|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.80
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.20
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.40
|
| Rate for Payer: Priority Health SBD |
$335.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.04
|
| Rate for Payer: UHC Exchange |
$73.67
|
|
|
HC PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
IP
|
$85.25
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$53.71 |
| Max. Negotiated Rate |
$76.72 |
| Rate for Payer: Aetna Commercial |
$72.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.41
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cofinity Commercial |
$59.68
|
| Rate for Payer: Cofinity Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$76.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.46
|
| Rate for Payer: PHP Commercial |
$72.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.68
|
| Rate for Payer: Priority Health SBD |
$53.71
|
|
|
HC PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
OP
|
$85.25
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$53.71 |
| Max. Negotiated Rate |
$416.61 |
| Rate for Payer: Aetna Commercial |
$72.46
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cofinity Commercial |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$59.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$76.72
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.46
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$72.46
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.61
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow Network |
$333.29
|
| Rate for Payer: Priority Health SBD |
$53.71
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$67.13
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
IP
|
$153.05
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Aetna Commercial |
$130.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.48
|
| Rate for Payer: Cash Price |
$122.44
|
| Rate for Payer: Cofinity Commercial |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$131.62
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.09
|
| Rate for Payer: PHP Commercial |
$130.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.14
|
| Rate for Payer: Priority Health SBD |
$96.42
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
OP
|
$153.05
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$416.61 |
| Rate for Payer: Aetna Commercial |
$130.09
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$122.44
|
| Rate for Payer: Cash Price |
$122.44
|
| Rate for Payer: Cofinity Commercial |
$131.62
|
| Rate for Payer: Cofinity Commercial |
$107.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.09
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$130.09
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.61
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow Network |
$333.29
|
| Rate for Payer: Priority Health SBD |
$96.42
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$88.74
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$128.52
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Aetna Commercial |
$109.24
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$102.82
|
| Rate for Payer: Cash Price |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$89.96
|
| Rate for Payer: Cofinity Commercial |
$110.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$115.67
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.24
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$109.24
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.96
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health SBD |
$80.97
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$130.98
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$128.52
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$80.97 |
| Max. Negotiated Rate |
$115.67 |
| Rate for Payer: Aetna Commercial |
$109.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.54
|
| Rate for Payer: Cash Price |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$110.53
|
| Rate for Payer: Cofinity Commercial |
$89.96
|
| Rate for Payer: Healthscope Commercial |
$115.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.24
|
| Rate for Payer: PHP Commercial |
$109.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.96
|
| Rate for Payer: Priority Health SBD |
$80.97
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.35
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.05
|
| Rate for Payer: UHC Exchange |
$12.77
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health SBD |
$28.35
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$98.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$81.20
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Healthscope Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.60
|
| Rate for Payer: PHP Commercial |
$98.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health SBD |
$73.08
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$98.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.40
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Cofinity Commercial |
$81.20
|
| Rate for Payer: Healthscope Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.60
|
| Rate for Payer: PHP Commercial |
$98.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health SBD |
$73.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.87
|
| Rate for Payer: UHC Exchange |
$63.52
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$126.72
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
OP
|
$7,147.66
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$443.69 |
| Max. Negotiated Rate |
$7,632.00 |
| Rate for Payer: Aetna Commercial |
$6,075.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,645.98
|
| Rate for Payer: BCBS Complete |
$2,859.06
|
| Rate for Payer: BCBS Trust/PPO |
$443.69
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cofinity Commercial |
$5,003.36
|
| Rate for Payer: Cofinity Commercial |
$6,146.99
|
| Rate for Payer: Healthscope Commercial |
$6,432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.51
|
| Rate for Payer: PHP Commercial |
$6,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.36
|
| Rate for Payer: Priority Health SBD |
$4,503.03
|
| Rate for Payer: UHC Core |
$7,632.00
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
IP
|
$7,147.66
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,503.03 |
| Max. Negotiated Rate |
$6,432.89 |
| Rate for Payer: Aetna Commercial |
$6,075.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,645.98
