|
HC ANGIOPLASTY INITIAL ARTERY WITH IMAGING
|
Facility
|
IP
|
$6,509.34
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
36100534
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,100.88 |
| Max. Negotiated Rate |
$5,858.41 |
| Rate for Payer: Aetna Commercial |
$5,532.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,231.07
|
| Rate for Payer: Cash Price |
$5,207.47
|
| Rate for Payer: Cofinity Commercial |
$4,556.54
|
| Rate for Payer: Cofinity Commercial |
$5,598.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,556.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,207.47
|
| Rate for Payer: Healthscope Commercial |
$5,858.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,532.94
|
| Rate for Payer: PHP Commercial |
$5,532.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.07
|
| Rate for Payer: Priority Health SBD |
$4,100.88
|
|
|
HC ANGIOPLASTY INITIAL VEIN WITH IMAGING
|
Facility
|
OP
|
$6,509.34
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
36100536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.65 |
| Max. Negotiated Rate |
$17,557.45 |
| Rate for Payer: Aetna Commercial |
$5,532.94
|
| Rate for Payer: Aetna Medicare |
$5,809.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,231.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,604.12
|
| Rate for Payer: BCN Commercial |
$4,604.12
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Cash Price |
$5,207.47
|
| Rate for Payer: Cash Price |
$5,207.47
|
| Rate for Payer: Cash Price |
$5,207.47
|
| Rate for Payer: Cofinity Commercial |
$4,556.54
|
| Rate for Payer: Cofinity Commercial |
$5,598.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,556.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,207.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Healthscope Commercial |
$5,858.41
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,532.94
|
| Rate for Payer: Nomi Health Commercial |
$11,731.10
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Commercial |
$5,532.94
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,557.45
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$14,045.96
|
| Rate for Payer: Priority Health SBD |
$4,100.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.65
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$3,145.05
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
HC ANGIOPLASTY INITIAL VEIN WITH IMAGING
|
Facility
|
IP
|
$6,509.34
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
36100536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,100.88 |
| Max. Negotiated Rate |
$5,858.41 |
| Rate for Payer: Aetna Commercial |
$5,532.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,231.07
|
| Rate for Payer: Cash Price |
$5,207.47
|
| Rate for Payer: Cofinity Commercial |
$4,556.54
|
| Rate for Payer: Cofinity Commercial |
$5,598.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,556.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,207.47
|
| Rate for Payer: Healthscope Commercial |
$5,858.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,532.94
|
| Rate for Payer: PHP Commercial |
$5,532.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.07
|
| Rate for Payer: Priority Health SBD |
$4,100.88
|
|
|
HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL DIFF FAM
|
Facility
|
OP
|
$1,011.36
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
36100277
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.54 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Commercial |
$859.66
|
| Rate for Payer: Aetna Medicare |
$505.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.38
|
| Rate for Payer: BCBS Complete |
$404.54
|
| Rate for Payer: Cash Price |
$809.09
|
| Rate for Payer: Cash Price |
$809.09
|
| Rate for Payer: Cofinity Commercial |
$707.95
|
| Rate for Payer: Cofinity Commercial |
$869.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.09
|
| Rate for Payer: Healthscope Commercial |
$910.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.66
|
| Rate for Payer: PHP Commercial |
$859.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.38
|
| Rate for Payer: Priority Health SBD |
$637.16
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
|
|
HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL DIFF FAM
|
Facility
|
IP
|
$1,011.36
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
36100277
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.16 |
| Max. Negotiated Rate |
$910.22 |
| Rate for Payer: Aetna Commercial |
$859.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.38
|
| Rate for Payer: Cash Price |
$809.09
|
| Rate for Payer: Cofinity Commercial |
$707.95
|
| Rate for Payer: Cofinity Commercial |
$869.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.09
|
| Rate for Payer: Healthscope Commercial |
$910.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.66
|
| Rate for Payer: PHP Commercial |
$859.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.38
|
| Rate for Payer: Priority Health SBD |
$637.16
|
|
|
HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL SAME FAM
|
Facility
|
OP
|
$1,011.36
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
36100276
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.54 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Commercial |
$859.66
|
| Rate for Payer: Aetna Medicare |
$505.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.38
|
| Rate for Payer: BCBS Complete |
$404.54
|
| Rate for Payer: Cash Price |
$809.09
|
| Rate for Payer: Cash Price |
$809.09
|
| Rate for Payer: Cofinity Commercial |
$707.95
|
| Rate for Payer: Cofinity Commercial |
$869.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.09
|
| Rate for Payer: Healthscope Commercial |
$910.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.66
|
| Rate for Payer: PHP Commercial |
$859.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.38
|
| Rate for Payer: Priority Health SBD |
$637.16
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
|
|
HC ANGIOPLASTY INTRACR VASOSPASM EACH ADDL SAME FAM
|
Facility
|
IP
|
$1,011.36
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
36100276
