|
HC NEONATAL VENT INIT DAY
|
Facility
|
IP
|
$1,600.44
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,008.28 |
| Max. Negotiated Rate |
$1,440.40 |
| Rate for Payer: Aetna Commercial |
$1,360.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.29
|
| Rate for Payer: Cash Price |
$1,280.35
|
| Rate for Payer: Cofinity Advantage |
$1,120.31
|
| Rate for Payer: Cofinity Commercial |
$1,376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,280.35
|
| Rate for Payer: Healthscope Commercial |
$1,440.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,360.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,200.33
|
| Rate for Payer: PHP Commercial |
$1,360.37
|
| Rate for Payer: Priority Health SBD |
$1,008.28
|
|
|
HC NEONATAL VENT INIT DAY
|
Facility
|
OP
|
$1,600.44
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000037
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$1,990.71 |
| Rate for Payer: Aetna Commercial |
$1,360.37
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,040.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$84.39
|
| Rate for Payer: BCN Commercial |
$84.39
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,280.35
|
| Rate for Payer: Cash Price |
$1,280.35
|
| Rate for Payer: Cofinity Advantage |
$1,120.31
|
| Rate for Payer: Cofinity Commercial |
$1,376.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,280.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,440.40
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,360.37
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,200.33
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$1,360.37
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$1,008.28
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,040.29
|
| Rate for Payer: UHC Core |
$833.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$628.97
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
IP
|
$1,221.40
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$769.48 |
| Max. Negotiated Rate |
$1,099.26 |
| Rate for Payer: Aetna Commercial |
$1,038.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.91
|
| Rate for Payer: Cash Price |
$977.12
|
| Rate for Payer: Cofinity Advantage |
$854.98
|
| Rate for Payer: Cofinity Commercial |
$1,050.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.12
|
| Rate for Payer: Healthscope Commercial |
$1,099.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.05
|
| Rate for Payer: PHP Commercial |
$1,038.19
|
| Rate for Payer: Priority Health SBD |
$769.48
|
|
|
HC NEONATAL VENT SUB DAY
|
Facility
|
OP
|
$1,221.40
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000038
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$1,990.71 |
| Rate for Payer: Aetna Commercial |
$1,038.19
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$62.18
|
| Rate for Payer: BCN Commercial |
$62.18
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$977.12
|
| Rate for Payer: Cash Price |
$977.12
|
| Rate for Payer: Cofinity Advantage |
$854.98
|
| Rate for Payer: Cofinity Commercial |
$1,050.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,099.26
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.19
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$916.05
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$1,038.19
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$769.48
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.91
|
| Rate for Payer: UHC Core |
$636.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$480.01
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
IP
|
$1,432.06
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$902.20 |
| Max. Negotiated Rate |
$1,288.85 |
| Rate for Payer: Aetna Commercial |
$1,217.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.84
|
| Rate for Payer: Cash Price |
$1,145.65
|
| Rate for Payer: Cofinity Advantage |
$1,002.44
|
| Rate for Payer: Cofinity Commercial |
$1,231.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,145.65
|
| Rate for Payer: Healthscope Commercial |
$1,288.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,217.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,074.05
|
| Rate for Payer: PHP Commercial |
$1,217.25
|
| Rate for Payer: Priority Health SBD |
$902.20
|
|
|
HC NEPHROSTOGRAM URETEROGRAM EXISTING ACCESS
|
Facility
|
OP
|
$1,432.06
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
36100503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$1,217.25
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$515.59
|
| Rate for Payer: BCN Commercial |
$515.59
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$1,145.65
|
| Rate for Payer: Cash Price |
$1,145.65
|
| Rate for Payer: Cash Price |
$1,145.65
|
| Rate for Payer: Cofinity Advantage |
$1,002.44
|
| Rate for Payer: Cofinity Commercial |
$1,231.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,145.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$1,288.85
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,217.25
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,074.05
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$1,217.25
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$902.20
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
IP
|
$1,228.49
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.95 |
| Max. Negotiated Rate |
$1,105.64 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.52
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cofinity Advantage |
$859.94
|
| Rate for Payer: Cofinity Commercial |
$1,056.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.79
|
| Rate for Payer: Healthscope Commercial |
$1,105.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.37
|
| Rate for Payer: PHP Commercial |
$1,044.22
|
| Rate for Payer: Priority Health SBD |
$773.95
|
|
|
HC NEPHROSTOGRAM URETEROGRAM NEW ACCESS
|
Facility
|
OP
|
$1,228.49
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
36100502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$377.25
|
| Rate for Payer: BCN Commercial |
$377.25
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cash Price |
$982.79
|
| Rate for Payer: Cofinity Advantage |
$859.94
|
