|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,709.30 |
| Rate for Payer: Aetna Commercial |
$5,138.37
|
| 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 |
$5,538.02
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,707.32
|
| Rate for Payer: BCN Commercial |
$4,707.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$5,366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,538.02
|
| Rate for Payer: Healthscope Whirlpool |
$5,709.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$5,138.37
|
| 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 |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| 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 |
$5,002.49
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,002.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
| 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 LIMITED AREA
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,281.98 |
| Max. Negotiated Rate |
$5,709.30 |
| Rate for Payer: Aetna Commercial |
$5,138.37
|
| Rate for Payer: ASR ASR |
$5,538.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,688.48
|
| Rate for Payer: BCN Commercial |
$4,688.48
|
| Rate for Payer: Cash Price |
$4,567.44
|
| Rate for Payer: Cofinity Commercial |
$5,366.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,567.44
|
| Rate for Payer: Healthscope Commercial |
$5,538.02
|
| Rate for Payer: Healthscope Whirlpool |
$5,709.30
|
| Rate for Payer: Mclaren Commercial |
$5,138.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,281.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,367.62 |
| Max. Negotiated Rate |
$5,823.49 |
| Rate for Payer: Aetna Commercial |
$5,241.14
|
| Rate for Payer: ASR ASR |
$5,648.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,782.25
|
| Rate for Payer: BCN Commercial |
$4,782.25
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,648.79
|
| Rate for Payer: Healthscope Whirlpool |
$5,823.49
|
| Rate for Payer: Mclaren Commercial |
$5,241.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,124.67
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,823.49
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,823.49 |
| Rate for Payer: Aetna Commercial |
$5,241.14
|
| 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 |
$5,648.79
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,801.47
|
| Rate for Payer: BCN Commercial |
$4,801.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,648.79
|
| Rate for Payer: Healthscope Whirlpool |
$5,823.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$5,241.14
|
| 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 |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| 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 |
$5,102.54
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,124.67
|
| 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 WHOLE BODY
|
Facility
|
IP
|
$5,823.49
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,367.62 |
| Max. Negotiated Rate |
$5,823.49 |
| Rate for Payer: Aetna Commercial |
$5,241.14
|
| Rate for Payer: ASR ASR |
$5,648.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,782.25
|
| Rate for Payer: BCN Commercial |
$4,782.25
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Healthscope Commercial |
$5,648.79
|
| Rate for Payer: Healthscope Whirlpool |
$5,823.49
|
| Rate for Payer: Mclaren Commercial |
$5,241.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,124.67
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,823.49
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,823.49 |
| Rate for Payer: Aetna Commercial |
$5,241.14
|
| 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 |
$5,648.79
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,801.47
|
| Rate for Payer: BCN Commercial |
$4,801.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cash Price |
$4,658.79
|
| Rate for Payer: Cofinity Commercial |
$5,474.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,658.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,648.79
|
| Rate for Payer: Healthscope Whirlpool |
$5,823.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$5,241.14
|
| 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 |
$4,949.97
|
| Rate for Payer: Nomi Health Commercial |
$4,775.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,367.62
|
| 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 |
$5,102.54
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,124.67
|
| 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 LIMITED AREA
|
Facility
|
OP
|
$2,679.83
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$2,679.83 |
| Rate for Payer: Aetna Commercial |
$2,411.85
|
| Rate for Payer: Aetna Medicare |
$1,289.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: ASR ASR |
$2,599.44
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.52
|
| Rate for Payer: BCN Commercial |
$2,209.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cofinity Commercial |
$2,519.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$2,599.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,679.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,289.99
|
| Rate for Payer: Mclaren Commercial |
$2,411.85
