Payer: ASR Commercial |
$1,574.03
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,328.84
|
| Rate for Payer: BCN Commercial |
$1,258.09
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| 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 |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,622.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,574.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,460.44
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| 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 |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.82
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.52
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,427.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT BRAIN WO CON
|
Facility
|
IP
|
$1,514.14
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
35100001
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$984.19 |
| Max. Negotiated Rate |
$1,514.14 |
| Rate for Payer: Aetna Commercial |
$1,362.73
|
| Rate for Payer: ASR ASR |
$1,468.72
|
| Rate for Payer: ASR Commercial |
$1,468.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.87
|
| Rate for Payer: BCN Commercial |
$1,173.91
|
| 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: Healthscope Commercial |
$1,514.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,468.72
|
| Rate for Payer: Mclaren Commercial |
$1,362.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,287.02
|
| Rate for Payer: Nomi Health Commercial |
$1,241.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,332.44
|
|
|
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 |
$55.59 |
| Max. Negotiated Rate |
$1,514.14 |
| Rate for Payer: Aetna Commercial |
$1,362.73
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$1,468.72
|
| Rate for Payer: ASR Commercial |
$1,468.72
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.93
|
| Rate for Payer: BCN Commercial |
$1,173.91
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,514.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,468.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,362.73
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| 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 |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,326.69
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.41
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,332.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
OP
|
$1,825.90
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,825.90 |
| Rate for Payer: Aetna Commercial |
$1,643.31
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$1,771.12
|
| Rate for Payer: ASR Commercial |
$1,771.12
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.23
|
| Rate for Payer: BCN Commercial |
$1,415.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,460.72
|
| Rate for Payer: Cash Price |
$1,460.72
|
| Rate for Payer: Cofinity Commercial |
$1,716.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,460.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,825.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,771.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,643.31
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,552.02
|
| Rate for Payer: Nomi Health Commercial |
$1,497.24
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,599.85
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,279.96
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,606.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT BRAIN WO W CON
|
Facility
|
IP
|
$1,825.90
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
35100003
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,186.84 |
| Max. Negotiated Rate |
$1,825.90 |
| Rate for Payer: Aetna Commercial |
$1,643.31
|
| Rate for Payer: ASR ASR |
$1,771.12
|
| Rate for Payer: ASR Commercial |
$1,771.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,487.93
|
| Rate for Payer: BCN Commercial |
$1,415.62
|
| Rate for Payer: Cash Price |
$1,460.72
|
| Rate for Payer: Cofinity Commercial |
$1,716.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,460.72
|
| Rate for Payer: Healthscope Commercial |
$1,825.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,771.12
|
| Rate for Payer: Mclaren Commercial |
$1,643.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,552.02
|
| Rate for Payer: Nomi Health Commercial |
$1,497.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,606.79
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$2,068.00 |
| Rate for Payer: Aetna Commercial |
$1,861.20
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$2,005.96
|
| Rate for Payer: ASR Commercial |
$2,005.96
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.49
|
| Rate for Payer: BCN Commercial |
$1,603.32
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,943.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,654.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$2,068.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,005.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,861.20
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.80
|
| Rate for Payer: Nomi Health Commercial |
$1,695.76
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,811.98
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,449.67
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,819.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT CHEST ANGIOGRAPHY
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,344.20 |
| Max. Negotiated Rate |
$2,068.00 |
| Rate for Payer: Aetna Commercial |
$1,861.20
|
| Rate for Payer: ASR ASR |
$2,005.96
|
| Rate for Payer: ASR Commercial |
$2,005.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,685.21
|
| Rate for Payer: BCN Commercial |
$1,603.32
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cofinity Commercial |
