|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
IP
|
$6,525.68
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,241.69 |
| Max. Negotiated Rate |
$6,525.68 |
| Rate for Payer: Aetna Commercial |
$5,873.11
|
| Rate for Payer: ASR ASR |
$6,329.91
|
| Rate for Payer: ASR Commercial |
$6,329.91
|
| Rate for Payer: BCBS Trust/PPO |
$5,317.78
|
| Rate for Payer: BCN Commercial |
$5,059.36
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$6,134.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$6,525.68
|
| Rate for Payer: Healthscope Whirlpool |
$6,329.91
|
| Rate for Payer: Mclaren Commercial |
$5,873.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: Nomi Health Commercial |
$5,351.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,742.60
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,375.00 |
| 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: ASR Commercial |
$36,375.00
|
| Rate for Payer: BCBS Trust/PPO |
$30,558.75
|
| Rate for Payer: BCN Commercial |
$29,073.75
|
| 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 |
$37,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$36,375.00
|
| 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: Priority Health Cigna Priority Health |
$24,375.00
|
| 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 |
$15,000.00 |
| Max. Negotiated Rate |
$37,500.00 |
| Rate for Payer: Aetna Commercial |
$33,750.00
|
| Rate for Payer: Aetna Medicare |
$18,750.00
|
| Rate for Payer: ASR ASR |
$36,375.00
|
| Rate for Payer: ASR Commercial |
$36,375.00
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$30,708.75
|
| Rate for Payer: BCN Commercial |
$29,073.75
|
| 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 |
$37,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$36,375.00
|
| 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: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: 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 |
$16,250.00 |
| Max. Negotiated Rate |
$40,625.00 |
| Rate for Payer: Aetna Commercial |
$36,562.50
|
| Rate for Payer: Aetna Medicare |
$20,312.50
|
| Rate for Payer: ASR ASR |
$39,406.25
|
| Rate for Payer: ASR Commercial |
$39,406.25
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$33,267.81
|
| Rate for Payer: BCN Commercial |
$31,496.56
|
| 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 |
$40,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$39,406.25
|
| 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: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: 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 |
$26,406.25 |
| 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: ASR Commercial |
$39,406.25
|
| Rate for Payer: BCBS Trust/PPO |
$33,105.31
|
| Rate for Payer: BCN Commercial |
$31,496.56
|
| 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 |
$40,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$39,406.25
|
| 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: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35,750.00
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: Aetna Medicare |
$85.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCBS Trust/PPO |
$204.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.87
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$94.46
|
| Rate for Payer: PHP Medicaid |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$175.18
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$133.10
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP DNSP |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: Aetna Commercial |
$224.91
|
| Rate for Payer: ASR ASR |
$242.40
|
| Rate for Payer: ASR Commercial |
$242.40
|
| Rate for Payer: BCBS Trust/PPO |
$203.64
|
| Rate for Payer: BCN Commercial |
$193.75
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$234.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$249.90
|
| Rate for Payer: Healthscope Whirlpool |
$242.40
|
| Rate for Payer: Mclaren Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.91
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: ASR ASR |
$23.75
|
| Rate for Payer: ASR Commercial |
$23.75
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.05
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.88
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$26.27
|
| Rate for Payer: PHP Medicaid |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$17.16
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP DNSP |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: ASR ASR |
$23.75
|
| Rate for Payer: ASR Commercial |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$102.39 |
| Max. Negotiated Rate |
$157.52 |
| Rate for Payer: Aetna Commercial |
$141.77
|
| Rate for Payer: ASR ASR |
$152.79
|
| Rate for Payer: ASR Commercial |
$152.79
|
| Rate for Payer: BCBS Trust/PPO |
$128.36
|
| Rate for Payer: BCN Commercial |
$122.13
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$148.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$157.52
