|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$228.89
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$194.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.78
|
| Rate for Payer: Cash Price |
$183.11
|
| Rate for Payer: Cofinity Advantage |
$160.22
|
| Rate for Payer: Cofinity Commercial |
$196.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.11
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.67
|
| Rate for Payer: PHP Commercial |
$194.56
|
| Rate for Payer: Priority Health SBD |
$144.20
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$228.89
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.95 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$194.56
|
| Rate for Payer: Aetna Medicare |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.78
|
| Rate for Payer: BCBS Complete |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$146.51
|
| Rate for Payer: BCN Commercial |
$146.51
|
| Rate for Payer: Cash Price |
$183.11
|
| Rate for Payer: Cash Price |
$183.11
|
| Rate for Payer: Cofinity Advantage |
$160.22
|
| Rate for Payer: Cofinity Commercial |
$196.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.11
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.67
|
| Rate for Payer: PHP Commercial |
$194.56
|
| Rate for Payer: Priority Health SBD |
$144.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.78
|
| Rate for Payer: UHC Core |
$119.25
|
| Rate for Payer: UHC Exchange |
$89.95
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,458.59
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,312.73 |
| Rate for Payer: Aetna Commercial |
$1,239.80
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$212.37
|
| Rate for Payer: BCN Commercial |
$212.37
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,166.87
|
| Rate for Payer: Cash Price |
$1,166.87
|
| Rate for Payer: Cofinity Advantage |
$1,021.01
|
| Rate for Payer: Cofinity Commercial |
$1,254.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,312.73
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.80
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.94
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$1,239.80
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$918.91
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$948.08
|
| Rate for Payer: UHC Core |
$759.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$573.23
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,458.59
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$918.91 |
| Max. Negotiated Rate |
$1,312.73 |
| Rate for Payer: Aetna Commercial |
$1,239.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.08
|
| Rate for Payer: Cash Price |
$1,166.87
|
| Rate for Payer: Cofinity Advantage |
$1,021.01
|
| Rate for Payer: Cofinity Commercial |
$1,254.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.87
|
| Rate for Payer: Healthscope Commercial |
$1,312.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.94
|
| Rate for Payer: PHP Commercial |
$1,239.80
|
| Rate for Payer: Priority Health SBD |
$918.91
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$504.95
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$429.21
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$60.20
|
| Rate for Payer: BCN Commercial |
$60.20
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$403.96
|
| Rate for Payer: Cash Price |
$403.96
|
| Rate for Payer: Cofinity Advantage |
$353.46
|
| Rate for Payer: Cofinity Commercial |
$434.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$454.45
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.21
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.71
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$429.21
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$318.12
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.22
|
| Rate for Payer: UHC Core |
$263.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$198.45
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$504.95
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$318.12 |
| Max. Negotiated Rate |
$454.45 |
| Rate for Payer: Aetna Commercial |
$429.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.22
|
| Rate for Payer: Cash Price |
$403.96
|
| Rate for Payer: Cofinity Advantage |
$353.46
|
| Rate for Payer: Cofinity Commercial |
$434.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.96
|
| Rate for Payer: Healthscope Commercial |
$454.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.71
|
| Rate for Payer: PHP Commercial |
$429.21
|
| Rate for Payer: Priority Health SBD |
$318.12
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$16.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.49
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS MAPPO |
$15.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$16.62
|
| Rate for Payer: BCN Medicare Advantage |
$15.59
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Advantage |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Mclaren Medicaid |
$8.15
|
| Rate for Payer: Mclaren Medicare |
$15.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$16.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$23.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: PACE Medicare |
$14.81
|
| Rate for Payer: PACE SWMI |
$15.59
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: PHP Medicare Advantage |
$15.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.59
|
| Rate for Payer: Priority Health Medicare |
$15.59
|
| Rate for Payer: Priority Health SBD |
$47.19
|
| Rate for Payer: Priority Health Tiered Network |
$12.47
|
| Rate for Payer: Railroad Medicare Medicare |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.39
|
| Rate for Payer: UHC Core |
$23.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.59
|
| Rate for Payer: UHC Exchange |
$23.39
|
| Rate for Payer: UHC Medicaid |
$8.15
|
| Rate for Payer: UHCCP Medicaid |
$8.15
|
| Rate for Payer: VA VA |
$15.59
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$74.91
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Advantage |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health SBD |
$47.19
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$32.09