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$708.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.86
|
| Rate for Payer: Nomi Health Commercial |
$2,197.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.87
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,418.99
|
| Rate for Payer: PHP Medicaid |
$691.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,348.07
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,878.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,358.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$1,999.48
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP DNSP |
$1,289.99
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: VA VA |
$1,289.99
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,679.83
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,009.87 |
| Max. Negotiated Rate |
$2,679.83 |
| Rate for Payer: Aetna Commercial |
$2,411.85
|
| Rate for Payer: ASR ASR |
$2,599.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,200.68
|
| Rate for Payer: BCN Commercial |
$2,200.68
|
| Rate for Payer: Cash Price |
$2,143.86
|
| Rate for Payer: Cofinity Commercial |
$2,519.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,143.86
|
| Rate for Payer: Healthscope Commercial |
$2,599.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,679.83
|
| Rate for Payer: Mclaren Commercial |
$2,411.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,277.86
|
| Rate for Payer: Nomi Health Commercial |
$2,197.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,009.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,358.25
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,448.84
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,147.92 |
| Max. Negotiated Rate |
$5,448.84 |
| Rate for Payer: Aetna Commercial |
$4,903.96
|
| Rate for Payer: Aetna Medicare |
$2,194.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,743.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,743.59
|
| Rate for Payer: ASR ASR |
$5,285.37
|
| Rate for Payer: BCBS Complete |
$1,205.42
|
| Rate for Payer: BCBS MAPPO |
$2,194.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,492.57
|
| Rate for Payer: BCN Commercial |
$4,492.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,194.87
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cofinity Commercial |
$5,121.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,359.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,194.87
|
| Rate for Payer: Healthscope Commercial |
$5,285.37
|
| Rate for Payer: Healthscope Whirlpool |
$5,448.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,194.87
|
| Rate for Payer: Mclaren Commercial |
$4,903.96
|
| Rate for Payer: Mclaren Medicaid |
$2,194.87
|
| Rate for Payer: Mclaren Medicare |
$2,194.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,304.61
|
| Rate for Payer: Meridian Medicaid |
$1,205.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,524.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,414.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.51
|
| Rate for Payer: Nomi Health Commercial |
$4,468.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,086.63
|
| Rate for Payer: PACE Medicare |
$2,085.13
|
| Rate for Payer: PACE SWMI |
$2,194.87
|
| Rate for Payer: PHP Commercial |
$2,414.36
|
| Rate for Payer: PHP Medicaid |
$1,176.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,194.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,840.70
|
| Rate for Payer: Priority Health Medicare |
$2,194.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,272.56
|
| Rate for Payer: Railroad Medicare Medicare |
$2,194.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,794.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,194.87
|
| Rate for Payer: UHC Exchange |
$3,402.05
|
| Rate for Payer: UHC Medicaid |
$1,147.92
|
| Rate for Payer: UHCCP DNSP |
$2,194.87
|
| Rate for Payer: UHCCP Medicaid |
$1,147.92
|
| Rate for Payer: VA VA |
$2,194.87
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,448.84
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,086.63 |
| Max. Negotiated Rate |
$5,448.84 |
| Rate for Payer: Aetna Commercial |
$4,903.96
|
| Rate for Payer: ASR ASR |
$5,285.37
|
| Rate for Payer: BCBS Trust/PPO |
$4,474.59
|
| Rate for Payer: BCN Commercial |
$4,474.59
|
| Rate for Payer: Cash Price |
$4,359.07
|
| Rate for Payer: Cofinity Commercial |
$5,121.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,359.07
|
| Rate for Payer: Healthscope Commercial |
$5,285.37
|
| Rate for Payer: Healthscope Whirlpool |
$5,448.84
|
| Rate for Payer: Mclaren Commercial |
$4,903.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.51
|
| Rate for Payer: Nomi Health Commercial |
$4,468.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,086.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,794.98
|
|
|
HC PET MYOCARD PERFUSION SINGLE STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
40400014
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$2,671.00 |
| Rate for Payer: Aetna Commercial |
$2,403.90
|
| 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 |
$2,590.87
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,202.24
|