|
| Rate for Payer: Healthscope Whirlpool |
$152.79
|
| Rate for Payer: Mclaren Commercial |
$141.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: Nomi Health Commercial |
$129.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.62
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$63.01 |
| Max. Negotiated Rate |
$157.52 |
| Rate for Payer: Aetna Commercial |
$141.77
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: ASR ASR |
$152.79
|
| Rate for Payer: ASR Commercial |
$152.79
|
| Rate for Payer: BCBS Complete |
$63.01
|
| Rate for Payer: BCBS Trust/PPO |
$128.99
|
| Rate for Payer: BCN Commercial |
$122.13
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$148.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$157.52
|
| Rate for Payer: Healthscope Whirlpool |
$152.79
|
| Rate for Payer: Mclaren Commercial |
$141.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: Nomi Health Commercial |
$129.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.02
|
| Rate for Payer: Priority Health Narrow Network |
$110.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.62
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$1,779.91 |
| Rate for Payer: Aetna Commercial |
$1,601.92
|
| Rate for Payer: Aetna Medicare |
$1,040.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,300.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,300.40
|
| Rate for Payer: ASR ASR |
$1,726.51
|
| Rate for Payer: ASR Commercial |
$1,726.51
|
| Rate for Payer: BCBS Complete |
$585.49
|
| Rate for Payer: BCBS MAPPO |
$1,040.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.57
|
| Rate for Payer: BCN Commercial |
$1,379.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.32
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,673.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.32
|
| Rate for Payer: Healthscope Commercial |
$1,779.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,726.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,040.32
|
| Rate for Payer: Mclaren Commercial |
$1,601.92
|
| Rate for Payer: Mclaren Medicaid |
$557.61
|
| Rate for Payer: Mclaren Medicare |
$1,040.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.34
|
| Rate for Payer: Meridian Medicaid |
$585.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,196.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: Nomi Health Commercial |
$1,459.53
|
| Rate for Payer: PACE Medicare |
$988.30
|
| Rate for Payer: PACE SWMI |
$1,040.32
|
| Rate for Payer: PHP Commercial |
$1,144.35
|
| Rate for Payer: PHP Medicaid |
$557.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$557.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,559.56
|
| Rate for Payer: Priority Health Medicare |
$1,040.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,247.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,040.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.32
|
| Rate for Payer: UHC Exchange |
$1,612.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.32
|
| Rate for Payer: UHCCP DNSP |
$1,040.32
|
| Rate for Payer: UHCCP Medicaid |
$557.61
|
| Rate for Payer: VA VA |
$1,040.32
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,156.94 |
| Max. Negotiated Rate |
$1,779.91 |
| Rate for Payer: Aetna Commercial |
$1,601.92
|
| Rate for Payer: ASR ASR |
$1,726.51
|
| Rate for Payer: ASR Commercial |
$1,726.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,450.45
|
| Rate for Payer: BCN Commercial |
$1,379.96
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,673.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Healthscope Commercial |
$1,779.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,726.51
|
| Rate for Payer: Mclaren Commercial |
$1,601.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: Nomi Health Commercial |
$1,459.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,566.32
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$134.02 |
| Rate for Payer: Aetna Commercial |
$120.62
|
| Rate for Payer: ASR ASR |
$130.00
|
| Rate for Payer: ASR Commercial |
$130.00
|
| Rate for Payer: BCBS Trust/PPO |
$109.21
|
| Rate for Payer: BCN Commercial |
$103.91
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$125.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$134.02
|
| Rate for Payer: Healthscope Whirlpool |
$130.00
|
| Rate for Payer: Mclaren Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.94
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$134.02 |
| Rate for Payer: Aetna Commercial |
$120.62
|
| Rate for Payer: Aetna Medicare |
$67.01
|
| Rate for Payer: ASR ASR |
$130.00
|
| Rate for Payer: ASR Commercial |
$130.00
|
| Rate for Payer: BCBS Complete |
$53.61
|
| Rate for Payer: BCBS Trust/PPO |
$109.75
|
| Rate for Payer: BCN Commercial |
$103.91
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$125.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$134.02
|
| Rate for Payer: Healthscope Whirlpool |
$130.00
|
| Rate for Payer: Mclaren Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.43
