|
HC PERQ TRANSL REVASC AMI/PCI
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
48100147
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,170.33 |
| Max. Negotiated Rate |
$50,000.00 |
| Rate for Payer: Aetna Commercial |
$45,000.00
|
| Rate for Payer: Aetna Medicare |
$18,500.00
|
| Rate for Payer: ASR ASR |
$48,500.00
|
| Rate for Payer: BCBS Complete |
$20,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,225.00
|
| Rate for Payer: BCN Commercial |
$41,225.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$47,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$48,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$50,000.00
|
| Rate for Payer: Mclaren Commercial |
$45,000.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,712.91
|
| Rate for Payer: Priority Health Narrow Network |
$6,170.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,000.00
|
|
|
HC PERQ TRANSL REVASC CABG ARTERY/BRANCHES PCI
|
Facility
|
IP
|
$49,300.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100146
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$36,975.00 |
| Max. Negotiated Rate |
$49,300.00 |
| Rate for Payer: Aetna Commercial |
$44,370.00
|
| Rate for Payer: ASR ASR |
$47,821.00
|
| Rate for Payer: BCBS Trust/PPO |
$40,485.16
|
| Rate for Payer: BCN Commercial |
$40,485.16
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$46,342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Healthscope Commercial |
$47,821.00
|
| Rate for Payer: Healthscope Whirlpool |
$49,300.00
|
| Rate for Payer: Mclaren Commercial |
$44,370.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43,384.00
|
|
|
HC PERQ TRANSL REVASC CABG ARTERY/BRANCHES PCI
|
Facility
|
OP
|
$49,300.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
48100146
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$49,300.00 |
| Rate for Payer: Aetna Commercial |
$44,370.00
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$47,821.00
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$40,647.85
|
| Rate for Payer: BCN Commercial |
$40,647.85
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cash Price |
$39,440.00
|
| Rate for Payer: Cofinity Commercial |
$46,342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$47,821.00
|
| Rate for Payer: Healthscope Whirlpool |
$49,300.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$44,370.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.00
|
| Rate for Payer: Nomi Health Commercial |
$40,426.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,712.91
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$6,170.33
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43,384.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$37,500.00 |
| Max. Negotiated Rate |
$50,000.00 |
| Rate for Payer: Aetna Commercial |
$45,000.00
|
| Rate for Payer: ASR ASR |
$48,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,060.00
|
| Rate for Payer: BCN Commercial |
$41,060.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$47,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$48,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$50,000.00
|
| Rate for Payer: Mclaren Commercial |
$45,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,000.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
48100148
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$50,000.00 |
| Rate for Payer: Aetna Commercial |
$45,000.00
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$48,500.00
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$41,225.00
|
| Rate for Payer: BCN Commercial |
$41,225.00
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$47,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$48,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$50,000.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$45,000.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,712.91
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$6,170.33
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,000.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
IP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$37,500.00 |
| Max. Negotiated Rate |
$50,000.00 |
| Rate for Payer: Aetna Commercial |
$45,000.00
|
| Rate for Payer: ASR ASR |
$48,500.00
|
| Rate for Payer: BCBS Trust/PPO |
$41,060.00
|
| Rate for Payer: BCN Commercial |
$41,060.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$47,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Healthscope Commercial |
$48,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$50,000.00
|
| Rate for Payer: Mclaren Commercial |
$45,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,000.00
|
|
|
HC PERQ TRANSL REVASC CTO/PCI ANTEGRADE & RETROGRADE
|
Facility
|
OP
|
$50,000.00
|
|
|
Service Code
|
CPT 92945
|
| Hospital Charge Code |
48100151
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$50,000.00 |
| Rate for Payer: Aetna Commercial |
$45,000.00
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$48,500.00
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$41,225.00
|
| Rate for Payer: BCN Commercial |
$41,225.00
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cash Price |
$40,000.00
|
| Rate for Payer: Cofinity Commercial |
$47,000.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$48,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$50,000.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$45,000.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,500.00
|
| Rate for Payer: Nomi Health Commercial |
$41,000.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,500.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,383.94
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$9,907.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44,000.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
