|
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 |
$762.48 |
| Max. Negotiated Rate |
$5,310.82 |
| Rate for Payer: Aetna Commercial |
$4,779.74
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$5,151.50
|
| Rate for Payer: ASR Commercial |
$5,151.50
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,349.03
|
| Rate for Payer: BCN Commercial |
$4,117.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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 |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,310.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,151.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$4,779.74
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| 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 |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| 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 |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,722.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,673.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
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
|
OP
|
$5,899.07
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400003
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,899.07 |
| Rate for Payer: Aetna Commercial |
$5,309.16
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$5,722.10
|
| Rate for Payer: ASR Commercial |
$5,722.10
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,830.75
|
| Rate for Payer: BCN Commercial |
$4,573.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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 |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,899.07
|
| Rate for Payer: Healthscope Whirlpool |
$5,722.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$5,309.16
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| 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 |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| 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 |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$4,135.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,191.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
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 LIMITED AREA
|
Facility
|
OP
|
$5,597.35
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
40400002
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,597.35 |
| Rate for Payer: Aetna Commercial |
$5,037.61
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$5,429.43
|
| Rate for Payer: ASR Commercial |
$5,429.43
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,583.67
|
| Rate for Payer: BCN Commercial |
$4,339.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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 |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,597.35
|
| Rate for Payer: Healthscope Whirlpool |
$5,429.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$5,037.61
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| 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 |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| 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 |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,923.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,925.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
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 |
$5,037.61
|
| 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 |
$5,037.61
|
| 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 |
$3,711.05 |
| 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 |
$3,711.05
|
| 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 |
$762.48 |
| Max. Negotiated Rate |
$5,709.30 |
| Rate for Payer: Aetna Commercial |
$5,138.37
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$5,538.02
|
| Rate for Payer: ASR Commercial |
$5,538.02
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,675.35
|
| Rate for Payer: BCN Commercial |
$4,426.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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 |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,709.30
|
| Rate for Payer: Healthscope Whirlpool |
$5,538.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| 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 |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,002.49
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$4,002.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
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 |
$3,711.05 |
| 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 |
$3,711.05
|
| 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 |
$762.48 |
| Max. Negotiated Rate |
$5,709.30 |
| Rate for Payer: Aetna Commercial |
$5,138.37
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$5,538.02
|
| Rate for Payer: ASR Commercial |
$5,538.02
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,675.35
|
| Rate for Payer: BCN Commercial |
$4,426.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| 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 |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,709.30
|
| Rate for Payer: Healthscope Whirlpool |
$5,538.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$5,138.37
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| 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 |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,711.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,002.49
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$4,002.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,024.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
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 LIMITED AREA
|
Facility
|
OP
|
$2,627.28
|
|
|
Service Code
|
CPT 78811
|
| Hospital Charge Code |
40400010
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$2,627.28 |
| Rate for Payer: Aetna Commercial |
$2,364.55
|
| Rate for Payer: Aetna Medicare |
$1,273.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: ASR ASR |
$2,548.46
|
| Rate for Payer: ASR Commercial |
$2,548.46
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,151.48
|
| Rate for Payer: BCN Commercial |
$2,036.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| 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 |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$2,627.28
|
| Rate for Payer: Healthscope Whirlpool |
$2,548.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,273.21
|
| Rate for Payer: Mclaren Commercial |
$2,364.55
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| 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 |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,400.53
|
| Rate for Payer: PHP Medicaid |