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.16 |
| Max. Negotiated Rate |
$910.22 |
| Rate for Payer: Aetna Commercial |
$859.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.38
|
| Rate for Payer: Cash Price |
$809.09
|
| Rate for Payer: Cofinity Commercial |
$707.95
|
| Rate for Payer: Cofinity Commercial |
$869.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.09
|
| Rate for Payer: Healthscope Commercial |
$910.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.66
|
| Rate for Payer: PHP Commercial |
$859.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.38
|
| Rate for Payer: Priority Health SBD |
$637.16
|
|
|
HC ANGIO ROOM TIME W/FLUORO 1 HOU
|
Facility
|
IP
|
$1,865.63
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,175.35 |
| Max. Negotiated Rate |
$1,679.07 |
| Rate for Payer: Aetna Commercial |
$1,585.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.66
|
| Rate for Payer: Cash Price |
$1,492.50
|
| Rate for Payer: Cofinity Commercial |
$1,305.94
|
| Rate for Payer: Cofinity Commercial |
$1,604.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,305.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,492.50
|
| Rate for Payer: Healthscope Commercial |
$1,679.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,585.79
|
| Rate for Payer: PHP Commercial |
$1,585.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,212.66
|
| Rate for Payer: Priority Health SBD |
$1,175.35
|
|
|
HC ANGIO ROOM TIME W/FLUORO 1 HOU
|
Facility
|
OP
|
$1,865.63
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
32000232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$1,679.07 |
| Rate for Payer: Aetna Commercial |
$1,585.79
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$1,492.50
|
| Rate for Payer: Cash Price |
$1,492.50
|
| Rate for Payer: Cofinity Commercial |
$1,604.44
|
| Rate for Payer: Cofinity Commercial |
$1,305.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,305.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,492.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$1,679.07
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,585.79
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$1,585.79
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,212.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$1,175.35
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$1,380.57
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC ANGIOTENSIN-1 CONVERTING ENZYME
|
Facility
|
OP
|
$108.12
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$1,614.37 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.92
|
| Rate for Payer: BCN Commercial |
$12.92
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$75.68
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: Meridian Medicaid |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$21.90
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.60
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$11.68
|
| Rate for Payer: Priority Health SBD |
$68.12
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$1,614.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.60
|
| Rate for Payer: UHC Exchange |
$1,614.37
|
| Rate for Payer: UHC Medicare Advantage |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$8.22
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC ANGIOTENSIN-1 CONVERTING ENZYME
|
Facility
|
IP
|
$108.12
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.28
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$75.68
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health SBD |
$68.12
|
|
|
HC ANGIOTENSIN CONVERTING ENZYME LEVEL
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$1,614.37 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.92
|
| Rate for Payer: BCN Commercial |
$12.92
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: Meridian Medicaid |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$21.90
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.60
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health Narrow Network |
$11.68
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$1,614.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.60
|
| Rate for Payer: UHC Exchange |
$1,614.37
|
| Rate for Payer: UHC Medicare Advantage |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$8.22
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC ANGIOTENSIN CONVERTING ENZYME LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
30100104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC ANGIOTENSIN II
|
Facility
|
IP
|
$331.50
|
|
|
Service Code
|
CPT 82163
|
| Hospital Charge Code |
30100103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$208.84 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.48
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$232.05
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health SBD |
$208.84
|
|
|
HC ANGIOTENSIN II
|
Facility
|
OP
|
$331.50
|
|
|
Service Code
|
CPT 82163
|
| Hospital Charge Code |
30100103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna Commercial |
$281.78
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.65
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: BCBS MAPPO |
$20.52
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: BCN Medicare Advantage |
$20.52
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cofinity Commercial |
$232.05
|
| Rate for Payer: Cofinity Commercial |
$285.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.52
|
| Rate for Payer: Healthscope Commercial |
$298.35
|
| Rate for Payer: Mclaren Medicaid |
$11.00
|
| Rate for Payer: Mclaren Medicare |
$20.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.55
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.78
|
| Rate for Payer: Nomi Health Commercial |
$30.78
|
| Rate for Payer: PACE Medicare |
$19.49
|
| Rate for Payer: PACE SWMI |
$20.52
|
| Rate for Payer: PHP Commercial |
$281.78
|
| Rate for Payer: PHP Medicare Advantage |
$20.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.11
|
| Rate for Payer: Priority Health Medicare |
$20.52
|
| Rate for Payer: Priority Health Narrow Network |
$16.89
|
