|
HC NON OPEN HEART TEG
|
Facility
|
OP
|
$906.19
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$362.48 |
| Max. Negotiated Rate |
$815.57 |
| Rate for Payer: Aetna Commercial |
$770.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.02
|
| Rate for Payer: BCBS Complete |
$362.48
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cofinity Commercial |
$634.33
|
| Rate for Payer: Cofinity Commercial |
$779.32
|
| Rate for Payer: Healthscope Commercial |
$815.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.26
|
| Rate for Payer: PHP Commercial |
$770.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.33
|
| Rate for Payer: Priority Health SBD |
$570.90
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
IP
|
$351.90
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.70 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.74
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$246.33
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.12
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.33
|
| Rate for Payer: Priority Health SBD |
$221.70
|
|
|
HC NON-SELECTIVE DEBRIDEMENT
|
Facility
|
OP
|
$351.90
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
42000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.26 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.26
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$246.33
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.12
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$221.70
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
OP
|
$3,877.64
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.55 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,295.99
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,520.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cofinity Commercial |
$2,714.35
|
| Rate for Payer: Cofinity Commercial |
$3,334.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,489.88
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,295.99
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,295.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,714.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,442.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.70
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$191.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC NON-SELECTIVE THORACIC AORTA W ANGIO
|
Facility
|
IP
|
$3,877.64
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
36100376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,442.91 |
| Max. Negotiated Rate |
$3,489.88 |
| Rate for Payer: Aetna Commercial |
$3,295.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,520.47
|
| Rate for Payer: Cash Price |
$3,102.11
|
| Rate for Payer: Cofinity Commercial |
$2,714.35
|
| Rate for Payer: Cofinity Commercial |
$3,334.77
|
| Rate for Payer: Healthscope Commercial |
$3,489.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,295.99
|
| Rate for Payer: PHP Commercial |
$3,295.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,714.35
|
| Rate for Payer: Priority Health SBD |
$2,442.91
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$9,359.88
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.98 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$7,955.90
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,083.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,052.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$6,551.92
|
| Rate for Payer: Cofinity Commercial |
$8,049.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$8,423.89
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$7,955.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$5,896.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.58
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$315.98
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC NON-SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$9,359.88
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
36100380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,896.72 |
| Max. Negotiated Rate |
$8,423.89 |
| Rate for Payer: Aetna Commercial |
$7,955.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,083.92
|
| Rate for Payer: Cash Price |
$7,487.90
|
| Rate for Payer: Cofinity Commercial |
$6,551.92
|
| Rate for Payer: Cofinity Commercial |
$8,049.50
|
| Rate for Payer: Healthscope Commercial |
$8,423.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,955.90
|
| Rate for Payer: PHP Commercial |
$7,955.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,551.92
|
| Rate for Payer: Priority Health SBD |
$5,896.72
|
|
|
HC NONSTRESS TEST
|
Facility
|
IP
|
$320.40
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$201.85 |
| Max. Negotiated Rate |
$288.36 |
| Rate for Payer: Aetna Commercial |
$272.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.26
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cofinity Commercial |
$224.28
|
| Rate for Payer: Cofinity Commercial |
$275.54
|
| Rate for Payer: Healthscope Commercial |
$288.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.34
|
| Rate for Payer: PHP Commercial |
$272.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.28
|
| Rate for Payer: Priority Health SBD |
$201.85
|
|
|
HC NONSTRESS TEST
|
Facility
|
OP
|
$320.40
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
92000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$48.46 |
| Max. Negotiated Rate |
$288.36 |
| Rate for Payer: Aetna Commercial |
$272.34
|
| Rate for Payer: Aetna Medicare |
$184.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.64
|
| Rate for Payer: BCBS Complete |
$101.85
|
| Rate for Payer: BCBS MAPPO |
$177.31
|
| Rate for Payer: BCBS Trust/PPO |
$111.35
|
| Rate for Payer: BCN Medicare Advantage |
$177.31
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cash Price |
$256.32
|
| Rate for Payer: Cofinity Commercial |
$224.28
|
| Rate for Payer: Cofinity Commercial |
$275.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.31
|
| Rate for Payer: Healthscope Commercial |
$288.36
|
| Rate for Payer: Mclaren Medicaid |
$96.99
|
| Rate for Payer: Mclaren Medicare |
$177.31
|
| Rate for Payer: Meridian Medicaid |
$101.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.34
|
| Rate for Payer: PACE Medicare |
$168.44
|
| Rate for Payer: PACE SWMI |
$177.31
|
| Rate for Payer: PHP Commercial |
$272.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.28
|
| Rate for Payer: Priority Health Medicare |
$177.31
|
| Rate for Payer: Priority Health SBD |
$201.85
|
| Rate for Payer: Railroad Medicare Medicare |
$177.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.31
|
| Rate for Payer: UHC Exchange |
$48.46
|
| Rate for Payer: UHC Medicare Advantage |
$182.63
|
| Rate for Payer: VA VA |
$177.31
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
IP
|
$3,247.14
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,045.70 |
| Max. Negotiated Rate |
$2,922.43 |
| Rate for Payer: Aetna Commercial |
$2,760.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,110.64
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cofinity Commercial |
$2,273.00
|
| Rate for Payer: Cofinity Commercial |
$2,792.54
|
| Rate for Payer: Healthscope Commercial |
$2,922.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,760.07
|
| Rate for Payer: PHP Commercial |
$2,760.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.00
|
| Rate for Payer: Priority Health SBD |
$2,045.70
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL EA ADDL VASCULAR TERRITORY
|
Facility
|
OP
|
$3,247.14
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
