|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.97 |
| Max. Negotiated Rate |
$443.03 |
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: ASR ASR |
$429.74
|
| Rate for Payer: ASR Commercial |
$429.74
|
| Rate for Payer: BCBS Trust/PPO |
$361.03
|
| Rate for Payer: BCN Commercial |
$343.48
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$416.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Healthscope Commercial |
$443.03
|
| Rate for Payer: Healthscope Whirlpool |
$429.74
|
| Rate for Payer: Mclaren Commercial |
$398.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$363.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.87
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$443.03 |
| Rate for Payer: Aetna Commercial |
$398.73
|
| Rate for Payer: Aetna Medicare |
$238.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: ASR ASR |
$429.74
|
| Rate for Payer: ASR Commercial |
$429.74
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$362.80
|
| Rate for Payer: BCN Commercial |
$343.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$416.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$443.03
|
| Rate for Payer: Healthscope Whirlpool |
$429.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.29
|
| Rate for Payer: Mclaren Commercial |
$398.73
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$363.28
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$262.12
|
| Rate for Payer: PHP Medicaid |
$127.72
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.95
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$211.96
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$369.35
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP DNSP |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,203.18 |
| Max. Negotiated Rate |
$15,697.20 |
| Rate for Payer: Aetna Commercial |
$14,127.48
|
| Rate for Payer: ASR ASR |
$15,226.28
|
| Rate for Payer: ASR Commercial |
$15,226.28
|
| Rate for Payer: BCBS Trust/PPO |
$12,791.65
|
| Rate for Payer: BCN Commercial |
$12,170.04
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$14,755.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Healthscope Commercial |
$15,697.20
|
| Rate for Payer: Healthscope Whirlpool |
$15,226.28
|
| Rate for Payer: Mclaren Commercial |
$14,127.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$12,871.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,813.54
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,955.64 |
| Max. Negotiated Rate |
$17,222.45 |
| Rate for Payer: Aetna Commercial |
$14,127.48
|
| Rate for Payer: Aetna Medicare |
$11,111.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: ASR ASR |
$15,226.28
|
| Rate for Payer: ASR Commercial |
$15,226.28
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$12,854.44
|
| Rate for Payer: BCN Commercial |
$12,170.04
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$14,755.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$15,697.20
|
| Rate for Payer: Healthscope Whirlpool |
$15,226.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,111.26
|
| Rate for Payer: Mclaren Commercial |
$14,127.48
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$12,871.70
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$12,222.39
|
| Rate for Payer: PHP Medicaid |
$5,955.64
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,782.73
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$7,026.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13,813.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$17,222.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP DNSP |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,042.85 |
| Max. Negotiated Rate |
$16,989.00 |
| Rate for Payer: Aetna Commercial |
$15,290.10
|
| Rate for Payer: ASR ASR |
$16,479.33
|
| Rate for Payer: ASR Commercial |
$16,479.33
|
| Rate for Payer: BCBS Trust/PPO |
$13,844.34
|
| Rate for Payer: BCN Commercial |
$13,171.57
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$15,969.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$16,989.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,479.33
|
| Rate for Payer: Mclaren Commercial |
$15,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: Nomi Health Commercial |
$13,930.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,950.32
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,795.60 |
| Max. Negotiated Rate |
$16,989.00 |
| Rate for Payer: Aetna Commercial |
$15,290.10
|
| Rate for Payer: Aetna Medicare |
$8,494.50
|
| Rate for Payer: ASR ASR |
$16,479.33
|
| Rate for Payer: ASR Commercial |
$16,479.33
|
| Rate for Payer: BCBS Complete |
$6,795.60
|
| Rate for Payer: BCBS Trust/PPO |
$13,912.29
|
| Rate for Payer: BCN Commercial |
$13,171.57
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$15,969.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$16,989.00
|
| Rate for Payer: Healthscope Whirlpool |
$16,479.33
|
| Rate for Payer: Mclaren Commercial |
$15,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: Nomi Health Commercial |
$13,930.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,885.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,909.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,950.32
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
IP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$77.25
|
| Rate for Payer: ASR ASR |
$83.26
|
| Rate for Payer: ASR Commercial |
$83.26
|
| Rate for Payer: BCBS Trust/PPO |
$69.94
|
| Rate for Payer: BCN Commercial |
$66.54
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Healthscope Whirlpool |
$83.26
|
| Rate for Payer: Mclaren Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.53
|
|
|
HC PESSARY NON RUBBER ANY TYPE
|
Facility
|
OP
|
$85.83
|
|
|
Service Code
|
HCPCS A4562
|
| Hospital Charge Code |
27200305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$77.25
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: ASR ASR |
$83.26
|
| Rate for Payer: ASR Commercial |