| Rate for Payer: Cofinity Commercial |
$1,056.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$1,105.64
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.22
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.37
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$1,044.22
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$773.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: VA VA |
$694.79
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL EA ADDL LEVEL
|
Facility
|
IP
|
$1,521.24
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$958.38 |
| Max. Negotiated Rate |
$1,369.12 |
| Rate for Payer: Aetna Commercial |
$1,293.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.81
|
| Rate for Payer: Cash Price |
$1,216.99
|
| Rate for Payer: Cofinity Advantage |
$1,064.87
|
| Rate for Payer: Cofinity Commercial |
$1,308.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,216.99
|
| Rate for Payer: Healthscope Commercial |
$1,369.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,293.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,140.93
|
| Rate for Payer: PHP Commercial |
$1,293.05
|
| Rate for Payer: Priority Health SBD |
$958.38
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL EA ADDL LEVEL
|
Facility
|
OP
|
$1,521.24
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
36100404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,293.05
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.81
|
| 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 |
$645.98
|
| Rate for Payer: BCN Commercial |
$645.98
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,216.99
|
| Rate for Payer: Cash Price |
$1,216.99
|
| Rate for Payer: Cash Price |
$1,216.99
|
| Rate for Payer: Cofinity Advantage |
$1,064.87
|
| Rate for Payer: Cofinity Commercial |
$1,308.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,216.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,369.12
|
| 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 |
$1,293.05
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,140.93
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,293.05
|
| 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 |
$958.38
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.81
|
| Rate for Payer: UHC Core |
$792.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$597.85
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
OP
|
$1,160.81
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$986.69
|
| Rate for Payer: Aetna Commercial |
$657.79
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$525.64
|
| Rate for Payer: BCBS Trust/PPO |
$525.64
|
| Rate for Payer: BCN Commercial |
$525.64
|
| Rate for Payer: BCN Commercial |
$525.64
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$928.65
|
| Rate for Payer: Cash Price |
$928.65
|
| Rate for Payer: Cash Price |
$619.10
|
| Rate for Payer: Cash Price |
$619.10
|
| Rate for Payer: Cash Price |
$619.10
|
| Rate for Payer: Cash Price |
$928.65
|
| Rate for Payer: Cofinity Advantage |
$541.71
|
| Rate for Payer: Cofinity Advantage |
$812.57
|
| Rate for Payer: Cofinity Commercial |
$998.30
|
| Rate for Payer: Cofinity Commercial |
$665.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,044.73
|
| Rate for Payer: Healthscope Commercial |
$696.48
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$657.79
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$580.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.61
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$986.69
|
| Rate for Payer: PHP Commercial |
$657.79
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$487.54
|
| Rate for Payer: Priority Health SBD |
$731.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.02
|
| Rate for Payer: UHC Core |
$403.19
|
| Rate for Payer: UHC Core |
$604.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$304.13
|
| Rate for Payer: UHC Exchange |
$456.20
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC NERVE ROOT BLOCK INTERCOSTAL SINGLE
|
Facility
|
IP
|
$1,160.81
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
36100403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.31 |
| Max. Negotiated Rate |
$1,044.73 |
| Rate for Payer: Aetna Commercial |
$986.69
|
| Rate for Payer: Aetna Commercial |
$657.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$754.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.02
|
| Rate for Payer: Cash Price |
$928.65
|
| Rate for Payer: Cash Price |
$619.10
|
| Rate for Payer: Cofinity Advantage |
$812.57
|
| Rate for Payer: Cofinity Advantage |
$541.71
|
| Rate for Payer: Cofinity Commercial |
$998.30
|
| Rate for Payer: Cofinity Commercial |
$665.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.65
|
| Rate for Payer: Healthscope Commercial |
$696.48
|
| Rate for Payer: Healthscope Commercial |
$1,044.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$657.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$580.40
|
| Rate for Payer: PHP Commercial |
$986.69
|
| Rate for Payer: PHP Commercial |
$657.79
|
| Rate for Payer: Priority Health SBD |
$731.31
|
| Rate for Payer: Priority Health SBD |
$487.54
|
|
|
HC NETTLE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC NETTLE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200049
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
OP
|
$137.96
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$54.22 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna Medicare |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: BCBS Complete |
$55.18
|
| Rate for Payer: Cash Price |
$110.37
|
| Rate for Payer: Cofinity Advantage |
$96.57
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.37
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.47
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: Priority Health SBD |
$86.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.67
|
| Rate for Payer: UHC Core |
$71.88
|
| Rate for Payer: UHC Exchange |
$54.22
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM EA ADDL HR
|
Facility
|
IP
|
$137.96
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
91800006