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cofinity Commercial |
$5,003.36
|
| Rate for Payer: Cofinity Commercial |
$6,146.99
|
| Rate for Payer: Healthscope Commercial |
$6,432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.51
|
| Rate for Payer: PHP Commercial |
$6,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.36
|
| Rate for Payer: Priority Health SBD |
$4,503.03
|
|
|
HC PTCA BALLOON
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.23 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna Commercial |
$867.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.65
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cofinity Commercial |
$714.70
|
| Rate for Payer: Cofinity Commercial |
$878.06
|
| Rate for Payer: Healthscope Commercial |
$918.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.85
|
| Rate for Payer: PHP Commercial |
$867.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.70
|
| Rate for Payer: Priority Health SBD |
$643.23
|
|
|
HC PTCA BALLOON
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna Commercial |
$867.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.65
|
| Rate for Payer: BCBS Complete |
$408.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cofinity Commercial |
$714.70
|
| Rate for Payer: Cofinity Commercial |
$878.06
|
| Rate for Payer: Healthscope Commercial |
$918.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.85
|
| Rate for Payer: PHP Commercial |
$867.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.70
|
| Rate for Payer: Priority Health SBD |
$643.23
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
IP
|
$10,980.15
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,917.49 |
| Max. Negotiated Rate |
$9,882.14 |
| Rate for Payer: Aetna Commercial |
$9,333.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,137.10
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cofinity Commercial |
$7,686.10
|
| Rate for Payer: Cofinity Commercial |
$9,442.93
|
| Rate for Payer: Healthscope Commercial |
$9,882.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,333.13
|
| Rate for Payer: PHP Commercial |
$9,333.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,686.10
|
| Rate for Payer: Priority Health SBD |
$6,917.49
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
OP
|
$10,980.15
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$505.90 |
| Max. Negotiated Rate |
$15,432.16 |
| Rate for Payer: Aetna Commercial |
$9,333.13
|
| Rate for Payer: Aetna Medicare |
$5,289.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,137.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,357.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,357.20
|
| Rate for Payer: BCBS Complete |
$2,921.26
|
| Rate for Payer: BCBS MAPPO |
$5,085.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,697.55
|
| Rate for Payer: BCN Medicare Advantage |
$5,085.76
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cofinity Commercial |
$7,686.10
|
| Rate for Payer: Cofinity Commercial |
$9,442.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,085.76
|
| Rate for Payer: Healthscope Commercial |
$9,882.14
|
| Rate for Payer: Mclaren Medicaid |
$2,781.91
|
| Rate for Payer: Mclaren Medicare |
$5,085.76
|
| Rate for Payer: Meridian Medicaid |
$2,921.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,340.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,848.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,333.13
|
| Rate for Payer: PACE Medicare |
$4,831.47
|
| Rate for Payer: PACE SWMI |
$5,085.76
|
| Rate for Payer: PHP Commercial |
$9,333.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,085.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,781.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,686.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,432.16
|
| Rate for Payer: Priority Health Medicare |
$5,085.76
|
| Rate for Payer: Priority Health Narrow Network |
$12,345.73
|
| Rate for Payer: Priority Health SBD |
$6,917.49
|
| Rate for Payer: Railroad Medicare Medicare |
$5,085.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.49
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,085.76
|
| Rate for Payer: UHC Exchange |
$505.90
|
| Rate for Payer: UHC Medicare Advantage |
$5,238.33
|
| Rate for Payer: VA VA |
$5,085.76
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,798.23 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,172.78
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$13,109.14
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health SBD |
$11,798.23
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,009.72 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,534.63 |
| Max. Negotiated Rate |
$43,745.07 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,581.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$12,852.33
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$20,010.80
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health SBD |
$18,009.72
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,745.07
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$29,818.17
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
OP
|
$11,706.18
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$762.22 |
| Max. Negotiated Rate |
$10,535.56 |
| Rate for Payer: Aetna Commercial |
$9,950.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,609.02
|
| Rate for Payer: BCBS Complete |
$4,682.47
|
| Rate for Payer: BCBS Trust/PPO |
$762.22
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cofinity Commercial |
$10,067.31
|
| Rate for Payer: Cofinity Commercial |
$8,194.33
|
| Rate for Payer: Healthscope Commercial |
$10,535.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,950.25
|
| Rate for Payer: PHP Commercial |
$9,950.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,194.33
|
| Rate for Payer: Priority Health SBD |
$7,374.89
|
| Rate for Payer: UHC Core |
$8,819.00
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
IP
|
$11,706.18
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,374.89 |
| Max. Negotiated Rate |
$10,535.56 |
| Rate for Payer: Aetna Commercial |
$9,950.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,609.02
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cofinity Commercial |
$10,067.31
|
| Rate for Payer: Cofinity Commercial |
$8,194.33
|
| Rate for Payer: Healthscope Commercial |
$10,535.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,950.25
|
| Rate for Payer: PHP Commercial |
$9,950.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,194.33
|
| Rate for Payer: Priority Health SBD |
$7,374.89
|
|