36100515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.62 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$2,760.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,110.64
|
| Rate for Payer: BCBS Complete |
$1,298.86
|
| Rate for Payer: BCBS Trust/PPO |
$778.62
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cash Price |
$2,597.71
|
| Rate for Payer: Cofinity Commercial |
$2,792.54
|
| Rate for Payer: Cofinity Commercial |
$2,273.00
|
| Rate for Payer: Healthscope Commercial |
$2,922.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,760.07
|
| Rate for Payer: PHP Commercial |
$2,760.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,273.00
|
| Rate for Payer: Priority Health SBD |
$2,045.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.98
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$243.62
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
OP
|
$4,427.92
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.40 |
| Max. Negotiated Rate |
$3,985.13 |
| Rate for Payer: Aetna Commercial |
$3,763.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,878.15
|
| Rate for Payer: BCBS Complete |
$1,771.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,831.30
|
| Rate for Payer: Cash Price |
$3,542.34
|
| Rate for Payer: Cash Price |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$3,099.54
|
| Rate for Payer: Cofinity Commercial |
$3,808.01
|
| Rate for Payer: Healthscope Commercial |
$3,985.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,763.73
|
| Rate for Payer: PHP Commercial |
$3,763.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,099.54
|
| Rate for Payer: Priority Health SBD |
$2,789.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.44
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$570.40
|
|
|
HC NON THROMBOLYTIC INTRACRANIAL INITIAL VASCULAR TERRITORY
|
Facility
|
IP
|
$4,427.92
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
36100514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,789.59 |
| Max. Negotiated Rate |
$3,985.13 |
| Rate for Payer: Aetna Commercial |
$3,763.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,878.15
|
| Rate for Payer: Cash Price |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$3,099.54
|
| Rate for Payer: Cofinity Commercial |
$3,808.01
|
| Rate for Payer: Healthscope Commercial |
$3,985.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,763.73
|
| Rate for Payer: PHP Commercial |
$3,763.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,099.54
|
| Rate for Payer: Priority Health SBD |
$2,789.59
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
HC NORTRIPTYLINE LVL
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$27.09
|
| Rate for Payer: UHC Core |
$29.23
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
OP
|
$406.40
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.16
|
| Rate for Payer: BCBS Complete |
$162.56
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$284.48
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health SBD |
$256.03
|
|
|
HC NOSEBLEED/ENT
|
Facility
|
IP
|
$406.40
|
|
| Hospital Charge Code |
45000061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.03 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Aetna Commercial |
$345.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.16
|
| Rate for Payer: Cash Price |
$325.12
|
| Rate for Payer: Cofinity Commercial |
$284.48
|
| Rate for Payer: Cofinity Commercial |
$349.50
|
| Rate for Payer: Healthscope Commercial |
$365.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.44
|
| Rate for Payer: PHP Commercial |
$345.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.48
|
| Rate for Payer: Priority Health SBD |
$256.03
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
OP
|
$929.67
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$836.70 |
| Rate for Payer: Aetna Commercial |
$790.22
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$161.18
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$743.74
|
| Rate for Payer: Cash Price |
$743.74
|
| Rate for Payer: Cofinity Commercial |
$799.52
|
| Rate for Payer: Cofinity Commercial |
$650.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$836.70
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$790.22
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$790.22
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$585.69
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC NUC MED STRESS TEST
|
Facility
|
IP
|
$929.67
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200005
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$585.69 |
| Max. Negotiated Rate |
$836.70 |
| Rate for Payer: Aetna Commercial |
$790.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.29
|
| Rate for Payer: Cash Price |
$743.74
|
| Rate for Payer: Cofinity Commercial |
$650.77
|
| Rate for Payer: Cofinity Commercial |
$799.52
|
| Rate for Payer: Healthscope Commercial |
$836.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$790.22
|
| Rate for Payer: PHP Commercial |
$790.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.77
|
| Rate for Payer: Priority Health SBD |
$585.69
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
OP
|
$211.74
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$620.74 |
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$84.74
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Cofinity Commercial |
$148.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.98
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Commercial |
$179.98
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.74
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$496.59
|
| Rate for Payer: Priority Health SBD |
$133.40
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Exchange |
$79.24
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
HC NURSEMAID ELBOW REDUCTION
|
Facility
|
IP
|
$211.74
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
45000008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$190.57 |
| Rate for Payer: Aetna Commercial |
$179.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.63
|
| Rate for Payer: Cash Price |
$169.39
|
| Rate for Payer: Cofinity Commercial |
$148.22
|
| Rate for Payer: Cofinity Commercial |
$182.10
|
| Rate for Payer: Healthscope Commercial |
$190.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.98
|
| Rate for Payer: PHP Commercial |
$179.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.22
|
| Rate for Payer: Priority Health SBD |
$133.40
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$604.35
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$241.74 |
| Max. Negotiated Rate |
$543.92 |
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.83
|
| Rate for Payer: BCBS Complete |
$241.74
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$423.04
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.70
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.04
|
| Rate for Payer: Priority Health SBD |
$380.74
|
|
|
HC NUSHIELD (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
IP
|
$604.35
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
63600153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.74 |
| Max. Negotiated Rate |
$543.92 |
| Rate for Payer: Aetna Commercial |
$513.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.83
|
| Rate for Payer: Cash Price |
$483.48
|
| Rate for Payer: Cofinity Commercial |
$423.04
|
| Rate for Payer: Cofinity Commercial |
$519.74
|
| Rate for Payer: Healthscope Commercial |
$543.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.70
|
| Rate for Payer: PHP Commercial |
$513.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.04
|
| Rate for Payer: Priority Health SBD |
$380.74
|
|
