|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
OP
|
$101.19
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$86.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.77
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS Trust/PPO |
$39.72
|
| Rate for Payer: BCCCP Commercial |
$54.20
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Healthscope Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: PHP Commercial |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health SBD |
$63.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.19
|
| Rate for Payer: UHC Exchange |
$51.08
|
|
|
HC SCREENING TOMOSYNTHESIS
|
Facility
|
IP
|
$101.19
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
32000301
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$86.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.77
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Healthscope Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: PHP Commercial |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health SBD |
$63.75
|
|
|
HC SDL MSLT/MWT
|
Facility
|
OP
|
$2,521.75
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$2,269.58 |
| Rate for Payer: Aetna Commercial |
$2,143.49
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.96
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cofinity Commercial |
$1,765.22
|
| Rate for Payer: Cofinity Commercial |
$2,168.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$2,269.58
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,143.49
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$2,143.49
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,765.22
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,588.70
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$424.36
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC SDL MSLT/MWT
|
Facility
|
IP
|
$2,521.75
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,588.70 |
| Max. Negotiated Rate |
$2,269.58 |
| Rate for Payer: Aetna Commercial |
$2,143.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,639.14
|
| Rate for Payer: Cash Price |
$2,017.40
|
| Rate for Payer: Cofinity Commercial |
$1,765.22
|
| Rate for Payer: Cofinity Commercial |
$2,168.70
|
| Rate for Payer: Healthscope Commercial |
$2,269.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,143.49
|
| Rate for Payer: PHP Commercial |
$2,143.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,765.22
|
| Rate for Payer: Priority Health SBD |
$1,588.70
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
OP
|
$3,490.58
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$3,141.52 |
| Rate for Payer: Aetna Commercial |
$2,966.99
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.75
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$2,792.46
|
| Rate for Payer: Cash Price |
$2,792.46
|
| Rate for Payer: Cofinity Commercial |
$3,001.90
|
| Rate for Payer: Cofinity Commercial |
$2,443.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$3,141.52
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,966.99
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$2,966.99
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.41
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$2,199.07
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$674.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Exchange |
$612.97
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC SDL POLYSOMNOGRAPHY
|
Facility
|
IP
|
$3,490.58
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
74000001
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,199.07 |
| Max. Negotiated Rate |
$3,141.52 |
| Rate for Payer: Aetna Commercial |
$2,966.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.88
|
| Rate for Payer: Cash Price |
$2,792.46
|
| Rate for Payer: Cofinity Commercial |
$2,443.41
|
| Rate for Payer: Cofinity Commercial |
$3,001.90
|
| Rate for Payer: Healthscope Commercial |
$3,141.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,966.99
|
| Rate for Payer: PHP Commercial |
$2,966.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.41
|
| Rate for Payer: Priority Health SBD |
$2,199.07
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
IP
|
$3,859.04
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,431.20 |
| Max. Negotiated Rate |
$3,473.14 |
| Rate for Payer: Aetna Commercial |
$3,280.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,508.38
|
| Rate for Payer: Cash Price |
$3,087.23
|
| Rate for Payer: Cofinity Commercial |
$2,701.33
|
| Rate for Payer: Cofinity Commercial |
$3,318.77
|
| Rate for Payer: Healthscope Commercial |
$3,473.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,280.18
|
| Rate for Payer: PHP Commercial |
$3,280.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,701.33
|
| Rate for Payer: Priority Health SBD |
$2,431.20
|
|
|
HC SDL PSG WITH CPAP/BIPAP
|
Facility
|
OP
|
$3,859.04
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$3,473.14 |
| Rate for Payer: Aetna Commercial |
$3,280.18
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,508.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.32
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$3,087.23
|
| Rate for Payer: Cash Price |
$3,087.23
|
| Rate for Payer: Cofinity Commercial |
$3,318.77
|
| Rate for Payer: Cofinity Commercial |
$2,701.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$3,473.14
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,280.18
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$3,280.18
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,701.33
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$2,431.20
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Exchange |
$640.80
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
OP
|
$720.47
