|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
IP
|
$6,656.19
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,992.14 |
| Max. Negotiated Rate |
$6,656.19 |
| Rate for Payer: Aetna Commercial |
$5,990.57
|
| Rate for Payer: ASR ASR |
$6,456.50
|
| Rate for Payer: BCBS Trust/PPO |
$5,466.06
|
| Rate for Payer: BCN Commercial |
$5,466.06
|
| Rate for Payer: Cash Price |
$5,324.95
|
| Rate for Payer: Cofinity Commercial |
$6,256.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,324.95
|
| Rate for Payer: Healthscope Commercial |
$6,456.50
|
| Rate for Payer: Healthscope Whirlpool |
$6,656.19
|
| Rate for Payer: Mclaren Commercial |
$5,990.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,657.76
|
| Rate for Payer: Nomi Health Commercial |
$5,458.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,992.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,857.45
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28,125.00 |
| Max. Negotiated Rate |
$37,500.00 |
| Rate for Payer: Aetna Commercial |
$33,750.00
|
| Rate for Payer: ASR ASR |
$36,375.00
|
| Rate for Payer: BCBS Trust/PPO |
$30,795.00
|
| Rate for Payer: BCN Commercial |
$30,795.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$35,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$36,375.00
|
| Rate for Payer: Healthscope Whirlpool |
$37,500.00
|
| Rate for Payer: Mclaren Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: Nomi Health Commercial |
$30,750.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28,125.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33,000.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,875.00 |
| Max. Negotiated Rate |
$37,500.00 |
| Rate for Payer: Aetna Commercial |
$33,750.00
|
| Rate for Payer: Aetna Medicare |
$13,875.00
|
| Rate for Payer: ASR ASR |
$36,375.00
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$30,918.75
|
| Rate for Payer: BCN Commercial |
$30,918.75
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$35,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$36,375.00
|
| Rate for Payer: Healthscope Whirlpool |
$37,500.00
|
| Rate for Payer: Mclaren Commercial |
$33,750.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: Nomi Health Commercial |
$30,750.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28,125.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32,857.50
|
| Rate for Payer: Priority Health Narrow Network |
$26,287.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33,000.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,031.25 |
| Max. Negotiated Rate |
$40,625.00 |
| Rate for Payer: Aetna Commercial |
$36,562.50
|
| Rate for Payer: Aetna Medicare |
$15,031.25
|
| Rate for Payer: ASR ASR |
$39,406.25
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$33,495.31
|
| Rate for Payer: BCN Commercial |
$33,495.31
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$38,187.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$39,406.25
|
| Rate for Payer: Healthscope Whirlpool |
$40,625.00
|
| Rate for Payer: Mclaren Commercial |
$36,562.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: Nomi Health Commercial |
$33,312.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30,468.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35,595.62
|
| Rate for Payer: Priority Health Narrow Network |
$28,478.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35,750.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30,468.75 |
| Max. Negotiated Rate |
$40,625.00 |
| Rate for Payer: Aetna Commercial |
$36,562.50
|
| Rate for Payer: ASR ASR |
$39,406.25
|
| Rate for Payer: BCBS Trust/PPO |
$33,361.25
|
| Rate for Payer: BCN Commercial |
$33,361.25
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$38,187.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$39,406.25
|
| Rate for Payer: Healthscope Whirlpool |
$40,625.00
|
| Rate for Payer: Mclaren Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: Nomi Health Commercial |
$33,312.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30,468.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35,750.00
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: Aetna Medicare |
$16.17
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$36.03
|
| Rate for Payer: BCN Commercial |
$36.03
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.29
|
| Rate for Payer: Priority Health Narrow Network |
$30.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.89
|
| Rate for Payer: BCN Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: Aetna Medicare |
$86.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: ASR ASR |
$247.25
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$210.17
|
| Rate for Payer: BCN Commercial |
$210.17
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$239.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$247.25
|
| Rate for Payer: Healthscope Whirlpool |
$254.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$86.71
|
| Rate for Payer: Mclaren Commercial |
$229.41
|