$83.26
|
| Rate for Payer: BCBS Complete |
$34.33
|
| Rate for Payer: BCBS Trust/PPO |
$70.29
|
| Rate for Payer: BCN Commercial |
$66.54
|
| Rate for Payer: Cash Price |
$68.66
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.66
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Healthscope Whirlpool |
$83.26
|
| Rate for Payer: Mclaren Commercial |
$77.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.96
|
| Rate for Payer: Nomi Health Commercial |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.20
|
| Rate for Payer: Priority Health Narrow Network |
$60.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.53
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
IP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$196.64 |
| Rate for Payer: Aetna Commercial |
$176.98
|
| Rate for Payer: ASR ASR |
$190.74
|
| Rate for Payer: ASR Commercial |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$160.24
|
| Rate for Payer: BCN Commercial |
$152.45
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$196.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.74
|
| Rate for Payer: Mclaren Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.04
|
|
|
HC PESSARY RUBBER ANY TYPE
|
Facility
|
OP
|
$196.64
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
27200345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.66 |
| Max. Negotiated Rate |
$196.64 |
| Rate for Payer: Aetna Commercial |
$176.98
|
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: ASR ASR |
$190.74
|
| Rate for Payer: ASR Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS Trust/PPO |
$161.03
|
| Rate for Payer: BCN Commercial |
$152.45
|
| Rate for Payer: Cash Price |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.31
|
| Rate for Payer: Healthscope Commercial |
$196.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.74
|
| Rate for Payer: Mclaren Commercial |
$176.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.14
|
| Rate for Payer: Nomi Health Commercial |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.30
|
| Rate for Payer: Priority Health Narrow Network |
$137.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.04
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
OP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,310.82 |
| Rate for Payer: Aetna Commercial |
$4,779.74
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$5,151.50
|
| Rate for Payer: ASR Commercial |
$5,151.50
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,349.03
|
| Rate for Payer: BCN Commercial |
$4,117.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$4,992.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,310.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,151.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$4,779.74
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: Nomi Health Commercial |
$4,354.87
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,653.34
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,722.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,673.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET BRAIN IMAGING METABOLIC
|
Facility
|
IP
|
$5,310.82
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
40400001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,452.03 |
| Max. Negotiated Rate |
$5,310.82 |
| Rate for Payer: Aetna Commercial |
$4,779.74
|
| Rate for Payer: ASR ASR |
$5,151.50
|
| Rate for Payer: ASR Commercial |
$5,151.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,327.79
|
| Rate for Payer: BCN Commercial |
$4,117.48
|
| Rate for Payer: Cash Price |
$4,248.66
|
| Rate for Payer: Cofinity Commercial |
$4,992.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,248.66
|
| Rate for Payer: Healthscope Commercial |
$5,310.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,151.50
|
| Rate for Payer: Mclaren Commercial |
$4,779.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,514.20
|
| Rate for Payer: Nomi Health Commercial |
$4,354.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,673.52
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
IP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,834.40 |
| Max. Negotiated Rate |
$5,899.07 |
| Rate for Payer: Aetna Commercial |
$5,309.16
|
| Rate for Payer: ASR ASR |
$5,722.10
|
| Rate for Payer: ASR Commercial |
$5,722.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,807.15
|
| Rate for Payer: BCN Commercial |
$4,573.55
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$5,545.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Healthscope Commercial |
$5,899.07
|
| Rate for Payer: Healthscope Whirlpool |
$5,722.10
|
| Rate for Payer: Mclaren Commercial |
$5,309.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: Nomi Health Commercial |
$4,837.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,191.18
|
|
|
HC PET CT CHEST NECK LIMITED AREA
|
Facility
|
OP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,899.07 |
| Rate for Payer: Aetna Commercial |
$5,309.16
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$5,722.10
|
| Rate for Payer: ASR Commercial |
$5,722.10
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,830.75
|
| Rate for Payer: BCN Commercial |
$4,573.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cash Price |
$4,719.26
|
| Rate for Payer: Cofinity Commercial |
$5,545.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,719.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,899.07
|
| Rate for Payer: Healthscope Whirlpool |
$5,722.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$5,309.16
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,014.21
|
| Rate for Payer: Nomi Health Commercial |
$4,837.24
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,834.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,168.77
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,135.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,191.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,597.35 |