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$288.19 |
| Max. Negotiated Rate |
$648.42 |
| Rate for Payer: Aetna Commercial |
$612.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.31
|
| Rate for Payer: BCBS Complete |
$288.19
|
| Rate for Payer: Cash Price |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$504.33
|
| Rate for Payer: Cofinity Commercial |
$619.60
|
| Rate for Payer: Healthscope Commercial |
$648.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.40
|
| Rate for Payer: PHP Commercial |
$612.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.33
|
| Rate for Payer: Priority Health SBD |
$453.90
|
|
|
HC SEDATION IV / IM OR INHALANT
|
Facility
|
IP
|
$720.47
|
|
| Hospital Charge Code |
37000005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$453.90 |
| Max. Negotiated Rate |
$648.42 |
| Rate for Payer: Aetna Commercial |
$612.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.31
|
| Rate for Payer: Cash Price |
$576.38
|
| Rate for Payer: Cofinity Commercial |
$504.33
|
| Rate for Payer: Cofinity Commercial |
$619.60
|
| Rate for Payer: Healthscope Commercial |
$648.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.40
|
| Rate for Payer: PHP Commercial |
$612.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.33
|
| Rate for Payer: Priority Health SBD |
$453.90
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC SED RATE WESTERGREN
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
30500060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.38
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$1.48
|
| Rate for Payer: Mclaren Medicare |
$2.70
|
| Rate for Payer: Meridian Medicaid |
$1.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$2.56
|
| Rate for Payer: PACE SWMI |
$2.70
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$2.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.24
|
| Rate for Payer: UHC Core |
$4.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.70
|
| Rate for Payer: UHC Exchange |
$2.70
|
| Rate for Payer: UHC Medicare Advantage |
$2.78
|
| Rate for Payer: VA VA |
$2.70
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
OP
|
$4,869.66
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.65 |
| Max. Negotiated Rate |
$4,382.69 |
| Rate for Payer: Aetna Commercial |
$4,139.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,165.28
|
| Rate for Payer: BCBS Complete |
$1,947.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,262.45
|
| Rate for Payer: Cash Price |
$3,895.73
|
| Rate for Payer: Cash Price |
$3,895.73
|
| Rate for Payer: Cofinity Commercial |
$4,187.91
|
| Rate for Payer: Cofinity Commercial |
$3,408.76
|
| Rate for Payer: Healthscope Commercial |
$4,382.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,139.21
|
| Rate for Payer: PHP Commercial |
$4,139.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,408.76
|
| Rate for Payer: Priority Health SBD |
$3,067.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.82
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$241.65
|
|
|
HC SELECTIVE EACH INTRACRANIAL UNI
|
Facility
|
IP
|
$4,869.66
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
36100386
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,067.89 |
| Max. Negotiated Rate |
$4,382.69 |
| Rate for Payer: Aetna Commercial |
$4,139.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,165.28
|
| Rate for Payer: Cash Price |
$3,895.73
|
| Rate for Payer: Cofinity Commercial |
$3,408.76
|
| Rate for Payer: Cofinity Commercial |
$4,187.91
|
| Rate for Payer: Healthscope Commercial |
$4,382.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,139.21
|
| Rate for Payer: PHP Commercial |
$4,139.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,408.76
|
| Rate for Payer: Priority Health SBD |
$3,067.89
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
IP
|
$5,633.63
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,549.19 |
| Max. Negotiated Rate |
$5,070.27 |
| Rate for Payer: Aetna Commercial |
$4,788.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,661.86
|
| Rate for Payer: Cash Price |
$4,506.90
|
| Rate for Payer: Cofinity Commercial |
$4,844.92
|
| Rate for Payer: Cofinity Commercial |
$3,943.54
|
| Rate for Payer: Healthscope Commercial |
$5,070.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,788.59
|
| Rate for Payer: PHP Commercial |
$4,788.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.54
|
| Rate for Payer: Priority Health SBD |
$3,549.19
|
|
|
HC SELECTIVE EXTERNAL CAROTID UNI
|
Facility
|
OP
|
$5,633.63
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
36100382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.22 |
| Max. Negotiated Rate |
$5,070.27 |
| Rate for Payer: Aetna Commercial |
$4,788.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,661.86
|
| Rate for Payer: BCBS Complete |
$2,253.45
|
| Rate for Payer: BCBS Trust/PPO |
$846.84
|
| Rate for Payer: Cash Price |
$4,506.90
|
| Rate for Payer: Cash Price |
$4,506.90
|
| Rate for Payer: Cofinity Commercial |
$4,844.92
|
| Rate for Payer: Cofinity Commercial |
$3,943.54
|
| Rate for Payer: Healthscope Commercial |
$5,070.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,788.59
|
| Rate for Payer: PHP Commercial |
$4,788.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.54
|
| Rate for Payer: Priority Health SBD |
$3,549.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$117.22
|
|
|
HC SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$9,359.88
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
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 SELECTIVE EXTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$9,359.88
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
36100377
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.71 |