| Rate for Payer: Priority Health SBD |
$208.84
|
| Rate for Payer: Railroad Medicare Medicare |
$20.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.62
|
| Rate for Payer: UHC Core |
$1,435.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.52
|
| Rate for Payer: UHC Exchange |
$1,435.00
|
| Rate for Payer: UHC Medicare Advantage |
$20.52
|
| Rate for Payer: UHCCP Medicaid |
$11.55
|
| Rate for Payer: VA VA |
$20.52
|
|
|
HC ANGLE TOLERANCE TEST 60 MINUTES
|
Facility
|
IP
|
$66.79
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$60.11 |
| Rate for Payer: Aetna Commercial |
$56.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Healthscope Commercial |
$60.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.77
|
| Rate for Payer: PHP Commercial |
$56.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: Priority Health SBD |
$42.08
|
|
|
HC ANGLE TOLERANCE TEST 60 MINUTES
|
Facility
|
OP
|
$66.79
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$160.94 |
| Rate for Payer: Aetna Commercial |
$56.77
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$160.94
|
| Rate for Payer: BCN Commercial |
$160.94
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$60.11
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.77
|
| Rate for Payer: Nomi Health Commercial |
$115.38
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$56.77
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.87
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$96.70
|
| Rate for Payer: Priority Health SBD |
$42.08
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$21.65
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC ANGLE TOLERANCE TEST EACH ADDL 30 MIN
|
Facility
|
IP
|
$33.41
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
51000088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Aetna Commercial |
$28.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.72
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$23.39
|
| Rate for Payer: Cofinity Commercial |
$28.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.73
|
| Rate for Payer: Healthscope Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.40
|
| Rate for Payer: PHP Commercial |
$28.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.72
|
| Rate for Payer: Priority Health SBD |
$21.05
|
|
|
HC ANGLE TOLERANCE TEST EACH ADDL 30 MIN
|
Facility
|
OP
|
$33.41
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
51000088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$28.40
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.72
|
| Rate for Payer: BCBS Complete |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$67.93
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$23.39
|
| Rate for Payer: Cofinity Commercial |
$28.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.73
|
| Rate for Payer: Healthscope Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.40
|
| Rate for Payer: PHP Commercial |
$28.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.72
|
| Rate for Payer: Priority Health SBD |
$21.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.51
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health SBD |
$321.30
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$454.80
|
| Rate for Payer: BCN Commercial |
$454.80
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Priority Health SBD |
$321.30
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$110.97
|
| Rate for Payer: VA VA |
$197.10
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
OP
|
$1,040.62
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.25 |
| Max. Negotiated Rate |
$936.56 |
| Rate for Payer: Aetna Commercial |
$884.53
|
| Rate for Payer: Aetna Medicare |
$520.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.40
|
| Rate for Payer: BCBS Complete |
$416.25
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cofinity Commercial |
$728.43
|
| Rate for Payer: Cofinity Commercial |
$894.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.50
|
| Rate for Payer: Healthscope Commercial |
$936.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.53
|
| Rate for Payer: PHP Commercial |
$884.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.40
|
| Rate for Payer: Priority Health SBD |
$655.59
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
IP
|
$1,040.62
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$655.59 |
| Max. Negotiated Rate |
$936.56 |
| Rate for Payer: Aetna Commercial |
$884.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.40
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cofinity Commercial |
$728.43
|
| Rate for Payer: Cofinity Commercial |
$894.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.50
|
| Rate for Payer: Healthscope Commercial |
$936.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.53
|
| Rate for Payer: PHP Commercial |
$884.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.40
|
| Rate for Payer: Priority Health SBD |
$655.59
|
|
|
HC ANOSCOPY
|
Facility
|
IP
|
$162.92
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$146.63 |
| Rate for Payer: Aetna Commercial |
$138.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Cofinity Commercial |
$140.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.34
|
| Rate for Payer: Healthscope Commercial |
$146.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.48
|
| Rate for Payer: PHP Commercial |
$138.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.90
|
| Rate for Payer: Priority Health SBD |
$102.64
|
|
|
HC ANOSCOPY
|
Facility
|
OP
|
$162.92
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$146.63 |
| Rate for Payer: Aetna Commercial |
$138.48
|
| Rate for Payer: Aetna Medicare |
$81.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: BCBS Complete |
$65.17
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Cofinity Commercial |
$140.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.34
|
| Rate for Payer: Healthscope Commercial |
$146.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.48
|
| Rate for Payer: PHP Commercial |
$138.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.90
|
| Rate for Payer: Priority Health SBD |
$102.64
|
|