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$86.91 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: Cash Price |
$110.37
|
| Rate for Payer: Cofinity Advantage |
$96.57
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.37
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.47
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: Priority Health SBD |
$86.91
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM FIRST HOUR
|
Facility
|
OP
|
$280.60
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
91800001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$110.28 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$238.51
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$224.48
|
| Rate for Payer: Cash Price |
$224.48
|
| Rate for Payer: Cofinity Advantage |
$196.42
|
| Rate for Payer: Cofinity Commercial |
$241.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$252.54
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.51
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.45
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$238.51
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$176.78
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.39
|
| Rate for Payer: UHC Core |
$146.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$110.28
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM FIRST HOUR
|
Facility
|
IP
|
$280.60
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
91800001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$176.78 |
| Max. Negotiated Rate |
$252.54 |
| Rate for Payer: Aetna Commercial |
$238.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.39
|
| Rate for Payer: Cash Price |
$224.48
|
| Rate for Payer: Cofinity Advantage |
$196.42
|
| Rate for Payer: Cofinity Commercial |
$241.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.48
|
| Rate for Payer: Healthscope Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.45
|
| Rate for Payer: PHP Commercial |
$238.51
|
| Rate for Payer: Priority Health SBD |
$176.78
|
|
|
HC NEUROFORM ATLAS STENT
|
Facility
|
OP
|
$12,117.67
|
|
| Hospital Charge Code |
27800118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,762.24 |
| Max. Negotiated Rate |
$10,905.90 |
| Rate for Payer: Aetna Commercial |
$10,300.02
|
| Rate for Payer: Aetna Medicare |
$6,058.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,876.49
|
| Rate for Payer: BCBS Complete |
$4,847.07
|
| Rate for Payer: Cash Price |
$9,694.14
|
| Rate for Payer: Cofinity Advantage |
$8,482.37
|
| Rate for Payer: Cofinity Commercial |
$10,421.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,694.14
|
| Rate for Payer: Healthscope Commercial |
$10,905.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,694.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,300.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,088.25
|
| Rate for Payer: PHP Commercial |
$10,300.02
|
| Rate for Payer: Priority Health SBD |
$7,634.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,876.49
|
| Rate for Payer: UHC Core |
$6,313.31
|
| Rate for Payer: UHC Exchange |
$4,762.24
|
|
|
HC NEUROFORM ATLAS STENT
|
Facility
|
IP
|
$12,117.67
|
|
| Hospital Charge Code |
27800118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,634.13 |
| Max. Negotiated Rate |
$10,905.90 |
| Rate for Payer: Aetna Commercial |
$10,300.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,876.49
|
| Rate for Payer: Cash Price |
$9,694.14
|
| Rate for Payer: Cofinity Advantage |
$8,482.37
|
| Rate for Payer: Cofinity Commercial |
$10,421.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,694.14
|
| Rate for Payer: Healthscope Commercial |
$10,905.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,300.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,088.25
|
| Rate for Payer: PHP Commercial |
$10,300.02
|
| Rate for Payer: Priority Health SBD |
$7,634.13
|
|
|
HC NEUROLYSIS CELIAC PLEXUS
|
Facility
|
IP
|
$1,968.54
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
36100479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,240.18 |
| Max. Negotiated Rate |
$1,771.69 |
| Rate for Payer: Aetna Commercial |
$1,673.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.55
|
| Rate for Payer: Cash Price |
$1,574.83
|
| Rate for Payer: Cofinity Advantage |
$1,377.98
|
| Rate for Payer: Cofinity Commercial |
$1,692.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,574.83
|
| Rate for Payer: Healthscope Commercial |
$1,771.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,673.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,476.40
|
| Rate for Payer: PHP Commercial |
$1,673.26
|
| Rate for Payer: Priority Health SBD |
$1,240.18
|
|
|
HC NEUROLYSIS CELIAC PLEXUS
|
Facility
|
OP
|
$1,968.54
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
36100479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,673.26
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.55
|
| 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 |
$710.17
|
| Rate for Payer: BCN Commercial |
$710.17
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,574.83
|
| Rate for Payer: Cash Price |
$1,574.83
|
| Rate for Payer: Cash Price |
$1,574.83
|
| Rate for Payer: Cofinity Advantage |
$1,377.98
|
| Rate for Payer: Cofinity Commercial |
$1,692.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,574.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,771.69
|
| 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 |
$1,673.26
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,476.40
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,673.26
|
| 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 |
$1,240.18
|
| 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 NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: Priority Health SBD |
$44.13
|
|
|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.40
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$44.13
|
| Rate for Payer: Priority Health Tiered Network |
$14.72
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.60
|
| Rate for Payer: UHC Core |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Advantage |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: Priority Health SBD |
$45.47
|
|