IP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21,150.00 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$25,380.00
|
| Rate for Payer: ASR ASR |
$27,354.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,157.84
|
| Rate for Payer: BCN Commercial |
$23,157.84
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Commercial |
$26,508.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Healthscope Commercial |
$27,354.00
|
| Rate for Payer: Healthscope Whirlpool |
$28,200.00
|
| Rate for Payer: Mclaren Commercial |
$25,380.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Nomi Health Commercial |
$23,124.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24,816.00
|
|
|
HC PERQ TRANSLUM ATHERECTOMY ARTERY/BRANCHES
|
Facility
|
OP
|
$28,200.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100142
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$25,380.00
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$27,354.00
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$23,250.90
|
| Rate for Payer: BCN Commercial |
$23,250.90
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cash Price |
$22,560.00
|
| Rate for Payer: Cofinity Commercial |
$26,508.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$27,354.00
|
| Rate for Payer: Healthscope Whirlpool |
$28,200.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$25,380.00
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,970.00
|
| Rate for Payer: Nomi Health Commercial |
$23,124.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,150.00
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,682.96
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$7,746.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24,816.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
OP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,900.00 |
| Rate for Payer: Aetna Commercial |
$17,010.00
|
| Rate for Payer: Aetna Medicare |
$5,671.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: ASR ASR |
$18,333.00
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$15,583.05
|
| Rate for Payer: BCN Commercial |
$15,583.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Commercial |
$17,766.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$18,333.00
|
| Rate for Payer: Healthscope Whirlpool |
$18,900.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,671.10
|
| Rate for Payer: Mclaren Commercial |
$17,010.00
|
| Rate for Payer: Mclaren Medicaid |
$5,671.10
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$3,114.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Nomi Health Commercial |
$15,498.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$6,238.21
|
| Rate for Payer: PHP Medicaid |
$3,039.71
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,078.10
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,062.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,632.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Exchange |
$8,790.20
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP DNSP |
$5,671.10
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC PERQ TRANSLUM BALLOON ANGIO ARTERY/BRANCHES
|
Facility
|
IP
|
$18,900.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14,175.00 |
| Max. Negotiated Rate |
$18,900.00 |
| Rate for Payer: Aetna Commercial |
$17,010.00
|
| Rate for Payer: ASR ASR |
$18,333.00
|
| Rate for Payer: BCBS Trust/PPO |
$15,520.68
|
| Rate for Payer: BCN Commercial |
$15,520.68
|
| Rate for Payer: Cash Price |
$15,120.00
|
| Rate for Payer: Cofinity Commercial |
$17,766.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,120.00
|
| Rate for Payer: Healthscope Commercial |
$18,333.00
|
| Rate for Payer: Healthscope Whirlpool |
$18,900.00
|
| Rate for Payer: Mclaren Commercial |
$17,010.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,065.00
|
| Rate for Payer: Nomi Health Commercial |
$15,498.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,175.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16,632.00
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$17,829.15 |
| Rate for Payer: Aetna Commercial |
$14,410.03
|
| Rate for Payer: Aetna Medicare |
$11,502.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: ASR ASR |
$15,530.81
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$13,201.18
|
| Rate for Payer: BCN Commercial |
$13,201.18
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Commercial |
$15,050.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$15,530.81
|
| Rate for Payer: Healthscope Whirlpool |
$16,011.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,502.68
|
| Rate for Payer: Mclaren Commercial |
$14,410.03
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$6,317.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Nomi Health Commercial |
$13,129.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$12,652.95
|
| Rate for Payer: PHP Medicaid |
$6,165.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,682.96
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Narrow Network |
$7,746.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,089.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Exchange |
$17,829.15
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP DNSP |
$11,502.68
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$16,011.14
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,008.35 |
| Max. Negotiated Rate |
$16,011.14 |
| Rate for Payer: Aetna Commercial |
$14,410.03
|
| Rate for Payer: ASR ASR |
$15,530.81
|
| Rate for Payer: BCBS Trust/PPO |
$13,148.35
|
| Rate for Payer: BCN Commercial |
$13,148.35
|
| Rate for Payer: Cash Price |
$12,808.91
|
| Rate for Payer: Cofinity Commercial |
$15,050.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,808.91
|
| Rate for Payer: Healthscope Commercial |
$15,530.81
|