$1,943.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,654.40
|
| Rate for Payer: Healthscope Commercial |
$2,068.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,005.96
|
| Rate for Payer: Mclaren Commercial |
$1,861.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.80
|
| Rate for Payer: Nomi Health Commercial |
$1,695.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,344.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,819.84
|
|
|
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 |
$55.59 |
| Max. Negotiated Rate |
$505.03 |
| Rate for Payer: Aetna Commercial |
$454.53
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$489.88
|
| Rate for Payer: ASR Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$413.57
|
| Rate for Payer: BCN Commercial |
$391.55
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| 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 |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$505.03
|
| Rate for Payer: Healthscope Whirlpool |
$489.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$454.53
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.28
|
| Rate for Payer: Nomi Health Commercial |
$414.12
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.51
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$354.03
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
|
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 |
$328.27 |
| Max. Negotiated Rate |
$505.03 |
| Rate for Payer: Aetna Commercial |
$454.53
|
| Rate for Payer: ASR ASR |
$489.88
|
| Rate for Payer: ASR Commercial |
$489.88
|
| Rate for Payer: BCBS Trust/PPO |
$411.55
|
| 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 Commercial |
$429.28
|
| Rate for Payer: Nomi Health Commercial |
$414.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$444.43
|
|
|
HC CT CHEST WITH CON
|
Facility
|
IP
|
$1,737.15
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,129.15 |
| Max. Negotiated Rate |
$1,737.15 |
| Rate for Payer: Aetna Commercial |
$1,563.43
|
| Rate for Payer: ASR ASR |
$1,685.04
|
| Rate for Payer: ASR Commercial |
$1,685.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.60
|
| Rate for Payer: BCN Commercial |
$1,346.81
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cofinity Commercial |
$1,632.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,389.72
|
| Rate for Payer: Healthscope Commercial |
$1,737.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,685.04
|
| Rate for Payer: Mclaren Commercial |
$1,563.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.58
|
| Rate for Payer: Nomi Health Commercial |
$1,424.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,528.69
|
|
|
HC CT CHEST WITH CON
|
Facility
|
OP
|
$1,737.15
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
35200001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$1,737.15 |
| Rate for Payer: Aetna Commercial |
$1,563.43
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.03
|
| Rate for Payer: ASR ASR |
$1,685.04
|
| Rate for Payer: ASR Commercial |
$1,685.04
|
| Rate for Payer: BCBS Complete |
$97.71
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.55
|
| Rate for Payer: BCN Commercial |
$1,346.81
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cash Price |
$1,389.72
|
| Rate for Payer: Cofinity Commercial |
$1,632.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,389.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$1,737.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,685.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$173.62
|
| Rate for Payer: Mclaren Commercial |
$1,563.43
|
| Rate for Payer: Mclaren Medicaid |
$93.06
|
| Rate for Payer: Mclaren Medicare |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$97.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.58
|
| Rate for Payer: Nomi Health Commercial |
$1,424.46
|
| Rate for Payer: PACE Medicare |
$164.94
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$190.98
|
| Rate for Payer: PHP Medicaid |
$93.06
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.09
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,217.74
|
| Rate for Payer: Railroad Medicare Medicare |
$173.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,528.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$269.11
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$93.06
|
| Rate for Payer: VA VA |
$173.62
|
|
|
HC CT CHEST WO CON
|
Facility
|
OP
|
$1,514.09
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$1,514.09 |
| Rate for Payer: Aetna Commercial |
$1,362.68
|
| Rate for Payer: Aetna Medicare |
$103.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: ASR ASR |
$1,468.67
|
| Rate for Payer: ASR Commercial |
$1,468.67
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.89
|
| Rate for Payer: BCN Commercial |
$1,173.87
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$1,211.27
|
| Rate for Payer: Cash Price |
$1,211.27
|
| Rate for Payer: Cofinity Commercial |
$1,423.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,211.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$1,514.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,468.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$103.71
|
| Rate for Payer: Mclaren Commercial |
$1,362.68
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.98
|
| Rate for Payer: Nomi Health Commercial |
$1,241.55
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: PHP Medicaid |
$55.59
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,326.65
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,061.38
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,332.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$160.75
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP DNSP |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$55.59
|
| Rate for Payer: VA VA |
$103.71
|
|