| Rate for Payer: BCN Commercial |
$2,202.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cofinity Commercial |
$2,510.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$2,590.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,671.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$2,403.90
|
| 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 |
$2,270.35
|
| Rate for Payer: Nomi Health Commercial |
$2,190.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.25
|
| 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 |
$1,821.42
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,457.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,350.48
|
| 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 MYOCARD PERFUSION SINGLE STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
40400014
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,003.25 |
| Max. Negotiated Rate |
$2,671.00 |
| Rate for Payer: Aetna Commercial |
$2,403.90
|
| Rate for Payer: ASR ASR |
$2,590.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,193.43
|
| Rate for Payer: BCN Commercial |
$2,193.43
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cofinity Commercial |
$2,510.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,136.80
|
| Rate for Payer: Healthscope Commercial |
$2,590.87
|
| Rate for Payer: Healthscope Whirlpool |
$2,671.00
|
| Rate for Payer: Mclaren Commercial |
$2,403.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,270.35
|
| Rate for Payer: Nomi Health Commercial |
$2,190.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,350.48
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,960.63
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,720.47 |
| Max. Negotiated Rate |
$4,960.63 |
| Rate for Payer: Aetna Commercial |
$4,464.57
|
| Rate for Payer: ASR ASR |
$4,811.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,073.67
|
| Rate for Payer: BCN Commercial |
$4,073.67
|
| Rate for Payer: Cash Price |
$3,968.50
|
| Rate for Payer: Cofinity Commercial |
$4,662.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,968.50
|
| Rate for Payer: Healthscope Commercial |
$4,811.81
|
| Rate for Payer: Healthscope Whirlpool |
$4,960.63
|
| Rate for Payer: Mclaren Commercial |
$4,464.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,216.54
|
| Rate for Payer: Nomi Health Commercial |
$4,067.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,720.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,365.35
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,960.63
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,960.63 |
| Rate for Payer: Aetna Commercial |
$4,464.57
|
| 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 |
$4,811.81
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,090.04
|
| Rate for Payer: BCN Commercial |
$4,090.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$3,968.50
|
| Rate for Payer: Cash Price |
$3,968.50
|
| Rate for Payer: Cofinity Commercial |
$4,662.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,968.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$4,811.81
|
| Rate for Payer: Healthscope Whirlpool |
$4,960.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$4,464.57
|
| 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 |
$4,216.54
|
| Rate for Payer: Nomi Health Commercial |
$4,067.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,720.47
|
| 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 |
$4,346.50
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,477.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,365.35
|
| 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 TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,414.62
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$4,414.62 |
| Rate for Payer: Aetna Commercial |
$3,973.16
|
| 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 |
$4,282.18
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,639.85
|
| Rate for Payer: BCN Commercial |
$3,639.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$3,531.70
|
| Rate for Payer: Cash Price |
$3,531.70
|
| Rate for Payer: Cofinity Commercial |
$4,149.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,531.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$4,282.18
|
| Rate for Payer: Healthscope Whirlpool |
$4,414.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$3,973.16
|
| 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 |
$3,752.43
|
| Rate for Payer: Nomi Health Commercial |
$3,619.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,310.97
|
| 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 |
$3,868.09
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,094.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,884.87
|
| 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 TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,414.62
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,310.97 |
| Max. Negotiated Rate |
$4,414.62 |
| Rate for Payer: Aetna Commercial |
$3,973.16
|
| Rate for Payer: ASR ASR |
$4,282.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,625.29
|
| Rate for Payer: BCN Commercial |
$3,625.29
|
| Rate for Payer: Cash Price |
$3,531.70
|