| 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 |
$8,049.50
|
| Rate for Payer: Cofinity Commercial |
$6,551.92
|
| 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) |
$303.28
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$275.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
IP
|
$10,751.21
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,773.26 |
| Max. Negotiated Rate |
$9,676.09 |
| Rate for Payer: Aetna Commercial |
$9,138.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,988.29
|
| Rate for Payer: Cash Price |
$8,600.97
|
| Rate for Payer: Cofinity Commercial |
$7,525.85
|
| Rate for Payer: Cofinity Commercial |
$9,246.04
|
| Rate for Payer: Healthscope Commercial |
$9,676.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,138.53
|
| Rate for Payer: PHP Commercial |
$9,138.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,525.85
|
| Rate for Payer: Priority Health SBD |
$6,773.26
|
|
|
HC SELECTIVE EXTRA/INTRACRANIAL ARTERY UNI
|
Facility
|
OP
|
$10,751.21
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
36100378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.60 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Commercial |
$9,138.53
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,988.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$4,618.73
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$8,600.97
|
| Rate for Payer: Cash Price |
$8,600.97
|
| Rate for Payer: Cofinity Commercial |
$9,246.04
|
| Rate for Payer: Cofinity Commercial |
$7,525.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$9,676.09
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,138.53
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$9,138.53
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,525.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Priority Health SBD |
$6,773.26
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.46
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$318.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
IP
|
$12,648.49
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,968.55 |
| Max. Negotiated Rate |
$11,383.64 |
| Rate for Payer: Aetna Commercial |
$10,751.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,221.52
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$8,853.94
|
| Rate for Payer: Cofinity Commercial |
$10,877.70
|
| Rate for Payer: Healthscope Commercial |
$11,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: PHP Commercial |
$10,751.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: Priority Health SBD |
$7,968.55
|
|
|
HC SELECTIVE INTRACRANIAL ART UNI
|
Facility
|
OP
|
$12,648.49
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
36100385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.89 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Commercial |
$10,751.22
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,221.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$5,749.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$8,853.94
|
| Rate for Payer: Cofinity Commercial |
$10,877.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$11,383.64
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$10,751.22
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Priority Health SBD |
$7,968.55
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.68
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$357.89
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
IP
|
$12,648.49
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,968.55 |
| Max. Negotiated Rate |
$11,383.64 |
| Rate for Payer: Aetna Commercial |
$10,751.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,221.52
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$10,877.70
|
| Rate for Payer: Cofinity Commercial |
$8,853.94
|
| Rate for Payer: Healthscope Commercial |
$11,383.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: PHP Commercial |
$10,751.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: Priority Health SBD |
$7,968.55
|
|
|
HC SELECTIVE VERTEBRAL ARTERY UNI
|
Facility
|
OP
|
$12,648.49
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
36100381
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Commercial |
$10,751.22
|
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,221.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$8,121.26
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cash Price |
$10,118.79
|
| Rate for Payer: Cofinity Commercial |
$8,853.94
|
| Rate for Payer: Cofinity Commercial |
$10,877.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Healthscope Commercial |
$11,383.64
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,751.22
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Commercial |
$10,751.22
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,853.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Priority Health SBD |
$7,968.55
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.16
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$355.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
HC SELECT SPECIALTY CATHETER INSERTION
|
Facility
|
IP
|
$1,686.32
|
|
| Hospital Charge Code |
36100565
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,062.38 |
| Max. Negotiated Rate |
$1,517.69 |
| Rate for Payer: Aetna Commercial |
$1,433.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.11
|
| Rate for Payer: Cash Price |
$1,349.06
|
| Rate for Payer: Cofinity Commercial |
$1,180.42
|
| Rate for Payer: Cofinity Commercial |
$1,450.24
|
| Rate for Payer: Healthscope Commercial |
$1,517.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,433.37
|
| Rate for Payer: PHP Commercial |
$1,433.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.42
|
| Rate for Payer: Priority Health SBD |
$1,062.38
|
|