| Rate for Payer: Mclaren Medicaid |
$86.71
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$47.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$95.38
|
| Rate for Payer: PHP Medicaid |
$46.48
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$223.34
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health Narrow Network |
$178.68
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$134.40
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP DNSP |
$86.71
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.18 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: ASR ASR |
$247.25
|
| Rate for Payer: BCBS Trust/PPO |
$209.32
|
| Rate for Payer: BCN Commercial |
$209.32
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$239.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$247.25
|
| Rate for Payer: Healthscope Whirlpool |
$254.90
|
| Rate for Payer: Mclaren Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.31
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$44.67 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: Aetna Medicare |
$28.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: ASR ASR |
$24.22
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$20.59
|
| Rate for Payer: BCN Commercial |
$20.59
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$28.82
|
| Rate for Payer: Mclaren Commercial |
$22.47
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$15.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$31.70
|
| Rate for Payer: PHP Medicaid |
$15.45
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.53
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Narrow Network |
$11.63
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$44.67
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP DNSP |
$28.82
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: ASR ASR |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.51
|
| Rate for Payer: BCN Commercial |
$20.51
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Healthscope Whirlpool |
$24.97
|
| Rate for Payer: Mclaren Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.97
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$160.67
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$59.45 |
| Max. Negotiated Rate |
$304.46 |
| Rate for Payer: Aetna Commercial |
$144.60
|
| Rate for Payer: Aetna Medicare |
$59.45
|
| Rate for Payer: ASR ASR |
$155.85
|
| Rate for Payer: BCBS Complete |
$64.27
|
| Rate for Payer: BCBS Trust/PPO |
$132.47
|
| Rate for Payer: BCN Commercial |
$132.47
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Cofinity Commercial |
$151.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.54
|
| Rate for Payer: Healthscope Commercial |
$155.85
|
| Rate for Payer: Healthscope Whirlpool |
$160.67
|
| Rate for Payer: Mclaren Commercial |
$144.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.57
|
| Rate for Payer: Nomi Health Commercial |
$131.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.46
|
| Rate for Payer: Priority Health Narrow Network |
$243.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.39
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$160.67
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$160.67 |
| Rate for Payer: Aetna Commercial |
$144.60
|
| Rate for Payer: ASR ASR |
$155.85
|
| Rate for Payer: BCBS Trust/PPO |
$131.94
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Cofinity Commercial |
$151.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.54
|
| Rate for Payer: Healthscope Commercial |
$155.85
|
| Rate for Payer: Healthscope Whirlpool |
$160.67
|
| Rate for Payer: Mclaren Commercial |
$144.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.57
|
| Rate for Payer: Nomi Health Commercial |
$131.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.39
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$2,706.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$488.55 |
| Max. Negotiated Rate |
$2,706.00 |
| Rate for Payer: Aetna Commercial |
$2,435.40
|
| Rate for Payer: Aetna Medicare |
$934.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,167.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,167.66
|
| Rate for Payer: ASR ASR |
$2,624.82
|
| Rate for Payer: BCBS Complete |
$513.02
|
| Rate for Payer: BCBS MAPPO |
$934.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,231.10
|
| Rate for Payer: BCN Commercial |
$2,231.10
|
| Rate for Payer: BCN Medicare Advantage |
$934.13
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Commercial |
$2,543.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.13
|
| Rate for Payer: Healthscope Commercial |
$2,624.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,706.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$934.13
|
| Rate for Payer: Mclaren Commercial |
$2,435.40
|
| Rate for Payer: Mclaren Medicaid |
$934.13
|
| Rate for Payer: Mclaren Medicare |
$934.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.84
|
| Rate for Payer: Meridian Medicaid |