| Rate for Payer: Cofinity Commercial |
$4,149.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,531.70
|
| Rate for Payer: Healthscope Commercial |
$4,282.18
|
| Rate for Payer: Healthscope Whirlpool |
$4,414.62
|
| Rate for Payer: Mclaren Commercial |
$3,973.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,752.43
|
| Rate for Payer: Nomi Health Commercial |
$3,619.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,310.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,884.87
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,816.48
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$5,816.48 |
| Rate for Payer: Aetna Commercial |
$5,234.83
|
| 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 |
$5,641.99
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,795.69
|
| Rate for Payer: BCN Commercial |
$4,795.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$4,653.18
|
| Rate for Payer: Cash Price |
$4,653.18
|
| Rate for Payer: Cofinity Commercial |
$5,467.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,653.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$5,641.99
|
| Rate for Payer: Healthscope Whirlpool |
$5,816.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$5,234.83
|
| 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 |
$4,944.01
|
| Rate for Payer: Nomi Health Commercial |
$4,769.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,362.36
|
| 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 |
$5,096.40
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$4,077.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,118.50
|
| 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 WHOLE BODY
|
Facility
|
IP
|
$5,816.48
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,362.36 |
| Max. Negotiated Rate |
$5,816.48 |
| Rate for Payer: Aetna Commercial |
$5,234.83
|
| Rate for Payer: ASR ASR |
$5,641.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,776.49
|
| Rate for Payer: BCN Commercial |
$4,776.49
|
| Rate for Payer: Cash Price |
$4,653.18
|
| Rate for Payer: Cofinity Commercial |
$5,467.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,653.18
|
| Rate for Payer: Healthscope Commercial |
$5,641.99
|
| Rate for Payer: Healthscope Whirlpool |
$5,816.48
|
| Rate for Payer: Mclaren Commercial |
$5,234.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,944.01
|
| Rate for Payer: Nomi Health Commercial |
$4,769.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,362.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,118.50
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,381.64
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$5,536.23 |
| Max. Negotiated Rate |
$7,381.64 |
| Rate for Payer: Aetna Commercial |
$6,643.48
|
| Rate for Payer: ASR ASR |
$7,160.19
|
| Rate for Payer: BCBS Trust/PPO |
$6,061.80
|
| Rate for Payer: BCN Commercial |
$6,061.80
|
| Rate for Payer: Cash Price |
$5,905.31
|
| Rate for Payer: Cofinity Commercial |
$6,938.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,905.31
|
| Rate for Payer: Healthscope Commercial |
$7,160.19
|
| Rate for Payer: Healthscope Whirlpool |
$7,381.64
|
| Rate for Payer: Mclaren Commercial |
$6,643.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,274.39
|
| Rate for Payer: Nomi Health Commercial |
$6,052.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,536.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,495.84
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$7,381.64
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$745.18 |
| Max. Negotiated Rate |
$7,381.64 |
| Rate for Payer: Aetna Commercial |
$6,643.48
|
| 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 |
$7,160.19
|
| Rate for Payer: BCBS Complete |
$782.51
|
| Rate for Payer: BCBS MAPPO |
$1,424.81
|
| Rate for Payer: BCBS Trust/PPO |
$6,086.16
|
| Rate for Payer: BCN Commercial |
$6,086.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.81
|
| Rate for Payer: Cash Price |
$5,905.31
|
| Rate for Payer: Cash Price |
$5,905.31
|
| Rate for Payer: Cofinity Commercial |
$6,938.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,905.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.81
|
| Rate for Payer: Healthscope Commercial |
$7,160.19
|
| Rate for Payer: Healthscope Whirlpool |
$7,381.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,424.81
|
| Rate for Payer: Mclaren Commercial |
$6,643.48
|
| 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 |
$6,274.39
|
| Rate for Payer: Nomi Health Commercial |
$6,052.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,536.23
|
| 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 |
$6,467.79
|
| Rate for Payer: Priority Health Medicare |
$1,424.81
|
| Rate for Payer: Priority Health Narrow Network |
$5,174.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,424.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,495.84
|
| 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 PFO
|
Facility
|
IP
|
$29,599.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$22,199.29 |
| Max. Negotiated Rate |
$29,599.06 |
| Rate for Payer: Aetna Commercial |
$26,639.15
|
| Rate for Payer: ASR ASR |
$28,711.09
|
| Rate for Payer: BCBS Trust/PPO |
$24,306.75
|