$682.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| 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 |
$1,273.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,841.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,312.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,973.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP DNSP |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$682.44
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
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 |
$1,176.45 |
| Max. Negotiated Rate |
$5,342.00 |
| Rate for Payer: Aetna Commercial |
$4,807.80
|
| 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 |
$5,181.74
|
| Rate for Payer: ASR Commercial |
$5,181.74
|
| Rate for Payer: BCBS Complete |
$1,235.27
|
| Rate for Payer: BCBS MAPPO |
$2,194.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,374.56
|
| Rate for Payer: BCN Commercial |
$4,141.65
|
| Rate for Payer: BCN Medicare Advantage |
$2,194.87
|
| 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 |
$2,194.87
|
| Rate for Payer: Healthscope Commercial |
$5,342.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,181.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,194.87
|
| Rate for Payer: Mclaren Commercial |
$4,807.80
|
| Rate for Payer: Mclaren Medicaid |
$1,176.45
|
| 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 |
$1,235.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,524.10
|
| 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 |
$2,085.13
|
| 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 |
$1,176.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,472.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,680.66
|
| Rate for Payer: Priority Health Medicare |
$2,194.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,744.74
|
| Rate for Payer: Railroad Medicare Medicare |
$2,194.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,700.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,194.87
|
| Rate for Payer: UHC Exchange |
$3,402.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,194.87
|
| Rate for Payer: UHCCP DNSP |
$2,194.87
|
| Rate for Payer: UHCCP Medicaid |
$1,176.45
|
| Rate for Payer: VA VA |
$2,194.87
|
|
|
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
|
|
|
HC PET SKULL-MIDTHIGH
|
Facility
|
OP
|
$4,863.36
|
|
|
Service Code
|
CPT 78812
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$4,863.36 |
| Rate for Payer: Aetna Commercial |
$4,377.02
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$4,717.46
|
| Rate for Payer: ASR Commercial |
$4,717.46
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,982.61
|
| Rate for Payer: BCN Commercial |
$3,770.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$3,890.69
|
| 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: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$4,863.36
|
| Rate for Payer: Healthscope Whirlpool |
$4,717.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$4,377.02
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,133.86
|
| Rate for Payer: Nomi Health Commercial |
$3,987.96
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,161.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,261.28
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,409.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,279.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
IP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$2,813.24 |
| Max. Negotiated Rate |
$4,328.06 |
| Rate for Payer: Aetna Commercial |
$3,895.25
|
| Rate for Payer: ASR ASR |
$4,198.22
|
| Rate for Payer: ASR Commercial |
$4,198.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,526.94
|
| Rate for Payer: BCN Commercial |
$3,355.54
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$4,068.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Healthscope Commercial |
$4,328.06
|
| Rate for Payer: Healthscope Whirlpool |
$4,198.22
|
| Rate for Payer: Mclaren Commercial |
$3,895.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$3,549.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,808.69
|
|
|
HC PET TUMOR SKULL TO THIGH
|
Facility
|
OP
|
$4,328.06
|
|
|
Service Code
|
CPT 78815
|
| Hospital Charge Code |
40400004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$4,328.06 |
| Rate for Payer: Aetna Commercial |
$3,895.25
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$4,198.22
|
| Rate for Payer: ASR Commercial |
$4,198.22
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,544.25
|
| Rate for Payer: BCN Commercial |
$3,355.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cash Price |
$3,462.45
|
| Rate for Payer: Cofinity Commercial |
$4,068.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,462.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$4,328.06
|
| Rate for Payer: Healthscope Whirlpool |
$4,198.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$3,895.25
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,678.85
|
| Rate for Payer: Nomi Health Commercial |
$3,549.01
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,813.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,792.25
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,033.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,808.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET WHOLE BODY
|
Facility
|
OP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$5,702.43 |
| Rate for Payer: Aetna Commercial |
$5,132.19
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$5,531.36
|
| Rate for Payer: ASR Commercial |
$5,531.36
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,669.72
|
| Rate for Payer: BCN Commercial |
$4,421.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$5,360.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$5,702.43
|
| Rate for Payer: Healthscope Whirlpool |
$5,531.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$5,132.19
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,675.99
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,996.47
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$3,997.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,018.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PET WHOLE BODY
|
Facility
|
IP
|
$5,702.43
|
|
|
Service Code
|
CPT 78813
|
| Hospital Charge Code |
40400011
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$3,706.58 |
| Max. Negotiated Rate |
$5,702.43 |
| Rate for Payer: Aetna Commercial |
$5,132.19
|
| Rate for Payer: ASR ASR |
$5,531.36
|
| Rate for Payer: ASR Commercial |
$5,531.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,646.91
|
| Rate for Payer: BCN Commercial |
$4,421.09
|
| Rate for Payer: Cash Price |
$4,561.94
|
| Rate for Payer: Cofinity Commercial |