| Rate for Payer: Aetna Commercial |
$5,037.62
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$5,429.43
|
| Rate for Payer: ASR Commercial |
$5,429.43
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,583.67
|
| Rate for Payer: BCN Commercial |
$4,339.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$5,261.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,597.35
|
| Rate for Payer: Healthscope Whirlpool |
$5,429.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$5,037.62
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: Nomi Health Commercial |
$4,589.83
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,904.40
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$3,923.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,925.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET CT LIMITED AREA
|
Facility
|
IP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,638.28 |
| Max. Negotiated Rate |
$5,597.35 |
| Rate for Payer: Aetna Commercial |
$5,037.62
|
| Rate for Payer: ASR ASR |
$5,429.43
|
| Rate for Payer: ASR Commercial |
$5,429.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,561.28
|
| Rate for Payer: BCN Commercial |
$4,339.63
|
| Rate for Payer: Cash Price |
$4,477.88
|
| Rate for Payer: Cofinity Commercial |
$5,261.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,477.88
|
| Rate for Payer: Healthscope Commercial |
$5,597.35
|
| Rate for Payer: Healthscope Whirlpool |
$5,429.43
|
| Rate for Payer: Mclaren Commercial |
$5,037.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,757.75
|
| Rate for Payer: Nomi Health Commercial |
$4,589.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,638.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,925.67
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,711.04 |
| 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: ASR Commercial |
$5,538.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,652.51
|
| Rate for Payer: BCN Commercial |
$4,426.42
|
| 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 |
$5,709.30
|
| Rate for Payer: Healthscope Whirlpool |
$5,538.02
|
| 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: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
|
|
HC PET CT SKULL BASE TO MID THIGH
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,709.30 |
| Rate for Payer: Aetna Commercial |
$5,138.37
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$5,538.02
|
| Rate for Payer: ASR Commercial |
$5,538.02
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,675.35
|
| Rate for Payer: BCN Commercial |
$4,426.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| 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 |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,709.30
|
| Rate for Payer: Healthscope Whirlpool |
$5,538.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,002.49
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,002.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
IP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,711.04 |
| 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: ASR Commercial |
$5,538.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,652.51
|
| Rate for Payer: BCN Commercial |
$4,426.42
|
| 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 |
$5,709.30
|
| Rate for Payer: Healthscope Whirlpool |
$5,538.02
|
| 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: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
|
|
HC PET CT WHOLE BODY
|
Facility
|
OP
|
$5,709.30
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400007
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$766.00 |
| Max. Negotiated Rate |
$5,709.30 |
| Rate for Payer: Aetna Commercial |
$5,138.37
|
| Rate for Payer: Aetna Medicare |
$1,429.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,786.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,786.38
|
| Rate for Payer: ASR ASR |
$5,538.02
|
| Rate for Payer: ASR Commercial |
$5,538.02
|
| Rate for Payer: BCBS Complete |
$804.30
|
| Rate for Payer: BCBS MAPPO |
$1,429.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,675.35
|
| Rate for Payer: BCN Commercial |
$4,426.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,429.10
|
| 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 |
$1,429.10
|
| Rate for Payer: Healthscope Commercial |
$5,709.30
|
| Rate for Payer: Healthscope Whirlpool |
$5,538.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,429.10
|
| Rate for Payer: Mclaren Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$766.00
|
| Rate for Payer: Mclaren Medicare |
$1,429.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,500.56
|
| Rate for Payer: Meridian Medicaid |
$804.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,643.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,852.90
|
| Rate for Payer: Nomi Health Commercial |
$4,681.63
|
| Rate for Payer: PACE Medicare |
$1,357.64
|
| Rate for Payer: PACE SWMI |
$1,429.10
|
| Rate for Payer: PHP Commercial |
$1,572.01
|
| Rate for Payer: PHP Medicaid |
$766.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,429.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,002.49
|
| Rate for Payer: Priority Health Medicare |
$1,429.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,002.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,429.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,429.10
|
| Rate for Payer: UHC Exchange |
$2,215.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,429.10
|
| Rate for Payer: UHCCP DNSP |
$1,429.10
|
| Rate for Payer: UHCCP Medicaid |
$766.00
|
| Rate for Payer: VA VA |
$1,429.10
|
|
|
HC PET LIMITED AREA
|
Facility
|
OP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$685.59 |
| Max. Negotiated Rate |
$2,627.28 |
| Rate for Payer: Aetna Commercial |
$2,364.55
|
| Rate for Payer: Aetna Medicare |
$1,279.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: ASR ASR |
$2,548.46
|
| Rate for Payer: ASR Commercial |