| Rate for Payer: BCN Commercial |
$24,306.75
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cofinity Commercial |
$27,823.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,679.25
|
| Rate for Payer: Healthscope Commercial |
$28,711.09
|
| Rate for Payer: Healthscope Whirlpool |
$29,599.06
|
| Rate for Payer: Mclaren Commercial |
$26,639.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,159.20
|
| Rate for Payer: Nomi Health Commercial |
$24,271.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,199.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,047.17
|
|
|
HC PFO
|
Facility
|
OP
|
$29,599.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$29,599.06 |
| Rate for Payer: Aetna Commercial |
$26,639.15
|
| Rate for Payer: Aetna Medicare |
$18,265.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: ASR ASR |
$28,711.09
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$24,404.42
|
| Rate for Payer: BCN Commercial |
$24,404.42
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cash Price |
$23,679.25
|
| Rate for Payer: Cofinity Commercial |
$27,823.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,679.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Healthscope Commercial |
$28,711.09
|
| Rate for Payer: Healthscope Whirlpool |
$29,599.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,265.72
|
| Rate for Payer: Mclaren Commercial |
$26,639.15
|
| Rate for Payer: Mclaren Medicaid |
$18,265.72
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$10,031.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,159.20
|
| Rate for Payer: Nomi Health Commercial |
$24,271.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,199.29
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Commercial |
$20,092.29
|
| Rate for Payer: PHP Medicaid |
$9,790.43
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,934.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health Narrow Network |
$20,748.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,047.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Exchange |
$28,311.87
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP DNSP |
$18,265.72
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,699.82
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,328.93 |
| Max. Negotiated Rate |
$11,699.82 |
| Rate for Payer: Aetna Commercial |
$10,529.84
|
| Rate for Payer: Aetna Medicare |
$4,328.93
|
| Rate for Payer: ASR ASR |
$11,348.83
|
| Rate for Payer: BCBS Complete |
$4,679.93
|
| Rate for Payer: BCBS Trust/PPO |
$9,646.50
|
| Rate for Payer: BCN Commercial |
$9,646.50
|
| Rate for Payer: Cash Price |
$9,359.86
|
| Rate for Payer: Cofinity Commercial |
$10,997.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,359.86
|
| Rate for Payer: Healthscope Commercial |
$11,348.83
|
| Rate for Payer: Healthscope Whirlpool |
$11,699.82
|
| Rate for Payer: Mclaren Commercial |
$10,529.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,359.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,944.85
|
| Rate for Payer: Nomi Health Commercial |
$9,593.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,774.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,251.38
|
| Rate for Payer: Priority Health Narrow Network |
$8,201.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,295.84
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,699.82
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,774.86 |
| Max. Negotiated Rate |
$11,699.82 |
| Rate for Payer: Aetna Commercial |
$10,529.84
|
| Rate for Payer: ASR ASR |
$11,348.83
|
| Rate for Payer: BCBS Trust/PPO |
$9,607.89
|
| Rate for Payer: BCN Commercial |
$9,607.89
|
| Rate for Payer: Cash Price |
$9,359.86
|
| Rate for Payer: Cofinity Commercial |
$10,997.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,359.86
|
| Rate for Payer: Healthscope Commercial |
$11,348.83
|
| Rate for Payer: Healthscope Whirlpool |
$11,699.82
|
| Rate for Payer: Mclaren Commercial |
$10,529.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,944.85
|
| Rate for Payer: Nomi Health Commercial |
$9,593.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,774.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,295.84
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,956.14
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,463.77 |
| Max. Negotiated Rate |
$3,956.14 |
| Rate for Payer: Aetna Commercial |
$3,560.53
|
| Rate for Payer: Aetna Medicare |
$1,463.77
|
| Rate for Payer: ASR ASR |
$3,837.46
|
| Rate for Payer: BCBS Complete |
$1,582.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,261.84
|
| Rate for Payer: BCN Commercial |
$3,261.84
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Commercial |
$3,718.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,837.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,956.14
|
| Rate for Payer: Mclaren Commercial |
$3,560.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,164.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Nomi Health Commercial |
$3,244.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,466.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,773.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,481.40
|
|