$513.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,074.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,027.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,300.10
|
| Rate for Payer: Nomi Health Commercial |
$2,218.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,029.50
|
| Rate for Payer: PACE Medicare |
$887.42
|
| Rate for Payer: PACE SWMI |
$934.13
|
| Rate for Payer: PHP Commercial |
$1,027.54
|
| Rate for Payer: PHP Medicaid |
$500.69
|
| Rate for Payer: PHP Medicare Advantage |
$934.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,748.25
|
| Rate for Payer: Priority Health Medicare |
$934.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,398.60
|
| Rate for Payer: Railroad Medicare Medicare |
$934.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,381.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$934.13
|
| Rate for Payer: UHC Exchange |
$1,447.90
|
| Rate for Payer: UHC Medicaid |
$488.55
|
| Rate for Payer: UHCCP DNSP |
$934.13
|
| Rate for Payer: UHCCP Medicaid |
$488.55
|
| Rate for Payer: VA VA |
$934.13
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,029.50 |
| Max. Negotiated Rate |
$2,706.00 |
| Rate for Payer: Aetna Commercial |
$2,435.40
|
| Rate for Payer: ASR ASR |
$2,624.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,222.17
|
| Rate for Payer: BCN Commercial |
$2,222.17
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Commercial |
$2,543.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,164.80
|
| Rate for Payer: Healthscope Commercial |
$2,624.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,706.00
|
| Rate for Payer: Mclaren Commercial |
$2,435.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,300.10
|
| Rate for Payer: Nomi Health Commercial |
$2,218.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,029.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,381.28
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$136.70
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$136.70 |
| Rate for Payer: Aetna Commercial |
$123.03
|
| Rate for Payer: ASR ASR |
$132.60
|
| Rate for Payer: BCBS Trust/PPO |
$112.26
|
| Rate for Payer: BCN Commercial |
$112.26
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cofinity Commercial |
$128.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.36
|
| Rate for Payer: Healthscope Commercial |
$132.60
|
| Rate for Payer: Healthscope Whirlpool |
$136.70
|
| Rate for Payer: Mclaren Commercial |
$123.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.19
|
| Rate for Payer: Nomi Health Commercial |
$112.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.30
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$136.70
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.58 |
| Max. Negotiated Rate |
$136.70 |
| Rate for Payer: Aetna Commercial |
$123.03
|
| Rate for Payer: Aetna Medicare |
$50.58
|
| Rate for Payer: ASR ASR |
$132.60
|
| Rate for Payer: BCBS Complete |
$54.68
|
| Rate for Payer: BCBS Trust/PPO |
$112.71
|
| Rate for Payer: BCN Commercial |
$112.71
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cofinity Commercial |
$128.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.36
|
| Rate for Payer: Healthscope Commercial |
$132.60
|
| Rate for Payer: Healthscope Whirlpool |
$136.70
|
| Rate for Payer: Mclaren Commercial |
$123.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.19
|
| Rate for Payer: Nomi Health Commercial |
$112.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$119.78
|
| Rate for Payer: Priority Health Narrow Network |
$95.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.30
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$140.39
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$165.85 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: Aetna Medicare |
$51.94
|
| Rate for Payer: ASR ASR |
$136.18
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$115.75
|
| Rate for Payer: BCN Commercial |
$115.75
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Commercial |
$131.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.31
|
| Rate for Payer: Healthscope Commercial |
$136.18
|
| Rate for Payer: Healthscope Whirlpool |
$140.39
|
| Rate for Payer: Mclaren Commercial |
$126.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.33
|
| Rate for Payer: Nomi Health Commercial |
$115.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165.85
|
| Rate for Payer: Priority Health Narrow Network |
$132.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.54
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$140.39
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$105.29 |
| Max. Negotiated Rate |
$140.39 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: ASR ASR |
$136.18
|
| Rate for Payer: BCBS Trust/PPO |
$115.29
|
| Rate for Payer: BCN Commercial |
$115.29
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Commercial |
$131.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.31
|
| Rate for Payer: Healthscope Commercial |
$136.18
|
| Rate for Payer: Healthscope Whirlpool |
$140.39
|