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: Priority Health SBD |
$32.09
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$184.55
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$156.87
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$147.64
|
| Rate for Payer: Cash Price |
$147.64
|
| Rate for Payer: Cofinity Advantage |
$129.19
|
| Rate for Payer: Cofinity Commercial |
$158.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$166.09
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.87
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.41
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$156.87
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$116.27
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.96
|
| Rate for Payer: UHC Core |
$96.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$72.53
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$184.55
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.27 |
| Max. Negotiated Rate |
$166.09 |
| Rate for Payer: Aetna Commercial |
$156.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.96
|
| Rate for Payer: Cash Price |
$147.64
|
| Rate for Payer: Cofinity Advantage |
$129.19
|
| Rate for Payer: Cofinity Commercial |
$158.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.64
|
| Rate for Payer: Healthscope Commercial |
$166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.41
|
| Rate for Payer: PHP Commercial |
$156.87
|
| Rate for Payer: Priority Health SBD |
$116.27
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$591.27
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$372.50 |
| Max. Negotiated Rate |
$532.14 |
| Rate for Payer: Aetna Commercial |
$502.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.33
|
| Rate for Payer: Cash Price |
$473.02
|
| Rate for Payer: Cofinity Advantage |
$413.89
|
| Rate for Payer: Cofinity Commercial |
$508.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.02
|
| Rate for Payer: Healthscope Commercial |
$532.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.45
|
| Rate for Payer: PHP Commercial |
$502.58
|
| Rate for Payer: Priority Health SBD |
$372.50
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$591.27
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Commercial |
$502.58
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$191.87
|
| Rate for Payer: BCN Commercial |
$191.87
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$473.02
|
| Rate for Payer: Cash Price |
$473.02
|
| Rate for Payer: Cash Price |
$473.02
|
| Rate for Payer: Cofinity Advantage |
$413.89
|
| Rate for Payer: Cofinity Commercial |
$508.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$532.14
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$502.58
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.45
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$502.58
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$372.50
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.33
|
| Rate for Payer: UHC Core |
$308.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$232.37
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$161.26
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$145.13 |
| Rate for Payer: Aetna Commercial |
$137.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.82
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Advantage |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Healthscope Commercial |
$145.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PHP Commercial |
$137.07
|
| Rate for Payer: Priority Health SBD |
$101.59
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$161.26
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.73 |
| Max. Negotiated Rate |
$145.13 |
| Rate for Payer: Aetna Commercial |
$137.07
|
| Rate for Payer: Aetna Medicare |
$80.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.82
|
| Rate for Payer: BCBS Complete |
$64.50
|
| Rate for Payer: BCBS Trust/PPO |
$57.73
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Advantage |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Healthscope Commercial |
$145.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PHP Commercial |
$137.07
|
| Rate for Payer: Priority Health SBD |
$101.59
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$129.47
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$110.05
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$103.58
|
| Rate for Payer: Cash Price |
$103.58
|
| Rate for Payer: Cofinity Advantage |
$90.63
|
| Rate for Payer: Cofinity Commercial |
$111.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$116.52
|
| Rate for Payer: Mclaren Medicaid |
$52.94
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.05
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.10
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$110.05
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$81.57
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.16
|
| Rate for Payer: UHC Core |
$67.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$50.88
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$129.47
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$116.52 |
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.58
|
| Rate for Payer: Aetna Commercial |
$110.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.16
|
| Rate for Payer: Cash Price |
$103.58
|
| Rate for Payer: Cofinity Advantage |
$90.63
|
| Rate for Payer: Cofinity Commercial |
$111.34
|
| Rate for Payer: Healthscope Commercial |
$116.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.10
|
| Rate for Payer: PHP Commercial |
$110.05
|
| Rate for Payer: Priority Health SBD |
$81.57
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$983.76
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.77 |
| Max. Negotiated Rate |
$885.38 |
| Rate for Payer: Aetna Commercial |
$836.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.44
|
| Rate for Payer: Cash Price |
$787.01
|
| Rate for Payer: Cofinity Advantage |
$688.63
|
| Rate for Payer: Cofinity Commercial |
$846.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.01
|
| Rate for Payer: Healthscope Commercial |
$885.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$737.82
|
| Rate for Payer: PHP Commercial |
$836.20