$5,360.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,561.94
|
| Rate for Payer: Healthscope Commercial |
$5,702.43
|
| Rate for Payer: Healthscope Whirlpool |
$5,531.36
|
| Rate for Payer: Mclaren Commercial |
$5,132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,847.07
|
| Rate for Payer: Nomi Health Commercial |
$4,675.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,706.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,018.14
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,703.98 |
| Max. Negotiated Rate |
$7,236.90 |
| Rate for Payer: Aetna Commercial |
$6,513.21
|
| Rate for Payer: ASR ASR |
$7,019.79
|
| Rate for Payer: ASR Commercial |
$7,019.79
|
| Rate for Payer: BCBS Trust/PPO |
$5,897.35
|
| Rate for Payer: BCN Commercial |
$5,610.77
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,802.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Healthscope Commercial |
$7,236.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,019.79
|
| Rate for Payer: Mclaren Commercial |
$6,513.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: Nomi Health Commercial |
$5,934.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,368.47
|
|
|
HC PET WMC CT WHOLE BODY
|
Facility
|
OP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$762.48 |
| Max. Negotiated Rate |
$7,236.90 |
| Rate for Payer: Aetna Commercial |
$6,513.21
|
| Rate for Payer: Aetna Medicare |
$1,422.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,778.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,778.16
|
| Rate for Payer: ASR ASR |
$7,019.79
|
| Rate for Payer: ASR Commercial |
$7,019.79
|
| Rate for Payer: BCBS Complete |
$800.60
|
| Rate for Payer: BCBS MAPPO |
$1,422.53
|
| Rate for Payer: BCBS Trust/PPO |
$5,926.30
|
| Rate for Payer: BCN Commercial |
$5,610.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,422.53
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,802.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,422.53
|
| Rate for Payer: Healthscope Commercial |
$7,236.90
|
| Rate for Payer: Healthscope Whirlpool |
$7,019.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,422.53
|
| Rate for Payer: Mclaren Commercial |
$6,513.21
|
| Rate for Payer: Mclaren Medicaid |
$762.48
|
| Rate for Payer: Mclaren Medicare |
$1,422.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,493.66
|
| Rate for Payer: Meridian Medicaid |
$800.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,635.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: Nomi Health Commercial |
$5,934.26
|
| Rate for Payer: PACE Medicare |
$1,351.40
|
| Rate for Payer: PACE SWMI |
$1,422.53
|
| Rate for Payer: PHP Commercial |
$1,564.78
|
| Rate for Payer: PHP Medicaid |
$762.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,422.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,340.97
|
| Rate for Payer: Priority Health Medicare |
$1,422.53
|
| Rate for Payer: Priority Health Narrow Network |
$5,073.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,422.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,368.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,422.53
|
| Rate for Payer: UHC Exchange |
$2,204.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,422.53
|
| Rate for Payer: UHCCP DNSP |
$1,422.53
|
| Rate for Payer: UHCCP Medicaid |
$762.48
|
| Rate for Payer: VA VA |
$1,422.53
|
|
|
HC PFO
|
Facility
|
IP
|
$27,024.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,565.64 |
| Max. Negotiated Rate |
$27,024.06 |
| Rate for Payer: Aetna Commercial |
$24,321.65
|
| Rate for Payer: ASR ASR |
$26,213.34
|
| Rate for Payer: ASR Commercial |
$26,213.34
|
| Rate for Payer: BCBS Trust/PPO |
$22,021.91
|
| Rate for Payer: BCN Commercial |
$20,951.75
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cofinity Commercial |
$25,402.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,619.25
|
| Rate for Payer: Healthscope Commercial |
$27,024.06
|
| Rate for Payer: Healthscope Whirlpool |
$26,213.34
|
| Rate for Payer: Mclaren Commercial |
$24,321.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,970.45
|
| Rate for Payer: Nomi Health Commercial |
$22,159.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,565.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,781.17
|
|
|
HC PFO
|
Facility
|
OP
|
$27,024.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$27,144.89 |
| Rate for Payer: Aetna Commercial |
$24,321.65
|
| Rate for Payer: Aetna Medicare |
$17,512.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: ASR ASR |
$26,213.34
|
| Rate for Payer: ASR Commercial |
$26,213.34
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCBS Trust/PPO |
$22,130.00
|
| Rate for Payer: BCN Commercial |
$20,951.75
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cofinity Commercial |
$25,402.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,619.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Healthscope Commercial |
$27,024.06
|
| Rate for Payer: Healthscope Whirlpool |
$26,213.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,512.83
|
| Rate for Payer: Mclaren Commercial |
$24,321.65
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,970.45
|
| Rate for Payer: Nomi Health Commercial |
$22,159.73
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Commercial |
$19,264.11
|
| Rate for Payer: PHP Medicaid |
$9,386.88
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,565.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,678.48
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Priority Health Narrow Network |
$18,943.87
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23,781.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Exchange |
$27,144.89
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP DNSP |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,386.88
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,470.41
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,455.77 |
| Max. Negotiated Rate |
$11,470.41 |
| Rate for Payer: Aetna Commercial |
$10,323.37
|
| Rate for Payer: ASR ASR |
$11,126.30
|
| Rate for Payer: ASR Commercial |
$11,126.30
|
| Rate for Payer: BCBS Trust/PPO |
$9,347.24
|
| Rate for Payer: BCN Commercial |
$8,893.01
|
| Rate for Payer: Cash Price |
$9,176.33
|
| Rate for Payer: Cofinity Commercial |
$10,782.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,176.33
|
| Rate for Payer: Healthscope Commercial |
$11,470.41
|
| Rate for Payer: Healthscope Whirlpool |
$11,126.30
|
| Rate for Payer: Mclaren Commercial |
$10,323.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,749.85
|
| Rate for Payer: Nomi Health Commercial |
$9,405.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,455.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10,093.96
|
|