| Rate for Payer: Mclaren Commercial |
$126.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.33
|
| Rate for Payer: Nomi Health Commercial |
$115.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.54
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$145.69
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$145.69 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: ASR ASR |
$141.32
|
| Rate for Payer: BCBS Trust/PPO |
$119.64
|
| Rate for Payer: BCN Commercial |
$119.64
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cofinity Commercial |
$136.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Healthscope Commercial |
$141.32
|
| Rate for Payer: Healthscope Whirlpool |
$145.69
|
| Rate for Payer: Mclaren Commercial |
$131.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$119.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.21
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$145.69
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$165.85 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: Aetna Medicare |
$53.91
|
| Rate for Payer: ASR ASR |
$141.32
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: BCBS Trust/PPO |
$120.12
|
| Rate for Payer: BCN Commercial |
$120.12
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cofinity Commercial |
$136.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Healthscope Commercial |
$141.32
|
| Rate for Payer: Healthscope Whirlpool |
$145.69
|
| Rate for Payer: Mclaren Commercial |
$131.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$119.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165.85
|
| Rate for Payer: Priority Health Narrow Network |
$132.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.21
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$48.56
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: ASR ASR |
$47.10
|
| Rate for Payer: BCBS Trust/PPO |
$39.88
|
| Rate for Payer: BCN Commercial |
$39.88
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$45.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.85
|
| Rate for Payer: Healthscope Commercial |
$47.10
|
| Rate for Payer: Healthscope Whirlpool |
$48.56
|
| Rate for Payer: Mclaren Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.28
|
| Rate for Payer: Nomi Health Commercial |
$39.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.73
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$48.56
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.97 |
| Max. Negotiated Rate |
$165.85 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$17.97
|
| Rate for Payer: ASR ASR |
$47.10
|
| Rate for Payer: BCBS Complete |
$19.42
|
| Rate for Payer: BCBS Trust/PPO |
$40.04
|
| Rate for Payer: BCN Commercial |
$40.04
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cofinity Commercial |
$45.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.85
|
| Rate for Payer: Healthscope Commercial |
$47.10
|
| Rate for Payer: Healthscope Whirlpool |
$48.56
|
| Rate for Payer: Mclaren Commercial |
$43.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.28
|
| Rate for Payer: Nomi Health Commercial |
$39.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165.85
|
| Rate for Payer: Priority Health Narrow Network |
$132.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.73
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$240.89
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$180.67 |
| Max. Negotiated Rate |
$240.89 |
| Rate for Payer: Aetna Commercial |
$216.80
|
| Rate for Payer: ASR ASR |
$233.66
|
| Rate for Payer: BCBS Trust/PPO |
$197.82
|
| Rate for Payer: BCN Commercial |
$197.82
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cofinity Commercial |
$226.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.71
|
| Rate for Payer: Healthscope Commercial |
$233.66
|
| Rate for Payer: Healthscope Whirlpool |
$240.89
|
| Rate for Payer: Mclaren Commercial |
$216.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.76
|
| Rate for Payer: Nomi Health Commercial |
$197.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.98
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$240.89
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$240.89 |
| Rate for Payer: Aetna Commercial |
$216.80
|
| Rate for Payer: Aetna Medicare |
$89.13
|
| Rate for Payer: ASR ASR |
$233.66
|
| Rate for Payer: BCBS Complete |
$96.36
|
| Rate for Payer: BCBS Trust/PPO |
$198.61
|
| Rate for Payer: BCN Commercial |
$198.61
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cofinity Commercial |
$226.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.71
|
| Rate for Payer: Healthscope Commercial |
$233.66
|
| Rate for Payer: Healthscope Whirlpool |
$240.89
|
| Rate for Payer: Mclaren Commercial |
$216.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.76
|
| Rate for Payer: Nomi Health Commercial |
$197.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.33
|
| Rate for Payer: Priority Health Narrow Network |
$52.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.98
|
|