|
| Rate for Payer: Priority Health SBD |
$619.77
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$983.76
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.58 |
| Max. Negotiated Rate |
$885.38 |
| Rate for Payer: Aetna Commercial |
$836.20
|
| Rate for Payer: Aetna Medicare |
$491.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.44
|
| Rate for Payer: BCBS Complete |
$393.50
|
| Rate for Payer: BCBS Trust/PPO |
$357.58
|
| Rate for Payer: BCN Commercial |
$357.58
|
| Rate for Payer: Cash Price |
$787.01
|
| Rate for Payer: Cash Price |
$787.01
|
| Rate for Payer: Cofinity Advantage |
$688.63
|
| Rate for Payer: Cofinity Commercial |
$846.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.01
|
| Rate for Payer: Healthscope Commercial |
$885.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$787.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$737.82
|
| Rate for Payer: PHP Commercial |
$836.20
|
| Rate for Payer: Priority Health SBD |
$619.77
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
OP
|
$1,292.55
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,098.67
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$510.60
|
| Rate for Payer: BCN Commercial |
$510.60
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,034.04
|
| Rate for Payer: Cash Price |
$1,034.04
|
| Rate for Payer: Cash Price |
$1,034.04
|
| Rate for Payer: Cofinity Advantage |
$904.78
|
| Rate for Payer: Cofinity Commercial |
$1,111.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,163.30
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,098.67
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.41
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,098.67
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$814.31
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,292.55
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.31 |
| Max. Negotiated Rate |
$1,163.30 |
| Rate for Payer: Aetna Commercial |
$1,098.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.16
|
| Rate for Payer: Cash Price |
$1,034.04
|
| Rate for Payer: Cofinity Advantage |
$904.78
|
| Rate for Payer: Cofinity Commercial |
$1,111.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.04
|
| Rate for Payer: Healthscope Commercial |
$1,163.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,098.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.41
|
| Rate for Payer: PHP Commercial |
$1,098.67
|
| Rate for Payer: Priority Health SBD |
$814.31
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
IP
|
$1,892.32
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,192.16 |
| Max. Negotiated Rate |
$1,703.09 |
| Rate for Payer: Aetna Commercial |
$1,608.47
|
| Rate for Payer: Aetna Commercial |
$2,412.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,845.02
|
| Rate for Payer: Cash Price |
$1,513.86
|
| Rate for Payer: Cash Price |
$2,270.79
|
| Rate for Payer: Cofinity Advantage |
$1,324.62
|
| Rate for Payer: Cofinity Advantage |
$1,986.94
|
| Rate for Payer: Cofinity Commercial |
$1,627.40
|
| Rate for Payer: Cofinity Commercial |
$2,441.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,513.86
|
| Rate for Payer: Healthscope Commercial |
$2,554.64
|
| Rate for Payer: Healthscope Commercial |
$1,703.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,608.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,419.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,128.87
|
| Rate for Payer: PHP Commercial |
$1,608.47
|
| Rate for Payer: PHP Commercial |
$2,412.72
|
| Rate for Payer: Priority Health SBD |
$1,192.16
|
| Rate for Payer: Priority Health SBD |
$1,788.25
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
OP
|
$1,892.32
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,608.47
|
| Rate for Payer: Aetna Commercial |
$2,412.72
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,845.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$650.99
|
| Rate for Payer: BCBS Trust/PPO |
$650.99
|
| Rate for Payer: BCN Commercial |
$650.99
|
| Rate for Payer: BCN Commercial |
$650.99
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,513.86
|
| Rate for Payer: Cash Price |
$1,513.86
|
| Rate for Payer: Cash Price |
$1,513.86
|
| Rate for Payer: Cash Price |
$2,270.79
|
| Rate for Payer: Cash Price |
$2,270.79
|
| Rate for Payer: Cash Price |
$2,270.79
|
| Rate for Payer: Cofinity Advantage |
$1,324.62
|
| Rate for Payer: Cofinity Advantage |
$1,986.94
|
| Rate for Payer: Cofinity Commercial |
$1,627.40
|
| Rate for Payer: Cofinity Commercial |
$2,441.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,513.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,703.09
|
| Rate for Payer: Healthscope Commercial |
$2,554.64
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,608.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.72
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,128.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,419.24
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,608.47
|
| Rate for Payer: PHP Commercial |
$2,412.72
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$1,192.16
|
| Rate for Payer: Priority Health SBD |
$1,788.25
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,292.55
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.31 |
| Max. Negotiated Rate |
$1,163.30 |
| Rate for Payer: Aetna Commercial |
$1,098.67
|
| Rate for Payer: Aetna Commercial |
$1,648.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.25
|
| Rate for Payer: Cash Price |
$1,034.04
|
| Rate for Payer: Cash Price |
$1,551.07
|
| Rate for Payer: Cofinity Advantage |
$904.78
|
| Rate for Payer: Cofinity Advantage |
$1,357.19
|
| Rate for Payer: Cofinity Commercial |
$1,111.59
|
| Rate for Payer: Cofinity Commercial |
$1,667.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.04
|
| Rate for Payer: Healthscope Commercial |
$1,744.96
|
| Rate for Payer: Healthscope Commercial |
$1,163.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,098.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.13
|
| Rate for Payer: PHP Commercial |
$1,098.67
|
| Rate for Payer: PHP Commercial |
$1,648.01
|
| Rate for Payer: Priority Health SBD |
$814.31
|
| Rate for Payer: Priority Health SBD |
$1,221.47
|
|