| Rate for Payer: Healthscope Whirlpool |
$16,011.14
|
| Rate for Payer: Mclaren Commercial |
$14,410.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,609.47
|
| Rate for Payer: Nomi Health Commercial |
$13,129.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,008.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,089.80
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,996.58 |
| Max. Negotiated Rate |
$17,328.78 |
| Rate for Payer: Aetna Commercial |
$15,595.90
|
| Rate for Payer: ASR ASR |
$16,808.92
|
| Rate for Payer: BCBS Trust/PPO |
$14,230.39
|
| Rate for Payer: BCN Commercial |
$14,230.39
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Commercial |
$16,289.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$16,808.92
|
| Rate for Payer: Healthscope Whirlpool |
$17,328.78
|
| Rate for Payer: Mclaren Commercial |
$15,595.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Nomi Health Commercial |
$14,209.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,249.33
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$17,328.78
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,411.65 |
| Max. Negotiated Rate |
$17,328.78 |
| Rate for Payer: Aetna Commercial |
$15,595.90
|
| Rate for Payer: Aetna Medicare |
$6,411.65
|
| Rate for Payer: ASR ASR |
$16,808.92
|
| Rate for Payer: BCBS Complete |
$6,931.51
|
| Rate for Payer: BCBS Trust/PPO |
$14,287.58
|
| Rate for Payer: BCN Commercial |
$14,287.58
|
| Rate for Payer: Cash Price |
$13,863.02
|
| Rate for Payer: Cofinity Commercial |
$16,289.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,863.02
|
| Rate for Payer: Healthscope Commercial |
$16,808.92
|
| Rate for Payer: Healthscope Whirlpool |
$17,328.78
|
| Rate for Payer: Mclaren Commercial |
$15,595.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,863.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,729.46
|
| Rate for Payer: Nomi Health Commercial |
$14,209.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,996.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,183.48
|
| Rate for Payer: Priority Health Narrow Network |
$12,147.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,249.33
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Aetna Commercial |
$78.80
|
| Rate for Payer: ASR ASR |
$84.92
|
| Rate for Payer: BCBS Trust/PPO |
$71.90
|
| Rate for Payer: BCN Commercial |
$71.90
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$84.92
|
| Rate for Payer: Healthscope Whirlpool |
$87.55
|
| Rate for Payer: Mclaren Commercial |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Nomi Health Commercial |
$71.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.04
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$87.55
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Aetna Commercial |
$78.80
|
| Rate for Payer: Aetna Medicare |
$32.39
|
| Rate for Payer: ASR ASR |
$84.92
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: BCBS Trust/PPO |
$72.18
|
| Rate for Payer: BCN Commercial |
$72.18
|
| Rate for Payer: Cash Price |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.04
|
| Rate for Payer: Healthscope Commercial |
$84.92
|
| Rate for Payer: Healthscope Whirlpool |
$87.55
|
| Rate for Payer: Mclaren Commercial |
$78.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.42
|
| Rate for Payer: Nomi Health Commercial |
$71.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.71
|
| Rate for Payer: Priority Health Narrow Network |
$61.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.04
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$200.57 |
| Rate for Payer: Aetna Commercial |
$180.51
|
| Rate for Payer: Aetna Medicare |
$74.21
|
| Rate for Payer: ASR ASR |
$194.55
|
| Rate for Payer: BCBS Complete |
$80.23
|
| Rate for Payer: BCBS Trust/PPO |
$165.37
|
| Rate for Payer: BCN Commercial |
$165.37
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Commercial |
$188.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$194.55
|
| Rate for Payer: Healthscope Whirlpool |
$200.57
|
| Rate for Payer: Mclaren Commercial |
$180.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Nomi Health Commercial |
$164.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$175.74
|
| Rate for Payer: Priority Health Narrow Network |
$140.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.50
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$200.57
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$200.57 |
| Rate for Payer: Aetna Commercial |
$180.51
|
| Rate for Payer: ASR ASR |
$194.55
|
| Rate for Payer: BCBS Trust/PPO |
$164.71
|
| Rate for Payer: BCN Commercial |
$164.71
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cofinity Commercial |
$188.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.46
|
| Rate for Payer: Healthscope Commercial |
$194.55
|
| Rate for Payer: Healthscope Whirlpool |
$200.57
|
| Rate for Payer: Mclaren Commercial |
$180.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.48
|
| Rate for Payer: Nomi Health Commercial |
$164.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.50
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
OP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$572.44 |
| Max. Negotiated Rate |
$5,342.76 |
| Rate for Payer: Aetna Commercial |
$4,808.48
|
| Rate for Payer: Aetna Medicare |
$1,976.82
|
| Rate for Payer: ASR ASR |
$5,182.48
|
| Rate for Payer: BCBS Complete |
$2,137.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,405.11
|
| Rate for Payer: BCN Commercial |
$4,405.11
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Commercial |
$5,022.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$5,182.48
|
| Rate for Payer: Healthscope Whirlpool |
$5,342.76
|
| Rate for Payer: Mclaren Commercial |