$2,548.46
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,151.48
|
| Rate for Payer: BCN Commercial |
$2,036.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$2,469.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$2,627.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,548.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$2,364.55
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: Nomi Health Commercial |
$2,154.37
|
| Rate for Payer: PACE Medicare |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$1,406.99
|
| Rate for Payer: PHP Medicaid |
$685.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,302.02
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,841.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,312.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$1,982.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP DNSP |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: VA VA |
$1,279.08
|
|
|
HC PET LIMITED AREA
|
Facility
|
IP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,707.73 |
| Max. Negotiated Rate |
$2,627.28 |
| Rate for Payer: Aetna Commercial |
$2,364.55
|
| Rate for Payer: ASR ASR |
$2,548.46
|
| Rate for Payer: ASR Commercial |
$2,548.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,140.97
|
| Rate for Payer: BCN Commercial |
$2,036.93
|
| Rate for Payer: Cash Price |
$2,101.82
|
| Rate for Payer: Cofinity Commercial |
$2,469.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.82
|
| Rate for Payer: Healthscope Commercial |
$2,627.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,548.46
|
| Rate for Payer: Mclaren Commercial |
$2,364.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.19
|
| Rate for Payer: Nomi Health Commercial |
$2,154.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,707.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,312.01
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
OP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,181.87 |
| Max. Negotiated Rate |
$5,342.00 |
| Rate for Payer: Aetna Commercial |
$4,807.80
|
| Rate for Payer: Aetna Medicare |
$2,204.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,756.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,756.24
|
| Rate for Payer: ASR ASR |
$5,181.74
|
| Rate for Payer: ASR Commercial |
$5,181.74
|
| Rate for Payer: BCBS Complete |
$1,240.97
|
| Rate for Payer: BCBS MAPPO |
$2,204.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,374.56
|
| Rate for Payer: BCN Commercial |
$4,141.65
|
| Rate for Payer: BCN Medicare Advantage |
$2,204.99
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$5,021.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,204.99
|
| Rate for Payer: Healthscope Commercial |
$5,342.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,181.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,204.99
|
| Rate for Payer: Mclaren Commercial |
$4,807.80
|
| Rate for Payer: Mclaren Medicaid |
$1,181.87
|
| Rate for Payer: Mclaren Medicare |
$2,204.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,315.24
|
| Rate for Payer: Meridian Medicaid |
$1,240.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,535.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: Nomi Health Commercial |
$4,380.44
|
| Rate for Payer: PACE Medicare |
$2,094.74
|
| Rate for Payer: PACE SWMI |
$2,204.99
|
| Rate for Payer: PHP Commercial |
$2,425.49
|
| Rate for Payer: PHP Medicaid |
$1,181.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,204.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,181.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,576.60
|
| Rate for Payer: Priority Health Medicare |
$2,204.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,061.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2,204.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,700.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,204.99
|
| Rate for Payer: UHC Exchange |
$3,417.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,204.99
|
| Rate for Payer: UHCCP DNSP |
$2,204.99
|
| Rate for Payer: UHCCP Medicaid |
$1,181.87
|
| Rate for Payer: VA VA |
$2,204.99
|
|
|
HC PET MYOCARD PERFUSION MULTI STUDY REST/STRESS CONCUR CT
|
Facility
|
IP
|
$5,342.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
40400012
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,472.30 |
| Max. Negotiated Rate |
$5,342.00 |
| Rate for Payer: Aetna Commercial |
$4,807.80
|
| Rate for Payer: ASR ASR |
$5,181.74
|
| Rate for Payer: ASR Commercial |
$5,181.74
|
| Rate for Payer: BCBS Trust/PPO |
$4,353.20
|
| Rate for Payer: BCN Commercial |
$4,141.65
|
| Rate for Payer: Cash Price |
$4,273.60
|
| Rate for Payer: Cofinity Commercial |
$5,021.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,273.60
|
| Rate for Payer: Healthscope Commercial |
$5,342.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,181.74
|
| Rate for Payer: Mclaren Commercial |
$4,807.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,540.70
|
| Rate for Payer: Nomi Health Commercial |
$4,380.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,700.96
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
IP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,161.18 |
| Max. Negotiated Rate |
$4,863.36 |
| Rate for Payer: Aetna Commercial |
$4,377.02
|
| Rate for Payer: ASR ASR |
$4,717.46
|
| Rate for Payer: ASR Commercial |
$4,717.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,963.15
|
| Rate for Payer: BCN Commercial |
$3,770.56
|
| Rate for Payer: Cash Price |
$3,890.69
|
| Rate for Payer: Cofinity Commercial |
$4,571.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,890.69
|
| Rate for Payer: Healthscope Commercial |
$4,863.36
|
| Rate for Payer: Healthscope Whirlpool |
$4,717.46
|
| Rate for Payer: Mclaren Commercial |
$4,377.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: Nomi Health Commercial |
$3,987.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,279.76
|
|