|
| Rate for Payer: Priority Health Narrow Network |
$93.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.94
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna Commercial |
$123.88
|
| Rate for Payer: ASR ASR |
$133.51
|
| Rate for Payer: ASR Commercial |
$133.51
|
| Rate for Payer: BCBS Trust/PPO |
$112.16
|
| Rate for Payer: BCN Commercial |
$106.71
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$137.64
|
| Rate for Payer: Healthscope Whirlpool |
$133.51
|
| Rate for Payer: Mclaren Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.12
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Aetna Commercial |
$123.88
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: ASR ASR |
$133.51
|
| Rate for Payer: ASR Commercial |
$133.51
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: BCBS Trust/PPO |
$112.71
|
| Rate for Payer: BCN Commercial |
$106.71
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$129.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$137.64
|
| Rate for Payer: Healthscope Whirlpool |
$133.51
|
| Rate for Payer: Mclaren Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.60
|
| Rate for Payer: Priority Health Narrow Network |
$96.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.12
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$142.83 |
| Rate for Payer: Aetna Commercial |
$128.55
|
| Rate for Payer: Aetna Medicare |
$71.42
|
| Rate for Payer: ASR ASR |
$138.55
|
| Rate for Payer: ASR Commercial |
$138.55
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: BCBS Trust/PPO |
$116.96
|
| Rate for Payer: BCN Commercial |
$110.74
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$134.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$142.83
|
| Rate for Payer: Healthscope Whirlpool |
$138.55
|
| Rate for Payer: Mclaren Commercial |
$128.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.15
|
| Rate for Payer: Priority Health Narrow Network |
$100.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.69
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$142.83 |
| Rate for Payer: Aetna Commercial |
$128.55
|
| Rate for Payer: ASR ASR |
$138.55
|
| Rate for Payer: ASR Commercial |
$138.55
|
| Rate for Payer: BCBS Trust/PPO |
$116.39
|
| Rate for Payer: BCN Commercial |
$110.74
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$134.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$142.83
|
| Rate for Payer: Healthscope Whirlpool |
$138.55
|
| Rate for Payer: Mclaren Commercial |
$128.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.69
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$47.61 |
| Rate for Payer: Aetna Commercial |
$42.85
|
| Rate for Payer: ASR ASR |
$46.18
|
| Rate for Payer: ASR Commercial |
$46.18
|
| Rate for Payer: BCBS Trust/PPO |
$38.80
|
| Rate for Payer: BCN Commercial |
$36.91
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$44.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$47.61
|
| Rate for Payer: Healthscope Whirlpool |
$46.18
|
| Rate for Payer: Mclaren Commercial |
$42.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: Nomi Health Commercial |
$39.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.90
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$47.61 |
| Rate for Payer: Aetna Commercial |
$42.85
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: ASR ASR |
$46.18
|
| Rate for Payer: ASR Commercial |
$46.18
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| Rate for Payer: BCN Commercial |
$36.91
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$44.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$47.61
|
| Rate for Payer: Healthscope Whirlpool |
$46.18
|
| Rate for Payer: Mclaren Commercial |
$42.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: Nomi Health Commercial |
$39.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.72
|
| Rate for Payer: Priority Health Narrow Network |
$33.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.90
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$153.51 |
| Max. Negotiated Rate |
$236.17 |
| Rate for Payer: Aetna Commercial |
$212.55
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Trust/PPO |
$192.45
|
| Rate for Payer: BCN Commercial |
$183.10
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$222.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$236.17
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.83
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$94.47 |
| Max. Negotiated Rate |
$236.17 |
| Rate for Payer: Aetna Commercial |
$212.55
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Complete |
$94.47
|
| Rate for Payer: BCBS Trust/PPO |
$193.40
|
| Rate for Payer: BCN Commercial |
$183.10
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$222.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$236.17
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.93
|
| Rate for Payer: Priority Health Narrow Network |
$165.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.83
|
|