$4,808.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,274.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Nomi Health Commercial |
$4,381.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$715.55
|
| Rate for Payer: Priority Health Narrow Network |
$572.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,701.63
|
|
|
HC PET AQMBF REST AND PHARM STRESS
|
Facility
|
IP
|
$5,342.76
|
|
|
Service Code
|
CPT 78434
|
| Hospital Charge Code |
40400013
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,007.07 |
| Max. Negotiated Rate |
$5,342.76 |
| Rate for Payer: Aetna Commercial |
$4,808.48
|
| Rate for Payer: ASR ASR |
$5,182.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,387.47
|
| Rate for Payer: BCN Commercial |
$4,387.47
|
| Rate for Payer: Cash Price |
$4,274.21
|
| Rate for Payer: Cofinity Commercial |
$5,022.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,274.21
|
| Rate for Payer: Healthscope Commercial |
$5,182.48
|
| Rate for Payer: Healthscope Whirlpool |
$5,342.76
|
| Rate for Payer: Mclaren Commercial |
$4,808.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,541.35
|
| Rate for Payer: Nomi Health Commercial |
$4,381.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,007.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,701.63
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,417.04 |
| Rate for Payer: Aetna Commercial |
$4,875.34
|
| Rate for Payer: Aetna Medicare |
$1,424.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: ASR ASR |
$5,254.53
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,466.35
|
| Rate for Payer: BCN Commercial |
$4,466.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Commercial |
$5,092.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,254.53
|
| Rate for Payer: Healthscope Whirlpool |
$5,417.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$4,875.34
|
| Rate for Payer: Mclaren Medicaid |
$1,424.81
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$782.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Nomi Health Commercial |
$4,441.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$1,567.29
|
| Rate for Payer: PHP Medicaid |
$763.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,746.41
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,797.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,767.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,208.46
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP DNSP |
$1,424.81
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,417.04
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,062.78 |
| Max. Negotiated Rate |
$5,417.04 |
| Rate for Payer: Aetna Commercial |
$4,875.34
|
| Rate for Payer: ASR ASR |
$5,254.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,448.47
|
| Rate for Payer: BCN Commercial |
$4,448.47
|
| Rate for Payer: Cash Price |
$4,333.63
|
| Rate for Payer: Cofinity Commercial |
$5,092.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,333.63
|
| Rate for Payer: Healthscope Commercial |
$5,254.53
|
| Rate for Payer: Healthscope Whirlpool |
$5,417.04
|
| Rate for Payer: Mclaren Commercial |
$4,875.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,604.48
|
| Rate for Payer: Nomi Health Commercial |
$4,441.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,062.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,767.00
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$6,017.05 |
| Rate for Payer: Aetna Commercial |
$5,415.35
|
| Rate for Payer: Aetna Medicare |
$1,424.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.01
|
| Rate for Payer: ASR ASR |
$5,836.54
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,961.06
|
| Rate for Payer: BCN Commercial |
$4,961.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Commercial |
$5,656.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,836.54
|
| Rate for Payer: Healthscope Whirlpool |
$6,017.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$5,415.35
|
| Rate for Payer: Mclaren Medicaid |
$1,424.81
|
| Rate for Payer: Mclaren Medicare |
$1,424.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.05
|
| Rate for Payer: Meridian Medicaid |
$782.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,567.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Nomi Health Commercial |
$4,933.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: PACE Medicare |
$1,353.57
|
| Rate for Payer: PACE SWMI |
$1,424.81
|
| Rate for Payer: PHP Commercial |
$1,567.29
|
| Rate for Payer: PHP Medicaid |
$763.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,272.14
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,217.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,295.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,424.81
|
| Rate for Payer: UHC Exchange |
$2,208.46
|
| Rate for Payer: UHC Medicaid |
$745.18
|
| Rate for Payer: UHCCP DNSP |
$1,424.81
|
| Rate for Payer: UHCCP Medicaid |
$745.18
|
| Rate for Payer: VA VA |
$1,424.81
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$6,017.05
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,512.79 |
| Max. Negotiated Rate |
$6,017.05 |
| Rate for Payer: Aetna Commercial |
$5,415.35
|
| Rate for Payer: ASR ASR |
$5,836.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,941.20
|
| Rate for Payer: BCN Commercial |
$4,941.20
|
| Rate for Payer: Cash Price |
$4,813.64
|
| Rate for Payer: Cofinity Commercial |
$5,656.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.64
|
| Rate for Payer: Healthscope Commercial |
$5,836.54
|
| Rate for Payer: Healthscope Whirlpool |
$6,017.05
|
| Rate for Payer: Mclaren Commercial |
$5,415.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.49
|
| Rate for Payer: Nomi Health Commercial |
$4,933.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,512.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,295.00
|
|
